Differences in coping effectiveness and well-being among aging mothers and fathers of adults with mental retardation.

In this longitudinal study, we examined stress and coping processes among 133 married mothers (age 59 to 83) and fathers (age 56 to 84) of adults with mental retardation (age 19 to 53). There were no differences between mothers and fathers with respect to their frequency of use of emotion-focused coping, but mothers used significantly more problem-focused coping strategies than did their husbands. For mothers, greater use of problem-focused coping strategies and lower use of emotion-focused coping buffered the impacts of caregiving stress on their psychological well-being. However, for fathers, no buffering effects of coping were detected. The implications of gender differences in coping effects were examined in the context of the impact of lifelong caregiving.

Residential transitions of adults with mental retardation: predictors of waiting list use and placement.

Predictors of residential planning and placement among 461 families of adults with mental retardation living at home were examined prospectively over a 4.5-year period. Factors predicting whether an adult's name would be put on a waiting list for residential placement were a diagnosis of Down syndrome, higher unmet service needs, smaller parental support networks, and better maternal health. Predictors of residential placement were being on a waiting list, poorer maternal health, and older age of the adult child. Result from qualitative analyses of parental reasons for use of the waiting list or of placement were also presented. Findings were interpreted using stress and coping, family life cycle, and postponed launching models.

Issues in chemical dependency treatment and aftercare for people with learning differences.

Without major adaptations, current substance abuse treatment models may not be productive for people with learning differences. The study described in this article examined ways to create accessibility to generic chemical dependency treatment for people with learning differences. A key informant survey of chemical dependency workers and developmental disabilities workers was conducted to determine the needs of chemical dependency treatment programs, staff, and people with learning differences in making treatment accessible. Training and information needs were identified, and responses were compared between the two groups of providers. Chemical dependency treatment staff need more information and training on differing learning and socialization skills, differences in reading comprehension, and personal prejudices or stereotypes. In-depth screening is also required to determine the appropriateness of integrated or specialized services or some combination of both.

A study of self poisoning with oral salbutamol--laboratory and clinical features.

1. The recent increase in asthma mortality coupled with reports of fatal asthma associated with beta-2-agonist therapy, has stimulated interest in the plasma concentrations of beta-2-agonists that produce systemic toxicity. 2. We prospectively studied 17 patients (9 male), mean age 23 years (range 2-72), who attended the emergency departments of hospitals throughout the United Kingdom having recently ingested an overdose of salbutamol. 3. Clinical, laboratory, ECG data, plasma and urine samples were obtained from each patient. Plasma was assayed for salbutamol concentration using a high performance TLC-photodensitometric method. 4. The mean (+/- s.d.) salbutamol dose reported to have been ingested was 89(+83)mg and the mean plasma salbutamol concentration was 166 (range 18-449) ng ml-1. The mean plasma potassium was 2.9 (s.d. +/- 0.6) mM (n = 16). None of the patients in this study developed serious cardiac dysrrhythmias. 5. There were significant correlations between the plasma salbutamol concentration and plasma potassium concentration (r = -0.85; P < 0.00005) and between plasma salbutamol concentration and pulse rate (r = 0.66; P < 0.005). 6. We conclude that in these patients, without respiratory decompensation, suprapharmacological plasma concentrations of salbutamol were tolerated without serious cardiac arrhythmias or any fatalities.

Rapid measurement of basic drugs in blood applied to clinical and forensic toxicology.

A gas chromatographic method is presented to measure blood, serum or plasma concentrations of more than 40 basic drugs. The sensitivity is 0.05 mg/L or less, which represents medium-high therapeutic and overdose concentrations, and in many instances the major active metabolites are also quantified. The paper describes a single step extraction from basic solution into n-butyl acetate containing maprotiline internal standard. Disposable glass tubes are used, with direct chromatography of the upper organic layer. GLC analysis is conducted for 10 min isothermally on a packed column (3% SP2250) with nitrogen-phosphorus detection. The coefficient of variation (CV) of the assay is between 2% and 5%, and data on the reproducibility of retention times are presented.

Gas chromatographic measurement of cocaine in serum, plasma and whole blood.

A gas chromatographic method is presented to measure cocaine in serum, plasma or blood. To reduce the in-vitro chemical and enzymic hydrolysis of cocaine, samples should be collected into fluoride oxalate tubes, frozen immediately and stored at -20 degrees C until analysis. Extractions are carried out in disposable glass tubes immersed in an ice-bath. The method uses a single step extraction from a mildly basic solution into n-butyl acetate containing maprotiline internal standard. A portion of the upper organic layer is chromatographed for 5 min isothermally on a packed column (3% SP2250) with nitrogen-phosphorus detection. The coefficient of variation (CV) of the assay is below 6% at 0.1 mg/L and the limit of accurate measurement is 0.02 mg/L. A case of acute cocaine intoxication is described to illustrate the application of the method.

Plasma concentrations of salbutamol in acute severe asthmatics.

