Relationships between handling, behaviour and stress in lambs at abattoirs.

There is community concern about the treatment of farm animals post-farm gate, particularly animal transport and slaughter. Relationships between lamb behavioural and physiological variables on farm, stockperson, dog and lamb behavioural variables pre-slaughter and plasma cortisol, glucose and lactate in lambs post-slaughter were studied in 400 lambs. The lambs were observed in three behavioural tests, novel arena, flight distance to a human and temperament tests, before transport for slaughter. Closed-circuit television video footage was used to record stockperson, dog and lamb behaviour immediately before slaughter. Blood samples for cortisol, glucose and lactate analyses were collected on farm following the three behavioural tests and immediately post-slaughter. The regression models that best predicted plasma cortisol, glucose and lactate concentrations post-slaughter included a mixture of stockperson and dog behavioural variables as well as lamb variables both on-farm and pre-slaughter. These regression models accounted for 33%, 34% and 44% of the variance in plasma cortisol, glucose and lactate concentrations post-slaughter, respectively. Some of the stockperson and dog behaviours pre-slaughter that were predictive of the stress and metabolic variables post-slaughter included the duration of negative stockperson behaviours such as fast locomotion and lifting/pulling lambs, and the duration of dog behaviours such as lunging and barking at the lamb, while some of the predictive lamb behaviour variables included the durations of jumping and fleeing. Some of the physiological and behavioural responses to the behavioural tests on farm were also predictive of the stress and metabolic variables post-slaughter. These relationships support the well-demonstrated effect of handling on fear and stress responses in livestock, and although not direct evidence of causal relationships, highlight the potential benefits of training stockpeople to reduce fear and stress in sheep at abattoirs.

A case of infant delirium in the neonatal intensive care unit.

Infant delirium is an under-recognized clinical entity in neonatal intensive care, and earlier identification and treatment could minimize morbidities associated with this condition. We describe a case of a 6-month-old former 32 weeks gestation infant undergoing a prolonged mechanical ventilation course diagnosed with delirium related to the combination of his underlying illness and the use of multiple sedative and analgesic medications. Initiation of the atypical antipsychotic risperidone allowed for weaning from continuous infusions of benzodiazepines and opiods, and lower dosages of bolus-dosed sedation and analgesics. The patient experienced no adverse side effects from use of this neuroleptic.

The effects of cigarette smoking and gestational weight change on birth outcomes in obese and normal-weight women.

OBJECTIVES: The associations of infant birth outcomes with maternal pregravid obesity, gestational weight gain, and prenatal cigarette smoking were examined. METHODS: A retrospective analysis of 1343 obese and normal-weight gravidas evaluated the associations of cigarette smoking, gestational weight change, and pregravid body mass index with birthweight, low birthweight, and small- and large-for-gestational-age births. RESULTS: Smoking was associated with the delivery of lower-birthweight infants for both obese and normal-weight women, and gestational weight gain did not eliminate the birthweight-lowering effects of smoking. Women at highest risk of delivering lower-birthweight infants were obese smokers whose gestational gains were less than 7 kg and normal-weight smokers whose gestational gains were less than 11.5 kg. CONCLUSIONS: To balance the risks of small and large-size infants, gains of 7 to 11.5 kg for obese women and 11.5 to 16 kg for normal-weight women appear appropriate.

Photodynamic therapy of rat endometrium sensitized with tin ethyl etiopurpurin.

