Preventing secondary pregnancy in adolescents: a model program.

The Dollar-A-Day program in Greensboro, North Carolina, was established in 1990 to prevent subsequent pregnancies in girls under 16 years of age who had already given birth to one child. Conceptualized by nursing professors and using principles from theories of adolescent development and social exchange, the program was planned and implemented in collaboration with nurses from the local health department. Weekly meetings featured food, an informal program focused on needs identified by members, setting of short-term goals, and an award of a dollar for each day they remained nonpregnant. After five years of operation with a series of small grants, only 15% of the 65 girls who had been enrolled in the program experienced subsequent pregnancies. The success of the program convinced health department officials to incorporate Dollar-A-Day into their budget as a permanent service to the population of adolescents they serve. It remains as a model program for others to emulate.

Results of large (8-9 mm) bilateral lateral rectus muscle recessions for exotropia.

PURPOSE: Commonly recommended maximum lateral rectus muscle recession for exotropia ranges from as little as 7 mm to as much as 11 mm. Published studies on recessions of 8 mm or more are scarce. Many ophthalmic surgeons still avoid recessions larger than 7 mm because of the fear of creating abduction deficits and surgical overcorrections. Therefore, we sought to determine the incidence of clinically detectable abduction deficits and their correlation with early surgical overcorrection in exotropic patients who had undergone large 8 to 9 mm lateral rectus muscle recessions. SUBJECTS AND METHODS: A retrospective chart review identified 30 patients with exotropia ranging from 35delta to 65delta who were treated with 8 to 9 mm recessions of both lateral rectus muscles. Patients with concurrent oblique muscle surgery were included. Mean followup time was 15 months (range 3-30 mos). RESULTS: Twenty-four patients (80%) required only one operation. The remaining 6 patients (20%) required a second operation, four for overcorrection and two for undercorrection. Nine patients (30%) had mild but persistent abduction deficits postoperatively. However, abduction deficits were not predictive of poor outcome (p=0.959). Other variables that did not significantly affect outcome included age (p=0.894), systemic anomalies (p=0.127), size of preoperative exotropia (p=0.987) and amount of rectus muscle recession (p=0.480). However, concurrent oblique muscle surgery was associated with a higher risk of a poor result. CONCLUSIONS: 8-9 mm lateral rectus recessions are not associated with a poor outcome, except in association with concurrent oblique muscle surgery.

Innovative collaboration to prevent repeated adolescent pregnancies.

Nurse educators from a university setting and staff from the county health department collaborated to establish an innovative program to prevent repeated pregnancy in adolescents. Called Dollar-A-Day and patterned after the original in Denver, CO, the program was operated jointly for 5 years and today continues to operate under the auspices of the health department. Success of the venture is attributed to use of skills in assessment, building, managing, and evaluating, as described by Loxley (1997). These elements were used to construct a context for collaboration.

PIP: This report describes a collaborative program for adolescent mothers designed to become a sustainable, permanent resource. The program, modeled after the "Dollar-A-Day" initiative, involves weekly meetings with adolescent mothers and weekly awards of $7 for avoiding a repeat pregnancy. This program began as a collaborative effort of health department nurses and members of the faculty of a nursing school. The program design applied Loxley's theory of collaboration (illuminating the relationships among structures, power, culture, and values through application of systems theory, social exchange theory, and cooperation theory). The core skills Loxley identified as necessary for collaboration were adopted by this program. "Assessment" involved reframing the perception of needs of the recipients and "mapping the terrain" (analyzing the overlaps and gaps, strengths and deficits, and resources of the collaborating agencies). "Building" involved creating structures, power, a culture, and values for the new initiative. The third skill, managing the process, was accomplished by open communication and information exchange. The final skill of evaluation involved 1) continuous evaluation through communication and weekly goal-setting exercises with the young mothers and 2) measuring the outcome for participants and for collaborative partners. Eventually, the goal of ending the collaboration and transferring the project to the county health department was achieved, and the program continues to operate successfully.

Assessment of the discriminative stimulus effects of the optical isomers of ecstasy (3,4-methylenedioxymethamphetamine; MDMA).

