Efficacy and user preference of two CO2 detectors in an infant mannequin randomized crossover trial.

Assessment of effective ventilation in neonatal mask ventilation can be difficult. This study aims to determine whether manual ventilation with a T-piece resuscitator containing an inline CO2 detector (either a Pedi-Cap® CO2 detector or a Neo-StatCO2

High-density lipoproteins and endothelial function.

Elevated plasma levels of HDL cholesterol or apolipoprotein A-I, the major protein moiety of HDL particles, are protective against coronary artery disease. HDL particles remove cholesterol from peripheral cells and transfer it to the liver for bile acid synthesis. The interaction between lipoproteins is not mediated through simple contact between 2 phospholipid membranes but involves specific protein-receptor interactions, charged phospholipid-phospholipid contact, and activation of cellular signaling pathways. These lead to regulation of genes or the modification of proteins involved in vasomotor function, platelet activation, thrombosis and thrombolysis, cell adhesion, apoptosis and cell proliferation, and cellular cholesterol homeostasis.

A longitudinal study of relations between job stressors and job strains while controlling for prior negative affectivity and strains.

Interpretation of observed relations between job stressors and job strains in cross-sectional surveys is often ambiguous because of possible 3rd variables (both stable background factors, such as personality, and transitory occasion factors, such as mood). In this longitudinal study, negative affectivity (NA) and strains were assessed both in college and later on the job. Stressors were assessed only on the job. Evidence was found that some background factors affected measures of job stressors and job strains in that college measures were significantly related to subsequent measures on the job. Relations between job stressors and job strains, however, were in most cases not affected significantly when prior strains and NA were controlled for. Furthermore, the results suggested that NA measures are subject to occasion factors.

The pediatrician and the sexually active adolescent. Treatment of common menstrual disorders.

Menstrual disorders in adolescents are a common medical problem. For young adolescents, the onset of menses is a time of dramatic physical and psychological change. Providing education to young women regarding the normal process of puberty helps ease some of the anxiety regarding this change. Health professionals can participate in the education of young women by defining the normal process of puberty and menstruation. Menstrual disorders, such as dysmenorrhea, irregularities in menstrual flow, and premenstrual symptoms, can be effectively diagnosed and treated in the adolescent population.

New contraceptives in the 1990s.

This article reviews the contraceptive methods levonorgestrel implants and depot medroxyprogesterone acetate. These methods provide effective and safe contraception for adolescents and adults. This review focuses on the use of these contraceptive techniques in the adolescent population, discussing patient selection, side effects, and controversies concerning the methods. Future hormonal contraceptive methods are also discussed.

PIP: In the US, the 90% of women, at risk of pregnancy, who use contraceptives account for 47% of all unplanned pregnancies. Thus, if women using no contraceptives or using user-dependent methods were to switch to long-acting hormonal contraceptives like Norplant or injectables, unplanned pregnancy rates would drop. Norplant was approved for use in the US in 1992. The device consists of six rods that release levonorgestrel over a period of five years to suppress the luteinizing hormone surge responsible for ovulation and thicken cervical mucus to prevent sperm penetration. Norplant is highly effective, results in few metabolic changes in users, and can be used by lactating mothers. Side effects (most prevalent in the first six months) include abnormal bleeding, weight gain, depression, and headaches. Adolescents studied reported overall satisfaction with the method. Difficulties with removal can be minimized if the implants are inserted properly. The injectable use of depot medroxyprogesterone acetate (DMPA) was approved in the US in 1992. Contraceptive plasma levels are reached within 24 hours of the injection and are maintained for 14 weeks. DMPA inhibits ovulation and is highly effective when administered once every three months. DMPA is associated with a longer delay in return to fertility than other methods. The side effects of DMPA are similar to those seen in Norplant users. Concern about changes in bone density are currently being investigated. DMPA users have increased low-density lipoprotein cholesterol levels and decreased high-density lipoprotein cholesterol levels as compared to IUD users. DMPA (unlike Norplant) can be used effectively in women using anticonvulsant medications or antibiotics. It is also safe during lactation. Research into hormonal methods is being concentrated on the development of a two-rod and one-rod Norplant delivery system, on biodegradable delivery systems, and on various injectable formulations, including once-a-month estrogen/progesterone combination methods.

Indications, techniques, and advantages of partial laser vaginectomy.

Partial vaginectomy is seldom used diagnostically to evaluate vaginal neoplasia because of its technical difficulty, the possible need for grafting, and postoperative vaginal agglutination or stenosis. We found that use of the carbon dioxide laser simplified vaginectomy in ten subjects, producing a low rate of complications, an excellent diagnostic specimen, and superior healing.

The relationship between pain and uterine contractions during laser vaporization of the cervix.

Laser vaporization of the uterine cervix to treat cervical dysplasia is usually described by patients as moderately painful. Many describe the pain as uterine cramping, but most authorities attribute the pain to heat buildup during the procedure. To specify the mechanism of pain, intrauterine pressures were measured in 16 subjects (randomly divided into placebo and control groups of eight each) before and during cervical laser vaporization for dysplasia. The women were told what to expect during intrauterine pressure recording and laser vaporization and that a study of pain medication during laser vaporization was being conducted. The session began with 5 minutes of baseline intrauterine pressure recording. Subjects were then randomly given oral placebo or ibuprofen, 600 mg. Thirty to 45 minutes later, the intrauterine catheter was reinserted and the pressure recorded during 5 minutes of cervical laser vaporization. Laser vaporization increased significantly the frequency (P less than .025) and amplitude (P less than .03) of contractions in the placebo group but not in subjects given ibuprofen. However, post-procedure pain questionnaires showed no difference in pain perception between the groups. This study shows that pain during laser vaporization of the cervix is not due to increased uterine contractions, and that pain was not significantly relieved by ibuprofen.

Improving the Cytobrush as an aid in the evaluation of the abnormal Papanicolaou test.

In a series of 39 patients undergoing cervical conization, the Cytobrush was used to determine whether dysplasia involved the endocervical canal. To improve the specificity of the Cytobrush for this purpose, a sleeve was designed to guide the brush into the endocervical canal in order to minimize contamination from ectocervical lesions. Both the unsleeved and sleeved Cytobrush demonstrated good sensitivity for detecting dysplasia within the endocervical canal (89 and 95%, respectively). The sleeved Cytobrush demonstrated greater specificity than the unsleeved Cytobrush (90 versus 60%; P less than .05). Compared with endocervical curettage, the Cytobrush used in conjunction with the described "cytosleeve" offers an inexpensive, less painful, and accurate method of determining endocervical involvement of dysplasia.

Grip strength as a function of exposure to red or green visual stimulation.

40 male college students exhibited greater grip strength in the presence of red visual stimulation than they did when exposed to green. Several confounding factors present in previous tests of the color-strength hypothesis were carefully controlled.