STUDY OBJECTIVE: To evaluate endometrial ablation in the rat using photodynamic therapy and the photosensitizer tin ethyl etiopurpurin (SnET2). DESIGN: Laboratory research. SETTING: A pharmaceutical and device manufacturing company. MATERIALS: Forty-five healthy female rats (age 8-10 wks). INTERVENTIONS: Groups of three to five rats were given SnET2 by either intrauterine or intravenous administration. Light treatment was given at either 3 or 24 hours after SnET2 administration at a light dose of 75, 150, or 200 J/cm. MEASUREMENTS AND MAIN RESULTS: A fluorescence detection system was employed to determine relative drug uptake of SnET2 into uterine tissue. The highest levels of SnET2 were detected at 3 hours. After light treatment, responses of uterine tissues were evaluated histologically. The best endometrial ablation was seen when SnET2 was given by intrauterine administration with light treatment at 150 J/cm 24 hours later. A consistent transmural response was seen with this route of administration at 200 J/cm. Intravenous SnET2 gave inconsistent responses. In light-only controls, all light doses caused no tissue response. The depth of necrosis in tissues treated with photodynamic therapy were light-dose dependent. CONCLUSION: With either route of SnET2 administration, drug uptake was confirmed and a light-dose-dependent response in the walls of rat uterine horns was demonstrated.

Pregnancy complications and birth outcomes in obese and normal-weight women: effects of gestational weight change.

OBJECTIVE: To compare the pregnancy course and outcomes in obese and normal-weight women and their associations with gestational weight change. METHODS: Multivariate logistic regression described the relation of weight change to pregnancy course and outcomes in a retrospective study of 683 obese and 660 normal-weight women who delivered singleton living neonates. RESULTS: Compared with normal-weight women, obese women gained an average of 5 kg (11 lb) less during pregnancy and were more likely to lose or gain no weight (11% versus less than 1%). Obese women were significantly more likely to have pregnancy complications, but the incidence of complications was not associated with weight change. Compared with obese women who gained 7-11.5 kg (15-25 lb), obese women who lost or gained no weight were at higher risk for delivery of infants under 3000 g or small for gestational age infants, and those who gained more than 16 kg (35 lb) were at twice the risk for delivery of infants who were 4000 g or heavier. CONCLUSION: Gestational weight change was not associated with pregnancy complications in obese or normal-weight women. To optimize fetal growth, weight gains of 7-11.5 kg (15-25 lb) for obese women and 11.5-16 kg (25-35 lb) for normal-weight women appear to be appropriate.

Pregnancy in Hmong refugee women.

PIP: A comparison of pregnancy course and outcome between 648 Hmong refugee women and 5278 non-Hmong controls, all of whom delivered at a Minnesota medical center in 1976-83, indicated that Hmong women were 5 times as likely to have a history of previous perinatal loss. In terms of demographic factors, Hmong women were more likely to be age 35 years or above at delivery (14% versus 2% among controls), to be grant multiparas (33% versus 3% among controls), and to be married (95% versus 61% among controls). While 59% of controls began prenatal care during the 1st trimester, only 16% of Hmong women fell into this category and 31% delayed receiving care until the 3rd trimester. A review of the obstetric histories revealed that 18.1% of Hmong women compared with 3.7% of controls had experienced 1 or more previous perinatal loss. Medical conditions found with significant frequency in the Hmong population included anemia, tuberculosis, malaria, and parasitic infestations. Preeclampsia, hypertension, diabetes, urinary and vaginal infections, and gonorrhea occurred less frequently among Hmong women than among controls. Moreover, the incidence of premature rupture of the membranes was only 4.2% among Hmong women compared to 11.8% among controls. The prematurity rate was 48.5/1000 in the study group and 117/1000 in controls; in addition, only 7.8% of Hmong infants compared to 10.9% of control infants were low birthweight (under 2500 grams). The perinatal mortality rate was similar in both groups: 14.6/1000 among Hmong infants and 15.0/1000 among controls. Contraception was accepted by 50% of the Hmong mothers, but under 10% remained users 12 months after delivery and 27% were pregnant again. The generally good pregnancy outcomes recorded among these Hmong women despite the existence of numerous high-risk factors--short stature, advanced maternal age, grand multiparity, late prenatal care, and poor nutrition--is surprising. It appears that relocation to the US has enabled this population to overcome the factors that contributed to their previous high rates of perinatal loss.^ieng

Transurethral resection of the prostate and bladder neck incision: a review of 700 cases.

