An inheritance of terror: postmemory and transgenerational transmission of trauma in second generation jews after the holocaust.

Postmemory, as Hirsch (1997) has defined it, describes the relationship of the second generation to powerful, often traumatic experiences that preceded their births, but that were nevertheless transmitted as to seem to constitute memories of their own. Although subsequent research has created a more complete picture of the interactions between parents and children, Hirsch's definition has clear bearing on how descendants have attempted to commemorate the prior generation's ordeals through various means, some narrative, some visual, while still qualifying those modes as acts of transfer or the resonant after-effects of trauma. Focusing on the Holocaust, this article examines certain lines of communication between survivors and their children as mediums of transgenerational transmission of trauma through both theoretical and experiential models of identification. It also attempts to signify how parenting styles contribute to children's maladaptive behaviors if no intervention is staged. Additionally, I conclude that while second generation Jews may suffer negatively from intrapsychic and interpersonal problems observable by clinicians, they can also learn to integrate and understand their heritage through personal and therapeutic expression linked to the larger cultural context.

Success of an educational intervention on maternal/newborn nurses' breastfeeding knowledge and attitudes.

OBJECTIVE: To test the effect of a breastfeeding educational program for improving breastfeeding knowledge, attitudes, and beliefs of maternal/newborn nurses, and to improve their intentions to provide breastfeeding support to new mothers. DESIGN: Quasi-experimental, pretest/posttest design. SETTING: Maternity units of 13 hospitals located in midwestern and east coast states. PARTICIPANTS: Nine experimental and three control hospital sites resulted in a convenience sample size of 240 registered nurses (RNs); 206 RNs in the experimental sites and 34 RNs in the control sites. METHODS: Participation in the experimental groups involved the completion of two questionnaires upon study entry and then again after completion of a self-study module. Participants in the control groups completed the two questionnaires twice with a 4- to 6-week interval between them without access to the self-study module. MAIN OUTCOME MEASURES: Nurses' breastfeeding knowledge, attitudes, beliefs, and intentions to support postpartum mothers who are breastfeeding. RESULTS: Findings suggest that this educational strategy was effective in improving maternal/newborn nurses' breastfeeding knowledge, attitudes, and beliefs, and intentions to support breastfeeding mothers. CONCLUSION: This self-paced, study module, which is guided by an on-site, trained staff member, may be a cost-effective strategy for improving nurses' breastfeeding knowledge and support to new breastfeeding mothers. Nurses may find this type of teaching modality to be less intimidating than a structured classroom setting, and more desirable for their busy schedules.

Using information technology to reduce asthma disparities in underserved populations: a pilot study.

BACKGROUND: Low health literacy has been identified as an independent predictor of poor asthma control. The Institute of Medicine considers the role of information technology (IT) as critical in providing "safe, effective, patient centered, timely, efficient, and equitable" care with the potential to reduce health disparities in underserved populations. The aim of this study was to design and evaluate an interactive computer-based questionnaire to assess asthma symptoms in children of parents with limited health literacy and/or limited English proficiency. METHODS: Volunteer caregivers attending a mobile asthma clinic were randomly assigned to complete the electronic or the paper-and-pencil version of an asthma screening questionnaire (ASQ) in their language of choice (English or Spanish). In the electronic version, a tablet computer was used to present the ASQ questions as video clips and to collect information through the touchscreen. Participants also completed a demographic questionnaire, a brief health literacy questionnaire, and a system usability and satisfaction questionnaire. Reliability of the paper and electronic self-assessments was evaluated by comparing each participant's answers to information they provided during a nurse-guided structured interview (gold standard). RESULTS: A total of 48 parents participated in the study, 26 completed the electronic ASQ and 21 the paper-and-pencil form. Thirty-five percent of the children had well-controlled asthma (n = 17). Most participants were Spanish speaking (67%) Hispanic (n = 44) mothers (n = 43) with a median age of 32 years. More than half had ≤8 years of education (n = 25) and earned <$20,000 per year (n = 27). The median health literacy score was 32 (range 0-36). The correlation between health literacy scores and years of education was significant (ρ = .47, p < .01). Concordance between the electronic ASQ and the nurse interview was significantly higher than concordance between the paper ASQ and the nurse interview (68% versus 54%; p < .01). All parents who completed the electronic questionnaire reported being satisfied; 96% felt comfortable using it, and found it simple to use. CONCLUSIONS: By facilitating the assessment of asthma symptoms at manageable cost, interactive information technology tools may help reduce barriers to access due to inadequate levels of English proficiency and health literacy.

