Prevalence of generalized anxiety at eight weeks postpartum.

OBJECTIVE: This study investigated the prevalence and nature of generalized anxiety symptoms in women who were eight weeks postpartum. METHOD: A community-based sample of 68 postpartum women completed an interview assessing generalized anxiety disorder and depression and a self-report measure of worry associated with concerns relevant to postpartum women. RESULTS: Three women (4.4%) met DSM-IV criteria for generalized anxiety disorder, and an additional 19 women (27.9%) endorsed subsyndromal difficulties with generalized anxiety. Approximately one third of these women endorsed symptoms of depression. In contrast, only two woman met criteria for major depressive disorder. CONCLUSION: Postpartum generalized anxiety has a higher prevalence than postpartum depression.

Ethnocultural resistance to multicultural training: students and faculty.

Teaching diversity courses in mental health programs presents a unique set of issues for the faculty. These courses generate various forms of emotional reactions in students that could take the form of anger, silence, avoidance, and passivity. The purpose of this article is to specifically focus on the experience of students of color who find themselves in these courses and the various ways they respond. This learning process is often impeded by resistance because of the personal experiences of all students, but students of color experience a unique set of resistances in each stage of this process, either because of their own experience or because of a lack of experience with racism, racial and biracial identity development, cultural and bicultural identity, or acculturation issues. Resistance in the classroom interferes with the reciprocal communication between instructors and students and interferes with learning and the development of trust between instructors and students of color. Suggestions are made to help faculty to understand these resistances and to develop appropriate responses for working through the process.

Cubital tunnel surgery. Complications and treatment of failures.

Cubital tunnel surgery should be considered a failure if patients have no relief of their symptoms of if the symptoms recur shortly after the surgery. Choice of treatment should be based on careful examination and evaluation of patient expectations, general medical condition, level of activity, and duration and severity of symptoms. Failure of the initial procedure may be the result of inadequate release, instability, subluxation, inadvertent creation of a new site of compression, and intraoperative nerve injury. Certain clinical manifestations specify the cause for failure. A positive Tinel's sign, for example, may indicate the exact location of persistent nerve compression. A palpable mobile mass on the medial aspect of the elbow is consistent with recurrent subluxation. Localized point tenderness along the course of the incision may indicate a neuroma secondary to injury to the medial antebrachial cutaneous nerve. In all cases, it is imperative that the surgeon be familiar with all the possible anatomic sources of compression as well as the variations in the ulnar nerve and the medial antebrachial cutaneous nerve. Once operative failure has been determined, efforts should be directed at completely releasing the nerve through external neurolysis, eliminating any mechanical stretch, and releasing any sites of compression or kinking. Some improvement should be expected if the surgeon thoroughly understands the anatomy, chooses the appropriate revision technique based on patient history, and adheres to the technical details of the chosen revision technique.

Ergonomics and the occupational health nurse. Instituting a workplace program.

The science of ergonomics is fairly new to industry. It encompasses the total physiological and psychological demands of the job on the employee. Through observations and recordkeeping, the occupational health nurse can note trends in range of motion illnesses related to specific job functions and specific employees. Ergonomic approaches are the same as with other hazardous situations: engineering, administrative controls, and employee training. As a member of the occupational safety and health team, the occupational health nurse plays a vital role in preventing mental and physical fatigue and promoting worker health.

Carbamylation of hemoglobin in vivo with chronic sublethal dietary cyanide: implications for hemoglobin S.

Carbamylation of the hemoglobin in sickle cell anemia has been demonstrated to improve the status of this hemoglobinopathy. Using an animal model of West African human patterns of chronic sublethal dietary cyanide ingestion, 12 miniature swine consuming either 0, 0.4, 0.7, or 1.2 mg of cyanide/kg body weight/day were studied for 24 weeks to determine if this dietary regime could produce irreversible carbamylated hemoglobin. Throughout the study, the hematological status of all animals remained similar; however, the levels of carbamylated hemoglobin as measured by nanomoles of valine hydantoin varied proportionally to dietary sublethal cyanide intakes, indicating that these natural dietary levels could effect an important and presumably permanent modification of the hemoglobin's beta chain. Serum thiocyanate levels were also positively correlated with cyanide ingestion loads (r = 0.83, P less than 0.01). The implications of these findings in swine are important for the millions of humans with hemoglobin S who regularly consume similar levels of dietary cyanide and for our assessments of the biochemical and medical status of hemoglobin S under natural conditions.

Influence of dietary cyanide on immunoglobulin and thiocyanate levels in the serum of Liberian adults.

Serum thiocyanate, antibody titers to thiocyanates, and serum immunoglobulins (IgM, IgG, IgA) were measured in 73 Liberian adults normally consuming diets of low, moderate, high, or no (control) cassava-derived cyanide (CN(-)). When control and low groups (n = 40; daily intake less than 0.60 mg CN(-) per kg body weight) were contrasted with moderate and high groups (n = 33; daily intake greater than or equal to 0.60 mg CN(-) per kg body weight), the authors observed that (1) one-time serum thiocyanate measurements were not sensitive to long-term cyanide intake; however, (2) antibody titers to thiocyanates were positively correlated with cassava-based cyanide intakes (r = .22, P = 0.05); and (3) serum IgM, IgG, and IgA levels were elevated in individuals regularly consuming moderate and high levels of dietary cyanide. Possible responsible mechanisms and health implications are discussed.

Malaria in Liberian children and mothers: biocultural perceptions of illness vs clinical evidence of disease.

1046 non-hospitalized children and mothers from various regions of Liberia were studied to determine the relationships between their indigenous perceptions of malaria illness with on-going Plasmodium parasitemia and annual incidence of clinical malaria. Eleven pediatric and 14 maternal signs and symptoms of malaria were described, ranked by cultural severity, and evaluated biomedically. Between cultural perceptions of the severity of illness and biomedical evidence of the severity of disease, significant rank order correlations are observed for children (rho = 0.713, P less than 0.01) and mothers (rho = 0.875, P less than 0.001). Clinical, parasitological and cultural concordance were observed for 'anorexia', 'joint pain', 'abdominal tenderness', 'nausea', 'chills', 'severe headache', 'stomach pain', and 'dizziness'. Five other symptoms however either over or underpredicted observed levels of biomedically confirmed malaria: 'fever', 'convulsions', 'vomiting', 'body weakness' and 'psychological distress'. Biomedical studies revealed a parasite rate among children of 68.6%, a mean annual incidence of pediatric clinical malaria of 3.12; and a mean annual incidence of maternal clinical malaria of 2.42. Clinical malaria demonstrated a very early onset among newborns and a shift in acute parasitemia to a chronic status around 2.3 years of age. A significant positive linear correlation (r = 0.75, P less than 0.01) was observed between parasitological and clinical measures of malaria in children. The indigenous perspectives on malaria and the biomedically predictive powers of various biocultural symptoms are discussed and evaluated as an integrative and valuable means of assessing the impact of malaria in an endemic region.