Transurethral resection (TUR) is regarded as the treatment of choice for relief of outflow tract obstruction in the male, but bladder neck incision (BNI) is an acceptable alternative when the gland is small. Seven hundred cases of TUR/BNI have been reviewed (TUR = 388; BNI = 312). BNI was performed when the gland was less than 35 g and where there was no clinical suspicion of malignancy. The operative details of our single incision technique are given. While the patients in the BNI group were younger, catheter stay was shorter, there was less infection, a significantly reduced need for blood transfusion and a satisfactory outcome in terms of control and need for further surgery. BNI is a technically simpler procedure than TUR and is easy to teach and learn. Results show it is safe and effective for patients in acute retention as well as those treated electively and it is the operation of choice for small benign prostates.

Effect of insulin and transferrin in the maintenance of the activated state of the T-lymphocyte induced by allo-antigen.

Insulin is an immuno-modulating molecule enhancing cytotoxic T-cell function and supporting intermediary metabolism in activated lymphocytes. Insulin also maintains the activated state of mitogen-stimulated lymphocytes. Because of the importance of allo-antigen response of diabetic patients for infections and transplant immunity, we explored the role of insulin in the allo-activated state of lymphocytes. Allo-stimulation was provided in one-way mixed lymphocyte reactions, with Balb/C mouse lymph node cells responding to irradiated spleen cells of C57BL/6 mice, in culture under conditions which permitted evaluation of hormonal modulation. Mixed lymphocyte reactions established in fetal calf serum, insulin-depleted by passage over antibody affinity columns, were of equal magnitude to those in insulin-replete serum. A weak but positive mixed lymphocyte reaction can be effected with an artificial serum substitute containing no additional hormone. Provision of insulin (10 nmol/l) restored a full mixed lymphocyte reaction response which was mimicked by addition of transferrin. The insulin-transferrin combination was not additive. In conclusion, insulin and transferrin maintain the allo-activated state of the mouse lymphocyte, transferrin alone being sufficient when full antigenic stimulation is provided. If the same applies to human lymphocytes, insulin-deficient diabetic patients will respond to full allo-antigen challenge, and so should be fully capable of mounting a transplant immune response.

School-based prenatal services: can similar outcomes be attained in a nonschool setting?

The purpose of this study is to evaluate whether enhancement of hospital-based prenatal care of adolescents results in pregnancy outcomes comparable to those found in adolescents receiving care at school-based clinics. An initial study comparing hospital clinic and school clinic programs administered by the St. Paul Maternal and Infant Care Project (MIC) from 1973-1976 indicated that delivered teens from the high school clinics had earlier and more frequent prenatal visits and fewer low birth weight babies than delivered adolescents who received care at hospital based clinics. After the initial study of 1976, MIC hospital based services for the adolescents were enhanced to include additional educational and support services. A follow up study, (1976-1979) was subsequently conducted, using criteria similar to the previous study, to compare the results of hospital and school-based programs for pregnant teens. The follow up data demonstrated that the School Group initiated care much earlier and had significantly more prenatal visits than the Comparison Group, but the Comparison Group demonstrated a dramatic improvement in both areas when compared to the first study. Rates of obstetrical complications and infant outcomes were more similar for both groups than in the initial study, supporting the premise that while the school provides a superior setting for provision of prenatal services, similar services at nonschool sites can be greatly enhanced and can demonstrate significant improvement in obstetrical outcomes.

Post-catheterisation urethral strictures. A clinical and experimental study.