Staying afloat: surviving curriculum change.

In response to calls for nursing education reform, a content-based curriculum was changed to a concept-based curriculum, using Kanter's 7 skills for effective change model. The skills include tuning in to the environment, challenging the prevailing organizational wisdom, communicating a compelling aspiration, building coalitions, transferring ownership to a working team, learning to persevere, and making everyone a hero. The authors describe the steps taken to successfully accomplish this arduous task.

A new curriculum for a new era of nursing education.

The need for curriculum reform, a common theme in the nursing and health sciences literature for a number of years, is becoming urgent. This article describes an innovative undergraduate nursing curriculum. Central to the curriculum revision were the adoption of a conceptual approach, the institution of clinical experiences driven by conceptually based learning, and a focus on experiences across population groups and practice settings. An innovative, Web-based community was developed as a platform for the curriculum.

The Hallmarks Survey: for those who care enough to teach the very best.

The Hallmarks Survey is based on the 85 indicators recommended by the National League for Nursing (NLN) for the Hallmarks of Excellence in Nursing Education. With permission from the NLN, graduate students in nursing education developed this survey as a holistic and systematic tool for nurse faculty to use for assessment of program components. Analysis of data from 53 faculty respondents yielded areas of strength and areas for development for each hallmark category. Recommendations based on survey findings were disseminated to diverse audiences in multiple venues. A follow-up evaluation of the survey was also conducted. The Hallmarks Survey provides comprehensive assessment data that faculty may use to promote excellence in nursing education.

Role of 5HT 2A and 5HT 2C polymorphisms in behavioural and psychological symptoms of Alzheimer's disease.

OBJECTIVE: Alzheimer's disease (AD) patients suffer from behavioural and psychological symptoms of dementia (BPSD). A genetic component to BPSD development in AD has been demonstrated. Polymorphisms within serotonin receptors 5HT(2A) and 5HT(2C) have been previously investigated in a few interesting studies reviewed here, however, their role remains unclear. METHODS: Our large cohort of 394 patients had longitudinal information on the BPSD (Neuropsychiatric Inventory), which was used to dichotomise patients into whether they had ever suffered from a given symptom within the study period and give each patient a severity score. These measures were related to the 5HT(2A) T102C and 5HT(2C) cys23ser genotype and allele frequencies. RESULTS: Our data supports previous reports of an increased frequency of the C allele and CC genotype of the T102C variant of 5HT(2A) with hallucinations, delusions, psychosis and aberrant motor behaviour, however, we dispute previous associations with depression and aggression. We describe for the first time an increase in the C allele and CC genotype frequencies of the cys23ser variant of 5HT(2C) with anxiety and support previous associations with appetite disturbances in females. CONCLUSION: This review and extension of previous data presents support for the role of 5HT(2A) and 5HT(2C) in the development of certain symptoms, although the effect size may be small.

The safety and efficacy of zileuton controlled-release tablets as adjunctive therapy to usual care in the treatment of moderate persistent asthma: a 6-month randomized controlled study.

This study was conducted to assess the safety and efficacy of zileuton controlled release [CR] 1,200 mg BID added to usual care (UC) in 926 patients with moderate asthma (619 patients randomized to zileuton CR and 307 to placebo). Sustained improvements in AM and PM peak expiratory flow (PEF) were observed in the zileuton CR group compared to placebo. The adverse event profile was similar in the two treatment groups. Eleven patients (1.8%) receiving zileuton CR and 2 (0.7%) receiving placebo experienced elevations of alanine aminotransferase (ALT) >or= 3X the upper limit of normal (ULN). These elevations typically occurred (81.8%) during the first 3 months of exposure and most resolved within 21 days after discontinuation.

