Prostate cancer screening and informed decision-making: provider and patient perspectives.

The objective was to determine the extent of informed decision making for prostate cancer screening in a defined population. A state-wide population based survey of men aged 50 and above (Behavioral Risk Factor Surveillance System, 2004, Washington state) and a simple random sample of primary care physicians, were conducted in the same geographic area. We examined prostate cancer screening rates among the men (defined as either PSA or digital rectal examination within the past year) and prostate cancer screening practices among the physicians. Screening rates were 56% at ages 50-64, 68% at ages 65-79 and 64% among men age 80 and older. Adjusted analyses indicated that age, income, marital status, possessing health insurance and a personal health care provider, and talking with a provider about prostate cancer screening tests were all positively associated with screening status. In the physician survey, most physicians recommend screening to their average-risk male patients. Three-fourths (74%) of physicians discussed benefits and risks of PSA testing with their patients; but few used educational tools. Only 35% discussed the side effects of prostate cancer treatment with their patients. The rates of screening reported by men were relatively high, given that current recommendations promote informed decision making rather than universal screening. The majority of physicians recommend prostate cancer screening to their patients, with few decision-making tools used. All relevant information may not be provided in the discussion. These results point to the need for increasing informed decision making about prostate cancer screening.

Surveying and screening preschool language development in community-focused intervention programmes: a review of instruments.

Preschool language intervention has come increasingly to the fore with the development of community-focused interventions including Sure Start in the UK. Successful intervention methods may well be incorporated into mainstream service delivery, especially in areas of disadvantage. The question of whether such interventions will work and of their impact on children's language development has focused attention on measures of language. This paper distinguishes two reasons for measuring language development: (1) surveying language; and (2) screening language. It goes on to suggest a set of criteria for selecting instruments for these applications. The review includes a wide range of language assessment instruments for preschool children and examines those most likely to be suitable. It suggests a role for paraprofessionals in survey and screening and argues that this may be advantageous in terms of reaching families and thereby achieving high levels of coverage of a population group. Finally, there is a discussion of the implications of such measures in community-focused preschool interventions.

Persistence of maternal concerns surrounding neonatal jaundice: an exploratory study.

OBJECTIVES: To explore whether mothers currently express concerns about neonatal jaundice and perceive it as a serious condition; if so, to identify factors influencing these perceptions; and to elicit maternal recommendations for improved health care interactions. DESIGN: Ethnographic interviews using grounded theory methods. Audiotaped data were transcribed and analyzed for themes using a qualitative data analysis software program. SETTING: University and community hospitals. PARTICIPANTS: Forty-seven Spanish- and English-speaking breastfeeding mothers of otherwise healthy infants with a diagnosis of neonatal jaundice and treated in inpatient and/or outpatient settings. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Qualitative descriptions of maternal experiences with neonatal jaundice. RESULTS: Mothers continued to voice concerns about jaundice and perceive it as serious. They expressed misconceptions, wished to have jaundice explained further, and offered suggestions to improve communications with medical staff. Guilt was common, with mothers believing that they had caused the jaundice. Mothers voiced alarm about the yellow skin and discomfort about jaundice management and worried about perceived short- and long-term effects. Maternal perceptions were exacerbated by cultural differences, language barriers, and subtlety of language and its meaning. Key factors in creating perceptions of jaundice as serious included unexpectedness of and lack of knowledge about jaundice, quality of information received, levels of intervention, and prolonged duration of illness and yellow color. Interactions with health care professionals and other mothers with personal experience with jaundice were important mediators in the way mothers reacted to information. CONCLUSION: Practitioners need to address these persisting misconceptions and concerns about neonatal jaundice with mothers.

Effectiveness and infant acceptance of the Rx medibottle versus the oral syringe.