Seventeen patients who developed urethral strictures following catheterisation have been studied; 14 of these (82%) were catheterised for standard monitoring purposes during and after major heart surgery, which was a coronary artery bypass graft (CABPG) in 12 cases. The possible aetiological mechanisms for the development of this complication are discussed. Animal experiments were designed and carried out to compare the effects of different catheter materials on the urethral mucosa. Silicone catheters provoked the least inflammation and rubber the most. A further experiment determined the flow rates through catheters of different sizes. From our results, we suggest that the careful insertion of a small silicone catheter, distally fixed, is least likely to induce stricture formation.

Adolescent contraceptive use: experience in 1,762 teenagers.

Retrospective analysis was done on 1,762 adolescent family planning patients who used the St. Paul Maternal and Infant Care Project Teen Clinic from 1969 through June 1979. Factors evaluated included method of contraception, demographic data, and continuation rates calculated by Life Table Method. A further comparison was done on 403 of these patients who initiated their family planning care at a project satellite clinic located within a local high school.

PIP: Retrospective analysis was done on 1762 adolescent family planning patients who used the St. Paul Maternal and Infant Project Teen Clinic from 1969 through June 1979 in the attempt to analyze their patterns of contraceptive usage. The contraceptive usage of a subgroup of 403 adolescents who received their initial services and follow-up in a high school clinic was further analyzed and compared to that of the overall group. Factors evaluated included method of contraception, demographic data, and continuation rates calculated by the Life Table Method. The ages of the study population at the time of their 1st visit in the Teen Birth Control Clinic ranged from 12-19 years. 85% were white, 10% black, and the remaining 5% were members of other races. 89.2% were nulliparas, and the remainder had had 1 or more abortions or 1 or more term pregnancies. 58% were already pregnant at the time of the initial visit and were referred for pregnancy counseling. Of these, 9 had an abortion and subsequently returned to the Clinic for contraception. Oral contraceptives (OCs) were the initial method chosen by 86.2% of those adolescents starting contraceptions. 10.3% chose other methods. Of the total study population, 889 patients (50.5%) were released from follow-up as active contraceptors. 381 patients were lost to follow-up. Among the high school group, the distribution of number of users of contraceptives who chose OCs, IUDs, and other methods was similar to that of the overall teen clinic population. Similarly high continuation rates were found in both the overall teen clinic population and the high school subgroup.

Teaching human sexuality in junior high school: an interdisciplinary approach.

A pilot educational program in human sexuality designed for junior high age adolescents was conducted jointly by the St. Paul, Minnesota Maternal and Infant Care Project and the St. Paul Public Schools. This program encompassed two courses which presented a comprehensive view of young men and women as sexual beings. The goal was to affect primary prevention of adolescent pregnancy and other problems related to adolescent sexuality. Pre- and posttest scores demonstrated a statistically significant increase in student knowledge, and weekly evaluations revealed consistent interest in subject matter presented.

PIP: An experimental sex education program was conducted at a junior high school in St. Paul, Minnesota. The course was developed and offered jointly by the St. Paul Maternal and Infant Care Project and the St. Paul public school system. Course content covered a wide range of topics, including methods of contraception. Responsible decision making was emphasized throughout the course and the major goal of the course was pregnancy prevention. Prior to the implementation of this course, no formal sex education course was given by the school system. The course was taught by a team composed of a teacher from the school, the school nurse, a nurser practitioner, and a health educator. Team members prepared individual class sessions on subjects in which they had expertise. Before the project was implemented a representative group of parents met with the school staff to discuss course structure and content. After the course was underway, all parents were invited to an open house where they had an opportunity to meet the staff and examine the teaching materials used in the course. Teaching techniques included lectures, decision making exercises, group discussions, and group projects. A variety of audio-visual materials were used. Students were encouraged to talk freely about their sexual feelings. Each week the students were expected to complete an evaluation sheet and were encouraged to constructively criticize the course. A comparison of scores achieved by the students on a test administered before the course and on a test administered after the completion of the course indicated that the students had significantly increased their sexual knowledge in the interim. The weekly evaluation sheets indicated that the students found the course interesting and helpful.