Relationships between childhood growth parameters and adult blood pressure: the Fels Longitudinal Study.

Previous research has shown that childhood body size is associated with blood pressure in adulthood, and that early and rapid growth rates are correlated with adverse cardiovascular outcomes. Our objectives are to estimate associations between childhood body size growth parameters and adult blood pressure, and to examine the effect of early attainment of critical growth milestones on adult blood pressure, relative to normal or late attainment. Lifetime height and body mass index (BMI) measurements in childhood, and systolic blood pressure (SBP) and diastolic blood pressure (DBP) measurements in adulthood are taken from participants in the Fels Longitudinal Study. Childhood growth curves are estimated separately for stature and BMI using the Preece-Baines and third-degree polynomial models, respectively. Associations between the resulting parameter estimates and adult blood pressure are then examined using linear mixed models. Our findings show that the ages of achievement of the stature-based growth onset and peak velocity, as well as the age of achievement of the BMI-based adiposity rebound, are negatively associated with adult blood pressure, implying that early height or BMI growth can lead to increased blood pressure in adulthood. There were subtle differences in these relationships based on age and gender, and also between SBP and DBP. These results expand on the existing literature, showing that not only childhood body size, but also the timing of childhood growth can have a deleterious effect on adult cardiovascular health.

The influence of personal message with music on anxiety and side effects associated with chemotherapy.

The purpose of this pilot study was to evaluate the benefits of a message from a patient's physician audiotaped over music on reducing anxiety and side effects of patients receiving chemotherapy. A convenience sample of 97 adult patients receiving chemotherapy for the first time was assigned to either an experimental or control group. Before beginning the first chemotherapy treatment, all subjects completed a demographic questionnaire and the Spielberger State Anxiety Inventory (SSAI). Participants in the experimental group (n = 47) received taped music and a message from their physicians during the next four chemotherapy treatments. Participants in the control group (n = 50) received no intervention from the researchers and underwent their next four chemotherapy treatments as prescribed. After the fourth chemotherapy treatment, the SSAI and a side-effects self-assessment evaluation were completed by all subjects. A paired one-tailed t test found a significant difference between pre- and postintervention scores on the state anxiety scale (p < 0.001). In addition, anxiety remained the same over time in the control group. There was no significant difference in the severity of side effects experienced between control and experimental groups. These preliminary findings indicate that a simple and cost-effective intervention can decrease a patient's anxiety when receiving chemotherapy.

Nurse practitioners: reevaluation of the need for and willingness to hire by nurse administrators, nurse practitioners, and physicians.

A survey of all nurse administrators and advanced practice nurses and a simple random sample survey of licensed physicians in Nevada were completed to reevaluate the perceived need for and willingness to hire nurse practitioners (NPs). The reevaluation was deemed necessary based on a similar survey that was completed by these authors in 1990. At that time significant questions were raised concerning the lack of understanding of the role of NPs in and their contribution to the health care team. The results of the study clearly indicate that the unique contributions of the NP to the health care team should be further publicized and clarified. In addition, for some physicians, a significant disparity continues to exist between the optimal, collaborative role and the more readily accepted dependent role of the NP. The family NP (FNP) continues to be the most desired specialty for those who hire NPs.

Clinicopathological study of familial late infantile Hallervorden-Spatz disease: a particular form of neuroacanthocytosis.

The cases of two sisters with late infantile Hallervorden-Spatz disease are reported, one of whom has died. Autopsy of the deceased patient showed typical pallidal lesions, such as axonal spheroids and iron deposits, without involvement of the substantia nigra. Ultrastructural examination revealed that pallidal axonal enlargements consisted of collection of mitochondria, dense bodies, vesicles and amorphous material. In the living patient, brain MRI showed the classical "tiger's eye" appearance of the globus pallidus. Retinitis pigmentosa, acanthocytosis and slight neuromuscular involvement with an increase in serum creatine kinase were observed in both subjects. The appearance of the globus pallidus on MRI was in line with the pathological abnormalities. Ultrastructural differences between the principal disorders characterized by neuroaxonal dystrophy are compared and the clinical spectrum and similarities of the different forms of neuroacanthocytosis analysed.

The challenge of conducting clinical research in diabetes care and education.

The current healthcare environment requires diabetes educators to design their care and education programs around findings in scientific- and research-based literature. They must be confident that what they do makes a difference in terms of patient outcomes. Although diabetes educators recognize the importance of research as a basis for their practice, they often do not see themselves as responsible for participating in the process. Clinicians such as diabetes educators are in an ideal position to incorporate research into their practice because they are the most knowledgeable about the clinical problems that need to be solved. The challenges of conducting clinical research will be explored in this article along with ways to promote greater participation of diabetes educators in conducting research in their practices.