STUDY OBJECTIVE: To compare the effectiveness and infant acceptance of drug delivery of the Rx medibottle with the standard oral syringe. DESIGN: Prospective open-label, randomized, crossover clinical study. SETTING: General pediatric outpatient clinic at an urban university. SUBJECTS: Thirty healthy, bottle-fed infants, aged 2-14 months, receiving routine vaccinations. INTERVENTION: Each infant received a single dose of acetaminophen (Tempra syrup), with one-half delivered by the Rx medibottle and one-half delivered with an oral syringe. MEASUREMENTS AND MAIN RESULTS: Three raters independently evaluated effectiveness and infant acceptance of each drug-delivery device. Effectiveness was based on the percentage of infants receiving 100% of the intended dose. Infant acceptance was scored using a validated infant medication acceptance scale (MAS, 10 = highest level). Significantly more infants received 100% of the intended dose with the Rx medibottle (93.3%) than with the oral syringe (56.7%, p=0.0074). Infants had a significantly higher mean MAS score when using the Rx medibottle (8.3+/-1.8 vs 7.3+/-1.7, p=0.002). In addition, a significantly higher percentage had ideal MAS scores of 9 or above with the Rx medibottle (73%) compared with the oral syringe (17%, p=0.0001). CONCLUSION: The Rx medibottle was more effective and had a higher level of infant acceptance than the oral syringe. Although further studies are necessary, this suggests that the Rx medibottle may be a better method of delivering liquid drug and may increase infant adherence.

African-American and Latina adolescent mothers' infant feeding decisions and breastfeeding practices: a qualitative study.

PURPOSE: To explore minority teen mothers' perceptions of breastfeeding and the influences on infant feeding choices. METHODS: A qualitative study using semistructured ethnographic interviews and focus groups involving 35 Latina and African-American girls in Chicago between the ages of 12 and 19 years who were primiparous and were currently pregnant or had delivered within the past 3 months. RESULTS: Adolescents identified three main influences on infant feeding decisions and practices: (a) their perceptions of the benefits of breastfeeding, (b) their perceptions of the problems with breastfeeding, and (c) influential people. In this study, teens reported no single influence which determined infant feeding choices. The decision to breastfeed was a dynamic process. Teens recognized that breastfeeding offered many benefits including facilitating maternal-child bonding and promoting the baby's health, but concern was raised regarding a potential for excessive attachment between teen mother and baby. Fear of pain, embarrassment with public exposure, and unease with the act of breastfeeding acted as barriers for teenagers who were considering breastfeeding. Teenagers discussed the breast pump as a strategy in dealing with these barriers. The adolescents' mothers continued to be an important influence. CONCLUSIONS: The ranges of perceptions and influences that minority adolescent mothers have identified as affecting their infant feeding choices, illustrated and explained in the teens' own words, are helpful to health care providers as they counsel teen mothers about infant feeding options.

Infant acceptance and effectiveness of a new oral liquid medication delivery system.

A medication acceptance scale (MAS) for pediatric oral liquids was developed and used to evaluate effectiveness and infant acceptance of a medication delivery system. The MAS incorporated five behavioral elements associated with pediatric drug administration: cry, facial expression, body movement or level of agitation, reaction to placement of medication in the mouth, and swallowing. A score of 1-10 was possible, with 10 indicating the highest level of infant acceptance. Preliminary field testing was conducted. In an open-label clinical study, a single dose of acetaminophen was administered to 20 infants with approximately one fluid ounce of infant formula or apple juice by pediatric nurses using the Rx medibottle (The Medicine Bottle Company). Past medication acceptance was rated on an infant global acceptance scale. The intended dose, the amount consumed, and the time taken to administer the dose were recorded. Infant acceptance was independently scored by a nurse and two pharmacists. A high preliminary estimate of internal consistency reliability of the MAS was found. Interrater reliability was high, with the highest correlation between the two pharmacists. Sixteen (80%) of the infants received 100% of the intended dose; it took 0.5-9 minutes to administer these doses. The median MAS score was 9 for each of the three raters. Mean MAS scores for the three raters were 7.85 and 7.45 (pharmacists) and 8.50 (nurse). There was a strong correlation between MAS scores and infant global acceptance scale scores. A pediatric oral liquid MAS that had content validity, concurrent validity, high internal consistency reliability, and high interrater reliability was developed; the Rx medibottle was an effective oral liquid medication delivery system and had a high level of infant and rater acceptance.

The influence of medroxyprogesterone on the duration of breast-feeding in mothers in an urban community.

