Nursing intervention with mothers who are substance abusers.
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Cocaine↗
Biomedical subjects
M Behnke
Publications and source records attributed to M Behnke.
Predictive value of Apgar scores for developmental outcome in premature infants.
For more than two decades, Apgar scores have been used to predict developmental outcome in newborns. However, most studies have used full-term babies for their data base, and the predictive value of Apgar scores for low birthweight infants has remained unclear. This study was designed to provide a data base for premature infants, demonstrating to what degree Apgar scores predict developmental outcome. We tested Apgar scores alone and in combination with two other easily quantified variables, birthweight and gestational age, as predictors of risk for 256 infants weighing less than 1800 gm at birth. Although significant correlations existed between Apgar scores and Bayley Mental and Psychomotor Developmental Indices, multiple regression analyses demonstrated that these relationships were not significant independent of birthweight and gestational age. That is, after controlling for birthweight and gestational age, Apgar scores did not predict morbidity in low birthweight infants and should not be used to provide a developmental prognosis.
Apgar Score↗
Hepatitis B: a case for prenatal screening of all patients.
Evaluation of a mass screening program to detect hepatitis B surface antigen in the obstetric population of Shands Hospital, University of Florida in Gainesville, from January 1, 1983, through December 31, 1985, was undertaken. Prevalence of hepatitis B surface antigen seropositivity was 0.54%. Review of medical records revealed that 67% of patients with positive hepatitis B surface antigen screens had no risk factors identifiable by routine prenatal history. Although all patients were screened on admission to the hospital, the results of the immunoassay were not available in time for staff to institute isolation procedures for the laboring mother or unwashed neonate. In 82% of the cases, treatment of neonates occurred later than 12 hours after delivery (the current Centers for Disease Control recommendation). It is recommended that prenatal screening of all patients with a hepatitis B surface antigen immunoassay be done by 34 weeks' gestation where the patient population is of predominantly low socioeconomic status to ensure appropriate isolation and timely neonatal immunoprophylaxis.
Enzyme-Linked Immunosorbent Assay↗
The relationship of Apgar scores, gestational age, and birthweight to survival of low-birthweight infants.
While Apgar scores provide a valid prediction of mortality in term infants (primarily reflecting asphyxia), intervening variables in premature newborns complicate interpretation. Physiologic states normal to preterm infants (such as, decreased muscle tone) can depress scores but may not influence survival significantly. Therefore the relationship between Apgar scores and survival in term and preterm infants differs. Because of the paucity of studies on preterm infants, we tested Apgar scores, as well as birthweight and gestational age, as outcome predictors in 748 low-birthweight infants (500-1800 gm). Our purpose was to assess the relationship between 1- and 5-minute Apgar scores and survival, and to evaluate all combinations of the four variables as outcome predictors. Univariate analysis showed a significant relationship between each of the four variables and survival; however, no single variable accounted for more than 32% of the variance in outcome, thus no single factor could be invoked as the major determinant of survival. Logistic regression analyses demonstrated the interrelationships of the four variables to survival. While both Apgar scores were related to survival, independent of the effects of birthweight and gestational age, they were slightly less predictive than either of these variables alone. However, when 1- and 5-minute Apgar scores were combined with gestational age, the predictive value was slightly better than any of the four variables alone or in other possible combinations.
Apgar Score↗
Grief responses of pediatric house officers to a patient's death.
Twenty-five pediatric house officers were surveyed (14 M; 11 F) to assess their behavioral and psychophysiologic responses to patient death. Vignettes about the deaths of two pediatric patients were included as part of a self-administered questionnaire. The vignettes were followed by 14 behavioral and 20 psychophysiologic responses to the deaths depicted, and physicians were asked to indicate the expected occurrence of these reactions for themselves and for an ideal physician. Reported reactions were found to be similar to grief responses experienced with the death of a loved one. Significant differences were found between the responses of female and male house officers to patient death. Additionally, differences were found between the manner in which the physicians personally responded to a patient's death in comparison to the way they considered an ideal physician would respond. Practical suggestions are given, based on these data, for inclusion of information in death education courses for physicians.
Attitude of Health Personnel↗
The pediatrician and the dying child.
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Adolescent↗
Influence of chorioamnionitis on long-term prognosis in low birth weight infants.