Women and HIV/AIDS.

The incidence of AIDS in women over the age of 13 is increasing dramatically in the United States, with 40,702 cases reported by the end of September 1993 (Department of Health and Human Services, 1993). Some data indicate women are becoming infected at an earlier age and have a shorter survival time than men. The authors provide a background to the female epidemic, discuss the unique pathophysiologic progress of HIV disease in women, and present the sociocultural and economic issues that contribute to women's risk. Nurses must become knowledgeable of the issues directly impacting on women in order to provide appropriate education, counseling, care, and leadership to women.

Nurse practitioners: need for and willingness to hire as viewed by nurse administrators, nurse practitioners, and physicians.

The problem investigated in this project was the identification of need for and desire to hire nurse practitioners in a rural western state. Participants included licensed nurse practitioners, nurse administrators of licensed agencies, and licensed physicians in the state of Nevada. The survey examined the participant groups' views of the need for and their desire to hire nurse practitioners. The findings showed differences among the groups in relation to their education levels and whether they were practicing in rural or urban areas. The most pronounced finding was the indicated need for more information related to the role and functions of nurse practitioners before hiring them. Recommendations for future study are also included.

[Echographic aspects of gynecomastia]. / Aspetti ecografici della ginecomastia.

Gynecomastia is a size increase of man's breast, due to non neoplastic ductal and glandular stroma proliferation. Prevalent ductal proliferation defines the "florid" type, while prevalent stroma increase defines the "quiescent" type. Pseudo-gynecomastia is a non glandular volume increase. Sonography is able to recognize the different parts of normal male breast and to diagnose gynecomastia. Moreover by sonography we can distinguish three echo-patterns linked to the anatomopathologic pattern which can lead therapy.

HIV infection in traditional rural communities.

The challenge to rural nurses to deliver knowledgeable and skilled nursing and health care to individuals with HIV infection and AIDS is indeed tremendous. Isolation of rural communities and health care facilities coupled with limited resources, financial concerns, conservative values of many traditional rural communities, and the tendency to exclude those who do not conform to community norms make it difficult to integrate the individual with HIV disease into the rural health care delivery system fully. Issues of particular concern to the rural nurse include maintenance of client confidentiality, obtaining and maintaining current knowledge and skills necessary to the provision of quality HIV nursing care, management of complex client health care problems, and provision of appropriate support services. Rural nurses must be innovative and creative in developing mechanisms to deal with these concerns. In addition, because rural nurses are well respected by the community and viewed as possessing a great deal of expertise in the delivery of health care, they are well positioned to provide leadership to the community in developing educational and care strategies to more effectively provide HIV care. Indeed, the delivery of high-quality HIV care in rural areas across the United States will likely depend on the expertise and leadership provided by rural nurses.

Photography as a tool in assessment and rapport development in clients with diabetes: research brief.

Certainly no major conclusions or generalizations can be made from a pilot study of this size. However, as is the nature of pilot studies, needed modifications in methodology have been discovered. Also, it is obvious that rapport development may be evaluated with the MISS, and the use of a camera has proven to be a worthwhile assessment and intervention tool. The results of this pilot study would certainly warrant continuation with a larger study. Rapport development has not been studied in diabetes. Perhaps rapport may be at risk because of the lengthy provider-patient relationship and the need for repeated physician reinforcement of required medical regimens and some associated life-style changes. In this study, rapport appeared to increase slightly in the experimental (camera) group and decrease in the control (non-camera) group. From the patients' perspective, use of photography communicates that the health care provider cares about them as individuals, is interested in their life-styles, and is seeking methods to best integrate the treatment regimen into their individual life patterns. However, rapport development may deteriorate over time with individuals who have a chronic illness (as indicated by some decrease in pretest/posttest mean differences in both groups), thus emphasizing the responsibility of health care providers to actively work to preserve rapport. The camera may be one method to accomplish this goal. When treating an individual with a chronic illness, health care providers tend to view the patient and problem as one entity rather than as two separate components. The camera may help to enhance this separation and promote understanding of the individual by means of rapport development.

Adult respiratory distress syndrome: a deadly complication of trauma.

The patient with ARDS presents a particular challenge to critical care nurses and other members of the health care team. The key to effective nursing management of the patient with ARDS is astute observation of the high-risk patient, particularly the trauma patient who has had chest trauma or cardiac or pulmonary contusion. Continual monitoring of arterial blood gas values and chest x-ray examinations aid in the early recognition of the clinical manifestations of ARDS. Although the trauma patient in whom ARDS develops faces a long and frequently difficult recovery, with astute, aggressive nursing intervention, patients with ARDS today face a much lower mortality rate than they did even 10 years ago. The overview of primary nursing diagnoses, goals, and interventions presented applies to most patients with ARDS. Individualized care plans can be formulated as an extension of the basic plan, thus ensuring optimum nursing care to the patient with ARDS.