OBJECTIVE: To assess the effect of medroxyprogesterone acetate on lactation when it is given immediately post partum. DESIGN: Prospective cohort study with follow-up through 16 weeks post partum. SETTING: Urban teaching hospital in Baltimore, Md. PARTICIPANTS: Consecutive sample (N = 95) of mothers who were delivered of healthy, term newborns, had home telephones, received either medroxyprogesterone or nonhormonal contraception at discharge, and were currently breast-feeding their newborns. MAIN OUTCOME MEASURES: Lactation (duration and frequency) and timing of first introduction of formula were measured by weekly telephone interviews. RESULTS: Maternal characteristics included the mean +/- SD maternal age (24 +/- 5 years), race (90% African American), history of pregnancy (63% multiparous), marital status or relationship (50% married or living with partner), and medical assistance (81% of the recipients received aid). Women who were receiving medroxyprogesterone (n = 43) were older (P < .05) and were more likely to be married (P < .05) compared with those who were receiving nonhormonal contraception (n = 52). No other factors that were likely to influence lactation were significantly different. Groups did not differ in the baseline-planned duration of lactation. Follow-up data were obtained on 90 women (96%). The groups were comparable in the duration of lactation (medroxyprogesterone: 98%, 74%, 55%, 47%, and 42% were breast-feeding at least once per day at 1, 4, 8, 12, and 16 weeks, respectively [median, 10.14 weeks], vs nonhormonal contraception: 86%, 70%, 47%, 36%, and 30%, respectively [median, 6.57 weeks] [P = .19]). The percentage of subjects who were exclusively breast-feeding at these times and the timing of formula introduction also did not differ by group. CONCLUSION: Medroxyprogesterone, when given to mothers in an urban community immediately after delivery, has no detrimental effect on the duration of lactation, frequency of lactation, and timing of introduction of formula within the first 16 weeks post partum.

The effects of ultraviolet-A radiation on visual evoked potentials in the young human eye.

A recent study from this laboratory using visual evoked potentials (VEPs) demonstrated that children's eyes are capable of detecting ultraviolet radiation. The aim of this study was to compare dose-response relationships in two age groups, 6-10 years (n = 10) and 20-25 years (n = 10). Under photopic viewing conditions (550 lux), exposures of monochromatic UV-A (339 nm) and visible radiation (502 nm) were correlated to VEPs. The results demonstrate that monochromatic UV-A can elicit age and dose dependent responses in the human visual system, suggesting that the eyes of children are more responsive to UV stimuli than the eyes of young adults.

Prophylaxis against venous thrombosis after total hip arthroplasty.

Venous thrombosis rates were compared in 200 patients undergoing total hip arthroplasty and randomized to receive either fixed mini-dose warfarin (1 mg daily) or adjusted-dose warfarin to maintain an international normalized prothrombin ratio (INR) of 2.0-4.0. Bilateral lower limb venography was performed between days 11 and 13 inclusive. Fixed mini-dose warfarin was associated with a significantly higher rate of total thrombosis (P less than 0.05). General anaesthesia was associated with a significantly higher rate of thrombosis than spinal anaesthesia (P less than 0.05). Adjusted-dose warfarin was associated with more bleeding complications than mini-dose warfarin although these were not attributable to excessive anticoagulation. A single death from pulmonary embolus occurred in the early postoperative period in a patient receiving adjusted-dose warfarin.

Effects of body position on crossed extension reflex in decerebrate cat: rectus femoris is more sensitive than is vastus medialis.

Physiological stimuli which increase postural extensor tone also increase excitability of the crossed extension reflex (CER). We report here that such stimuli increase excitability of the CER recorded from rectus femoris (RF) more than that of vastus medialis (VM). The difference might reflect an important role of the biarticular actions of RF, which is also a weak hip flexor, in stabilizing the hip as well as extending the knee during maintenance of posture.

Kinematics of locomotion in cats with partially deafferented spinal cords: the spared-root preparation.

The spinal cord was partially deafferented in two cats by dorsal rhizotomy sparing the dorsal root, L6. Kinematic methods were used to study movements of the pelvis and the affected hindlimb during treadmill walking. The E2 yield of the ankle 2 days postsurgery was of greater duration and extent than normal. Longer duration remained at 14 days, whereas the extent was normal by 5 days. Knee displacement was limited during E3. Lateral oscillations of the pelvis were exaggerated initially, but normal by 14 days. Pelvic shift over the contralateral limb suggested abnormal loading patterns during early recovery. These qualitative descriptions of motor recovery are consistent with reported central nervous system responses following partial deafferentation.