The discriminative stimulus effects of the stereoisomers of 3,4-methylenedioxymethamphetamine (MDMA) were studied in rats trained to discriminate 1.25mg/kg of (+)-MDMA or 3.5mg/kg of (-)-MDMA from saline, in a two lever, water-reinforced, drug discrimination situation. The isomers of MDMA and 3,4-methylenedioxyamphetamine (MDA) substituted completely for both training drugs. The stimulants amphetamine and cocaine did not substitute for either MDMA isomer. The hallucinogens (+/-)-2,5-dimethoxy-4-methylamphetamine (DOM), (+)-lysergic acid diethylamide (LSD), and mescaline failed to substitute completely for (+)-MDMA. Similarly, DOM and mescaline did not substitute for (-)-MDMA; however, LSD did substitute for this isomer at a dose of 0.06mg/kg but not at higher doses. Substitution tests with 5-HT-releasing agents revealed that fenfluramine substituted partially for (+)-MDMA and completely for (-)-MDMA, while p-chloroamphetamine substituted completely for both isomers of MDMA. When given in combination with (+)-or (-)-MDMA, neither the 5-HT(2) antagonist pirenpirone nor the less selective 5-HT antagonist metergoline consistently blocked drug-appropriate responding. These results indicate that the stereoisomers of MDMA and MDA have similar discriminative stimulus properties. More importantly, the present findings suggest that 5-HT release may be important for the discriminative stimulus effects of (+)-and (-)-MDMA. Actions at 5-HT(2) receptors, however, do not appear to be critical.

The role of monoamine uptake in the discriminative stimulus effects of cocaine and related compounds.

The involvement of monoamine neurotransmitter uptake in the discriminative stimulus effects of cocaine was examined in rats (n = 48) trained to discriminate 10mg/kg of this substance from saline in a two-level, water-reinforced (FR 20), drug discrimination situation. Compounds that act primarily by inhibiting dopamine (DA) uptake substituted for the cocaine cue; the order of potency was mazindol > nomifensine > GBR 12909 > bupropion, although efficacy was lowest with GBR 12909. Desipramine, which inhibits norepinephrine (NE) uptake, substituted partially for cocaine while two drugs that inhibit serotonin (5-HT) uptake, citalopram and fluoxetine, did not mimic cocaine. When given in combination with cocaine, cis flupenthixol and SCH 23390 reduced responding on the cocaine-appropriate lever significantly and to a greater extent than either haloperidol, (+/-) sulpiride or (-) sulpiride; neither (+) sulpiride nor metergoline had significant effects. Cocaine substitutions with DA uptake inhibitors were also attenuated to varying extents by cis-flupenthixol, SCH 23390 and haloperidol, but not by metergoline. These data, in conjunction with results reported previously, suggest that inhibition of DA uptake is involved to a greater extent than either NE or 5-HT uptake in the discriminative stimulus properties of cocaine and related compounds. Since both the cocaine cue and its substitution by DA uptake inhibitors appear to be blocked most effectively, reliably and potently by compounds that act either non-selectively at DA receptors (cis-flupenthixol) or primarily at D1 receptors (SCH 23390), D1 mechanisms may play a particularly important role in the neuronal substrates of these behavioral effects.

Feeding preterm infants. Schedule or demand?

Weight gain, length of hospitalization, and feeding behaviors were compared for preterm infants who were fed on demand (n = 15) with preterm infants who were fed on a schedule (n = 14). Weight gain and hospital stays were similar for both groups, and self-regulated feeding was found to be safe for physiologically stable infants. Benefits related to feeding behaviors included longer rest periods between interventions and the opportunity for infants to demonstrate hunger cues. The study findings indicate that feeding on demand may enhance contingency interactions between parents and their preterm infants.

Symbolic interactionism: a framework for the care of parents of preterm infants.

Because of stressors surrounding preterm birth, parents can be expected to have difficulty in early interactions with their preterm infants. Care givers who work with preterm infants and their parents can positively affect the early parental experiences of these mothers and fathers. If care givers are consciously guided by a conceptual model, therapeutic care for distressed parents is more likely to be provided. A logical framework, such as symbolic interactionism, helps care givers to proceed systematically in assessing parental behaviors, in intervening appropriately, and in evaluating both the process and outcome of the care. Selected aspects of the symbolic interaction model are described in this article and applied to the care of parents of preterm infants.

Pediatric family care: an interdisciplinary team approach.

Providing adequate psychosocial support for hospitalized pediatric patients and their families is sometimes difficult. An interdisciplinary team can help caregivers to assess needs and develop strategies for working with difficult patients and families. This paper describes the development of a pediatric family care team that has been effective in one hospital, outlining the general steps followed in establishing the team. A review of practical considerations related to team membership, costs, and procedures is followed by a discussion of the problems encountered. A case study demonstrates how the team helped meet the psychosocial needs of one pediatric patient.

Enhancing the educational benefits of collaborative research.

Careful planning for student involvement in collaborative research will greatly enhance the potential for teaching and learning. Active participation by students as contributing members of the research team results in an increased understanding of the research process and of content related to the research question. Students also profit from the teamwork involved. The authors offer practical suggestions for maximizing student involvement at each stage of the research project.