Parental selection: a third selection process in the evolution of human hairlessness and skin color.

It is proposed that human hairlessness, and the pale skin seen in modern Europeans and Asians, are not the results of Darwinian selection; these attributes provide no survival benefits. They are instead the results of sexual selection combined with a third, previously unrecognized, process: parental selection. The use of infanticide as a method of birth control in premodern societies gave parents - in particular, mothers - the power to exert an influence on the course of human evolution by deciding whether to keep or abandon a newborn infant. If such a decision was made before the infant was born, it could be overturned in the positive direction if the infant was particularly beautiful - that is, if the infant conformed to the standards of beauty prescribed by the mother's culture. It could be overturned in the negative direction if the infant failed to meet those standards. Thus, human hairlessness and pale skin could have resulted in part from cultural preferences expressed as decisions made by women immediately after childbirth.

Association study and meta-analysis of low-density lipoprotein receptor related protein in Alzheimer's disease.

Genome scans in sporadic Alzheimer's disease (AD) have revealed a possible susceptibility locus on chromosome 12. The low density lipoprotein receptor related protein (LRP1) gene lies within this area of linkage. Eighteen previous AD case-control studies have investigated the C766T polymorphism in LRP1 with conflicting results, including a protective effect on AD of the T allele, an increased susceptibility towards AD with both the C and T alleles, or no association at all. We have now performed a case-control study based on a large UK cohort of 477 AD patients and 466 matched controls, and have included these data, with those drawn from the 18 previous studies, into in a meta-analysis of 4668 AD patients and 4473 controls. We find no evidence for influence on the risk for AD in either our own present cohort or in the combined data set. Furthermore, we investigated whether the C766T polymorphism might modify the clinical and pathological phenotype in our cohort. We found no association with AD when the cohort was stratified into those with early (<65 years) or late (>65 years) onset, or when split into Apolipoprotein E (APOE) epsilon4 bearers and epsilon4 non-bearers. In addition, the C766T polymorphism was shown not to influence the age onset of AD. In a separate autopsy-confirmed cohort of 130 AD cases, no association with genotype or allele was observed for tissue levels of beta-amyloid 40, beta-amyloid 42, total beta-amyloid, pathological tau proteins, microglial cells or extent of astrocytic activity. Therefore, in this present study, we find no evidence for the involvement of this polymorphism either in increasing the susceptibility to AD, or by acting as a phenotypic modifier.

Interleukin-6 promoter polymorphism: risk and pathology of Alzheimer's disease.

Inflammatory and immune responses are involved in the pathogenesis of Alzheimer's disease (AD). Interleukin-6 (IL-6), an inflammatory cytokine, is thought to play a role in neurodegeneration of the central nervous system and has been associated with increased amyloid precursor protein expression in vitro and greater cognitive decline. Previously a C-174G polymorphism in the promoter of IL-6, which influences expression in vitro, has been found associated in some studies but not all. We investigated this polymorphism in a large independent UK sample of AD cases (n = 356) and controls (n 434) but found no association. We extended the study to genotype/phenotype correlations but found no correlation with age of onset (n = 338), brain amyloid load (n = 126) or Tau load (n = 101), brain microglial cell load (n = 65) or brain reactive astrocytes (n = 127). Our data do not support a pathogenic role in AD for the C-174G polymorphism in isolation.

The Health Assessment Longitudinal File imperative: foundation for improving the health of the force.

A smaller active duty force and an increased operational tempo have made the Reserve components (RC) essential elements in the accomplishment of the mission of the U.S. Army. One critical factor in meeting mission is maintaining the optimal health of each soldier. Baseline health data about the RC is currently not being collected, even though increasing numbers of reserve soldiers are being activated. The Annual Health Certification and Survey is being developed as a way to meet the RCs' statutory requirement for annual certification of health while at the same time generating and tracking baseline data on each reservist in a longitudinal health file, the Health Assessment Longitudinal File. This article discusses the Annual Health Certification Questionnaire/Health Assessment Longitudinal File, which will greatly enhance the Army's ability to accurately certify the health status of the RC and track health in relation to training, mission activities, and deployment.