The contribution of obstetric management to quality of life of surviving low birth weight infants is unclear. A possible association between maternal chorioamnionitis and development outcome was evaluated. One hundred twenty-seven mother/infant pairs with infant birth weight less than 2000 g were studied. The antenatal course was complicated by chorioamnionitis, premature rupture of membranes without chorioamnionitis, premature labor, or abruptio placenta. Analysis of variance was performed using these four diagnosis groups. After potentially confounding variables were taken into account, the overall difference in the four groups in Mental Development Index (Bayley Scales) was borderline (P = .138). However, significant differences remained between the group with chorioamnionitis and the group with premature rupture of membranes without chorioamnionitis (P = .017). The potential advantage of leaving infants in utero after premature rupture of membranes may be offset by disadvantage of chorioamnionitis with respect to future development in surviving infants.
Abruptio Placentae↗
Death counseling and psychosocial support by physicians concerning dying children.
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Adult↗
[The structure of the gastric mucosa of the llamas (Lama guanocoe and Lama lamae). I. Forestomach].
The mucous membrane of the first and second compartments (ventral regions) as well as of the third compartment of Lama guanacoe and Lama lamae stomach shows tubular glands opening into pits. Below the surface epithelium blood capillaries of the fenestrated type form a regular network, each mesh of which surrounds a gastric pit. From a morphological point of view (thin section and freeze-fracture replicas) the columnar cells of the surface epithelium and those of the pits closest to the capillaries are largely similar to the epithelial cells of the rabbit gallbladder. This similarity suggests that at the level of the columnar cells sodium-dependent water reabsorption occurs. This reabsorption has already been demonstrated in the abovementioned compartments by physiological methods. The surface and foveolae epithelial cells as well as some cells of the tubular glands have a secretory function. Their secretory granules contain mucosubstances, as indicated by light-(PAS- and Alcian blue reactions) and electron microscopic (PA-TCH-Ag-reaction) histochemistry. The secretory granules originate from the Golgi complex which shows a positive histochemical reaction in its innermost sacculi at the electron microscope level. Endocrine cells (s. second part of this investigation) are rare. The mucosal membrane of each muscular lip separating the glandular sacs in the first compartment shows a stratified, not keratinized, squamous epithelium.
Absorption↗
Prenatal cocaine use: a comparison of neonates matched on maternal risk factors.
This study was designed to overcome some of the methodological limitations of previous work and investigate the impact of prenatal cocaine use in an understudied population: women using rural county public health units who had minimal access to drug rehabilitation. Through maternal history, interviews, and urine screens, 172 cocaine users were identified. Using an independently collected perinatal data base, 168 nonusers were matched for six variables known to affect pregnancy outcome and chosen a priori: race, age, parity, prenatal care, alcohol, and nicotine use. To avoid chance findings, 10 adverse perinatal outcome variables were identified prospectively. Cocaine-exposed neonates experienced significantly more of the adverse events than the matched controls and were more likely to be preterm, low birthweight, resuscitated at birth, and to remain in the hospital after their mothers were discharged. We conclude that prenatal cocaine use can be a contributor to adverse perinatal outcome in this population. An understanding of the effects of prenatal cocaine use and the needs of these women and infants is important for designing appropriate prenatal care, treatment, and follow-up programs.
Adolescent↗
Multiple risk factors do not identify cocaine use in rural obstetrical patients.
This nonconcurrent, cohort study of consecutive admissions to one of three hospital units: labor and delivery (n = 474), well-born nursery (n = 100), and the neonatal intensive care unit (n = 100), was designed to determine the prevalence of cocaine exposure in a rural obstetrical sample and to determine the relationship between exposure and perinatal variables. Urines were analyzed for benzoylecgonine, and the Obstetrical Complications Scale was completed for each mother-infant pair. Elementary comparisons were made using chi 2 analyses and Student's t test. Stepwise discriminant and discriminant function analyses were performed. The prevalence of exposure in the three groups of subjects ranged from 5%-7%. No significant differences in perinatal variables were found between users and nonusers in either of the newborn samples. In the maternal sample the groups differed on twelve mother or infant factors. However, no single variable or set of variables predicted use versus nonuse in any of the groups.
Cocaine↗
Newborn evaluations of toxicity and withdrawal related to prenatal cocaine exposure.