Nursing management of the diabetic patient receiving nutritional support.

The diabetic patient receiving nutritional support presents a particular challenge to critical care nurses and other members of the health care team. Typical protocols concerning TPN administration must be reevaluated given the special considerations associated with the pathology of diabetes mellitus. These patients are particularly susceptible to the development of acute complications including those associated with glucose metabolism abnormalities and electrolyte imbalances. In addition, diabetic patients receiving TPN have the added stress of an acute illness complicating a chronic illness. An understanding of the interrelationships between the pathophysiology of diabetes mellitus and the stress response will provide the nurse with the background information necessary to meet the challenges imposed by TPN administration. The critical care nurse will be able to recognize early signs and symptoms of complications and implement appropriate nursing interventions. An overview of primary nursing diagnoses, goals, and interventions has been presented and will apply to most patients receiving nutritional support. Individualized care plans can now be formulated as an extension of the basic plan, thus ensuring optimum nursing care to the diabetic patient receiving nutritional support.

Microperfusion studies on the permeability of retinal vessels. A new model demonstrating organic anion transport and a reabsorptive fluid flux.

We developed an experimental model to study the permeability of individual retinal vessels in vitro using microperfusion techniques adapted from kidney tubule studies. The retinal vessels were isolated by freehand dissection and mounted on a microperfusion apparatus. When inulin was perfused luminally, it was diluted to 80.2 +/- 2.3% of its initial concentration. However, no radioactive leak into the bath side was observed, suggesting that the dilution was due to fluid flux from bath to lumen. The dilution of fluorescein (81.9 +/- 3.8%) was in the same range as that of inulin, the reference marker. The extremely low lumen-to-bath fluorescein flux, 0.5 +/- 0.9 X 10(-12) mol/min/mm, increased by 68% when probenecid was added to the perfusate and by 210% when probenecid was placed in the bath. The effect was concentration-dependent. When placed in the bath, fluorescein moved rapidly across the retinal vessel walls, accumulating in the lumen to concentrations 40 times higher than in the bath. This movement from bath to lumen, which was much higher (13.6 +/- 0.3 X 10(-12) mol/min/mm) than the lumen-to-bath fluorescein flux for the same fluorescein concentration, decreased by adding probenecid to the bath. The kinetics of this unidirectional movement of fluorescein were consistent with a saturable active transport process. The fluid flux from bath to lumen across the retinal vessels, which was 6.3 +/- 1.0 nl/min/mm for perfusion rates of 6.6 +/- 0.2 nl/min, was temperature-dependent and was coupled to the fluorescein transport. Fluorescein stimulated the fluid flux by 17% when added to the perfusate and by 60% when added to the bath, and this effect could be reversed by probenecid. Our results showed an active transport of fluorescein in the rabbit retinal vessels coupled with net fluid flux from outside the vessels into the lumen.

Management of the diabetic patient receiving nutritional support.

The diabetic patient receiving TPN presents a challenge to health care personnel. Usual protocols concerning TPN administration must be reevaluated given the special considerations associated with the pathology of diabetes mellitus. These patients are susceptible to the development of complications including those associated with glucose metabolism abnormalities and electrolyte imbalances. In addition, diabetic patients receiving TPN have the added stress of an acute illness complicating a chronic illness. An understanding of the interrelationships between the pathophysiology of diabetes mellitus and the stress response will provide the nutritional support team with the background information necessary to meet the challenges imposed by TPN administration. The health care team will be able to recognize early signs and symptoms of complications and implement appropriate interventions. Individualized care plans can be formulated as an extension of the basic plan that has been presented, thus providing optimum care to the diabetic patient receiving nutritional support.

Drug therapy for the hypertensive diabetic patient: implications for the diabetes educator.

A variety of side effects associated with the use of antihypertensive medications may occur in any patient with diabetes mellitus. Also, some antihypertensive agents produce symptoms that would be insignificant to the nondiabetic patient but may be life-threatening to the patient with diabetes mellitus. Therefore, it is imperative to instruct patients to be aware of any changes they may notice after starting an antihypertensive medication or changing their antihypertensive drug regimen. With this increased awareness and an increase in glucose monitoring (when necessary), the patient is prepared to recognize subtle changes in blood glucose levels or other conditions related to diabetes mellitus--changes that might otherwise go unnoticed. As diabetes educators, being knowledgeable about the pharmacodynamics of various antihypertensive medications, their influence on diabetes, and any risks the drugs may impose on the diabetic patient gives us a sound base to intervene with patients and prevent potentially life-threatening complications.