We studied prospectively 11 asthmatic patients presenting to the Accident and Emergency department with acute asthma. (Four patients reported historically that they were taking some form of oral salbutamol as part of their maintenance therapy.) Standard cardiovascular and respiratory parameters and plasma salbutamol concentrations were measured before and one hour after treatment with five milligrams of nebulised salbutamol. The median plasma salbutamol concentration before treatment was below the level of detection of the assay (less than 3 micrograms.l-1) with a range from less than 3 micrograms.l-1 to 34.6 micrograms.l-1. One hour post treatment the median plasma salbutamol concentration was 7.4 micrograms.l-1 (range less than 3.0 micrograms.l-1 to 56.0 micrograms.l-1) p less than 0.05. (Wilcoxons test). Correlations were investigated between the measured pretreatment physiological variables and pre-treatment plasma salbutamol concentrations. None were found to be significant. Similar analysis of the measured post-treatment physiological variables and post-treatment plasma salbutamol concentrations again revealed no significant correlations. However, a significant negative correlation was noted between the change in plasma salbutamol concentration with treatment and the change in respiratory rate (Rs = -0.56, p = 0.04). If asthmatics do indeed use high doses of inhaled beta-2-agonists (salbutamol) in an attempt to abort an acute attack (as many clinicians suspect), little, if any, of the drug appears to reach the systemic circulation. In this study the administration of five milligrams of nebulised salbutamol to acute asthmatics did not produce excessive increases in plasma salbutamol concentration, even in those patients taking oral salbutamol as part of their maintenance therapy.

Does urinary salbutamol reflect compliance with the aerosol regimen in patients with asthma?

Compliance with inhaled beta agonist therapy in a group of asthmatic patients in general practice has been monitored using a high performance thin layer chromatographic assay of salbutamol in urine. Urine salbutamol levels were lower than expected in five of 51 patients and much higher than expected in a further 11 patients. These results suggest the assay may be clinically useful for monitoring compliance of asthmatic patients with inhaled salbutamol.

The pharmacokinetics of uniphyllin in nocturnal asthma.

Three consecutive doses of approximately 10 mg/kg of a once daily slow-release theophylline preparation (Uniphyllin) were given at 22.00 hours to 15 patients with nocturnal asthma who were recovering from an acute exacerbation of their asthma. Twenty-four hour plasma theophylline profiles were obtained after the first and third doses. Following the first dose, the mean peak level was 12.5 mg/litre, mean time to peak was 8.1 hours and mean apparent elimination half-life was 6.6 hours. Pharmacokinetic data were similar following the third dose. In nocturnal asthma, Uniphyllin should be given at about 20.00 hours to coincide peak levels with the time of maximum airflow obstruction.

Acute chlormethiazole poisoning in patients notified to the Poisons Unit, Guy's Hospital, 1978--1981.

1 Out of 493 patients with suspected acute chlormethiazole poisoning notified to the Poisons Unit, Guy's Hospital during 1978--1981, the diagnosis was confirmed either analytically or by detailed clinical information in 108 patients, 40 of whom had ingested chlormethiazole alone. 2 The principal signs reported indicate that the clinical features of acute chlormethiazole poisoning resemble those of barbiturate poisoning, with deep coma (n = 66), respiratory depression (n = 26) and hypotension (n = 17) in the severe cases. Five patients died as a result of early, profound respiratory depression. 3 In 53 survivors in whom toxicological analyses were performed, poisoning with chlormethiazole alone had a better prognosis than when ethanol or other drugs were also present, except in patients with hepatic or pulmonary disease or in the elderly. 4 These results emphasise that although patients poisoned with chlormethiazole who survive to reach hospital generally have a good prognosis, fatal respiratory complications often occur before the patient can be treated.

Hemoperfusion in "late" paracetamol poisoning.

Seven patients who presented to hospital later than 10 h following an overdose of paracetamol were treated by charcoal hemoperfusion. In all cases there was a rapid fall in the plasma paracetamol concentrations, although the total amounts of drug removed varied from 364.5 to 6699 mg. One patient developed fulminant hepatic failure and died; the remainder recovered, sustaining only mild hepatic damage (maximum AST less than 1000 IU/L). Charcoal hemoperfusion may be effective in mitigating the severity of liver injury in those patients who are not eligible to receive specific antidotal therapy.

Engineering Techniques for Nondestructive Quality Evaluation of Agricultural Products1.

A number of nondestructive methods have been developed to detect defects and evaluate physical characteristics associated with quality of agricultural products. The methods involve the application of a well-characterized source of energy (such as x-rays, light, infrared radiation, or sonic energy) to the test object. Because of the composition and condition of the material, the input energy is modified in some unique manner. The difference between the input energy and energy response can be measured and recorded, and may provide a basis for development of empirical relations and correlations for assessing quality-related factors. This paper reviews some of the nondestructive techniques which have been developed for testing agricultural products.

DYNAMIC ELASTIC PROPERTIES AND SENSORY QUALITY OF APPLE FRUIT.

A nondestructive resonance technique for measuring the textural qualities of apple fruit was evaluated. The resonance frequency, f, and the mass, m, were measured on each intact fruit, and a factor, f2 m, was computed. This resonance factor, f2 m, directly reflected the elastic properties of the fruit flesh and correlated significantly with sensory judgements of apple firmness during harvest. The dynamic resonance test is not as reliable an index of sensory firmness as the pressure test, but it has the advantage of being nondestructive.

OBJECTIVE MEASUREMENTS FOR TEXTURE IN FOODS.

Foods are complex systems exhibiting various degrees of elasticity, viscosity, and plasticity. Because of its complex structure and mechanical behavior, objective measurements of food texture may be influenced by a variety of test conditions, including rate of loading, the magnitude of deformations imposed upon the material, geometry of the loading surface, and localized yielding within the product tested. These sources of variance are discussed. Brief descriptions are given of methods for measuring texture of meats, dairy products, bakery foods, fresh fruits and vegetables, and processed commodities. The paper concludes with a discussion of new techniques for assessing textural qualities of foods based upon an analysis of sound, light transmission, and vibration phenomena.