Antenatal education for expectant mothers results in sustained improvement in knowledge of newborn care.

OBJECTIVE: Basic perinatal education to increase parental knowledge of neonatal illnesses (such as respiratory distress, sepsis, complications of prematurity) could be a feasible way to reduce high neonatal mortality rates in limited-resource nurseries. To assess the efficacy of antenatal education in increasing mothers' knowledge of basic newborn care in a limited-resource nursery, and to determine whether the knowledge is retained postpartum. STUDY DESIGN: In March to April 2008, we implemented a 10-min educational program on basic neonatal care for women receiving prenatal care in a maternal child hospital in Vientiane, Laos. The educational intervention was a structured, face-to-face interactive module taught by Lao providers using pictographic and written materials about temperature control, umbilical cord care and signs of neonatal illness. We assessed knowledge before and immediately after the module using a standardized interview tool. When possible, we reassessed knowledge postpartum to determine whether they retained information after the training. RESULT: We recruited 101 women (average age=26.3 years), and the majority (53%) were primigravidas. Participants were well educated by local standards; 57% of women had >8 years and 28% had >12 years of education. Women's knowledge of neonatal care increased by 10% on immediate posttest (P<0.0001), especially regarding knowledge of umbilical cord care and temperature control (normal temperature ranges, thermometer use). Maternal education (P=0.025) and previous births (P=0.037) correlated positively with higher pretest scores. Higher maternal education correlated with higher posttest scores (P=0.01); however, less-educated women increased their scores as much as did women with more education. Nulliparous women also increased their posttest scores to comparable levels in women with previous deliveries. Women retested after delivery retained the educational message, achieving similar posttest and postdelivery scores (P=0.08). CONCLUSION: Brief antenatal education increases mothers' understanding of basic newborn care. Mothers retain this knowledge into the early postpartum period and during early infancy when it might help reduce morbidity and mortality. The education was efficacious for women with little education. Brief antenatal educational modules seem a feasible, sustainable means of improving mothers' knowledge of newborn care. We speculate that similar programs could improve neonatal morbidity and mortality in developing countries.

Transbronchial needle aspiration: guidance with CT fluoroscopy.

BACKGROUND: Bronchoscopy with transbronchial needle aspiration (TBNA) is valuable to diagnose lesions in the mediastinum and lung, but conventional fluoroscopic guidance may be suboptimal. We describe the use of CT fluoroscopy to provide real-time, transaxial TBNA localization, thus facilitating biopsy. METHODS: Patients were selected because of prior unsuccessful bronchoscopy or anticipated difficulty owing to small size or inaccessibility of the lesion. CT fluoroscopy consists of a spiral CT scanner adapted using a rapid-reconstruction algorithm and hardware that permits real-time in-room imaging. The bronchoscope was inserted on the CT scanner, which was used to guide TBNA instruments into the target lesion. RESULTS: Of 27 patients who underwent TBNA with CT fluoroscopic assistance, 15 had mediastinal nodes, and 12 had lung nodules or focal infiltrates. Mean lesion size was 1.7 cm in the mediastinum, 2. 2 cm in the lung. A correct diagnosis was established in 10 of 12 mediastinal lesions (83%) for which follow-up was available and in 8 lung lesions (67%). Diagnoses included small cell and non-small cell lung cancer and invasive aspergillosis. False-negative results were caused by sampling errors or inability to reach the lesion as documented by CT fluoroscopy. Postprocedure CT fluoroscopy revealed no complications. CONCLUSION: CT fluoroscopy provides effective, real-time guidance for TBNA and may be particularly valuable in patients with small or less accessible mediastinal or lung lesions.

Differential effects of norepinephrine on phosphatidylinositol 4,5-bisphosphate stimulated hydrolysis in brains of mice genetically selected for differences in ethanol sensitivity.

The effects of norepinephrine on phosphoinositide turnover were evaluated in five brain regions of the long sleep (LS) and short sleep (SS) mice. These mice were selectively bred for differences in central nervous system sensitivity to ethanol with the LS exhibiting much greater sensitivity to a hypnotic dose of ethanol than the SS, as determined by the ability of the mice to regain their righting reflex. Norepinephrine (10(-3) M, 10(-4) M, and 10(-5) M) significantly increased phosphoinositide turnover in the hippocampus, hypothalamus, locus ceruleus, cerebellum, and cortex within each line of mice. Basal and norepinephrine-stimulated phosphoinositide turnover were significantly higher in the SS mice as compared with the LS mice in the cerebellum and cortex but not the other brain regions. Incorporation of 3H-inositol into 3H-phosphatidylinositols was not different between SS and LS mice in the cerebellum and cortex. The greater norepinephrine-stimulated phosphoinositide turnover in the cerebellum and cortex of the SS versus the LS mice may contribute to the CNS sensitivity to ethanol in these two lines of mice. However, ethanol (500 mM) had no effect on basal or norepinephrine-stimulated phosphoinositide turnover in any of the five brain areas examined in the LS and SS mice.

Squamous cell carcinoma in situ of the vagina and cervix after intrauterine DES exposure.

Two patients exposed in utero to maternal DES ingestion presented with adenosis. Each developed intraepithelial neoplasia in an area of active metaplastic change. The question is raised whether a continuum exists beginning with DES exposure and proceeding through the occurrence of adenosis and active squamous metaplasia to dysplastic alteration and finally squamous neoplasia. Since the cytologic smear is negative in 50% of cases during the dysplastic phase, it is recommened that all cases of adenosis be followed by colposcopy.

Sex differences as related to measurement of emotional arousal.

This study examined two categories of stress as a possible factor in previously mixed findings with regard to sex differences. Imagined physical stress and mental stress were induced by having Ss listen to tape-recorded descriptions of a car accident or taking a final exam. A self-report checklist was used to obtain ratings of anxiety, hostility and depression, and a Likert-type scale was employed to get Ss' estimates of their own emotional reactions. All Ss showed marked increase in emotionality scores after scene presentations. The results did not support the view that there are sex differences in responding due to different stressful conditions. However, females tended to express more emotionality than males to the stressful scenes. These differences were discussed in view of in vivo vs. in vitro presentation of stressful stimuli and the obtainment of sex differences as a function of where the measurement instrument falls on a subtle-obvious dimension.

DIFFERENTIATION OF RETARDED AND NORMAL CHILDREN THROUGH TOY-PLAY ANALYSIS.

An observational measurement technique f o r differentiation of organic mentally retarded and normal children was examined. Three groups of Ss-20 six-year-old retardates and 40 normal children matched with the retardates on CA or MA -were videotaped individually during an 18-minute period in which each S was free to play with any toys he chose. This period was divided usages in one of 10 predetermined categories of toy play. Discriminant function analyses were computed comparing the three possible pairs of groups. Significant differences were found between (a) retardates and normal 6-year-olds, (b) normal 6-year-olds and normal 3-year-olds, and (c) retardates and normal 3-year-olds. The Combinations category of toy play was the most important predictor in differentiating both normal groups from the retarded group. into 54 20-second intervals with two independent observers recording all toy.