The literature on prenatal cocaine exposure is unclear whether immediate postpartum effects on the infant are transient, related to either acute toxicity of cocaine, or to a withdrawal effect as cocaine is metabolized, or whether they might persist. This prospective, longitudinal study was designed to test the hypotheses that newborns urine-positive for cocaine metabolites, compared to those exposed but urine-negative, and to nonexposed controls would (1) have poorer neurobehavioral scores (toxicity effect) and (2) worsen or demonstrate less improvement over the first week (withdrawal effect). We approached over 2500 pregnant women designated to deliver at our referral hospital from public health clinics; 85% consented to participate in a longitudinal study. We excluded women <18 years old with major chronic illness and prenatal drug use except cocaine, marijuana, alcohol and tobacco. From positive urine toxicologies or admissions in private, thorough interviews, 154 were identified as prenatal cocaine users; 154 were selected from noncocaine users matched on socioeconomic status (SES), race, parity and location of prenatal care (that related to perinatal risk), for a total sample size of 308. Included in this article are the 155 surviving infants who were full-term, delivered vaginally and were well and available for testing over the first week postpartum. Infant urine specimens were collected, and neurobehavorial testing was performed by certified, blinded examiners using the Neonatal Behavioral Assessment Scale on days 1, 2-4 and 5-7 postpartum. In toxicity analyses, controlling for amount of prenatal drug exposures, only autonomic regulation demonstrated significant overall and cocaine drug group effects. Urine-positive newborns had the poorest scores (i.e., more startles, tremors). However, given that planned comparisons were not significant, these data provided little support for acute toxicity effects. In withdrawal analyses, only one significant change over time varied among exposure groups. Those infants exposed and positive for cocaine metabolites increased their scores on regulation of state on days 2-4 and decreased them on days 5-7 (when withdrawal might be evident). However, their scores on days 5-7 were not significantly lower than their initial scores, nor different from the days 5-7 scores of the exposed negatives or control infants, lending little support for withdrawal effects. Our data support those of other controlled studies in failing to demonstrate devastating early effects of prenatal cocaine exposure. They add to our understanding that effects observed do not appear to be related to acute toxicity nor to cocaine withdrawal. The uncertainty of persistent effects of cocaine exposure warrants long-term follow-up.
Cocaine↗
Comparison of intravenous valproate versus intramuscular dihydroergotamine and metoclopramide for acute treatment of migraine headache.
OBJECTIVE: To determine the effectiveness and tolerability of intravenous valproate for the acute treatment of migraine headache with or without aura (International Headache Society diagnostic criteria 1.1 and 1.2) compared with intramuscular metoclopramide 10 mg followed 10 minutes later by intramuscular dihydroergotamine 1 mg. BACKGROUND: Divalproex sodium is approved for prophylaxis of migraine headache. We studied the possible effectiveness of intravenous sodium valproate for the treatment of acute migraine headache. Valproate offers a treatment option for patients with migraine who recently have used a triptan or dihydroergotamine, theoretically avoiding the risk of drug interactions or cardiovascular complications. DESIGN/METHODS: In an open-label randomization, patients with an established diagnosis of migraine with or without aura were administered either intravenous valproate or intramuscular dihydroergotamine with metoclopramide to treat moderate-to-severe migraine headache of 24 to 96 hours' duration. Forty patients alternately received either 500 mg intravenous valproate or 10 mg metoclopramide intramuscularly followed by 1 mg dihydro- ergotamine. Patients rated severity of headache and the presence or absence of nausea, photophobia, or phonophobia at baseline, and at 1, 2, 4, and 24 hours. RESULTS: With intravenous valproate, 50% of patients reported headache improvement from moderate or severe to none or mild at 1 hour following treatment, 60% reported such improvement at 2 hours, 60% at 4 hours, and 60% at 24 hours. Corresponding improvement rates for dihydroergotamine were 45% at 1 hour, 50% at 2 hours, 60% at 4 hours, and 90% at 24 hours. Intravenous valproate and intramuscular dihydroergotamine provided similar relief from associated migrainous symptoms (nausea, photophobia, and phonophobia) during the first 4 hours following treatment. While none of the patients who received intravenous valproate experienced drug-related side effects during treatment, 15% of patients who took dihydroergotamine experienced one or more episodes of nausea and diarrhea during the first 4 hours of treatment. CONCLUSIONS: Intravenous valproate is similar in effectiveness to dihydroergotamine/metoclopramide as abortive therapy for prolonged moderate-to-severe acute migraine headache. Although the results were not statistically significant (P =.3635), intravenous valproate appears to offer a safe, effective, and well-tolerated treatment for patients with acute migraine. Relative to dihydroergotamine/metoclopramide, however, headache relief was not as likely to be sustained at 24 hours as with intravenous valproate.
Acute Disease↗
Constructs and coping: physicians' responses to patient death.
This paper explores the relationship between physicians' personal orientations toward death and their responses to patient death. A group of 25 pediatric residents were asked to complete the Threat Index and to respond to vignettes depicting personal death. Consistent with predictions derived from personal construct theory, particular death orientations were associated with various behavioral and psychophysiological reactions. Residents with high death threat and anxiety were more likely to adopt avoidance and denial strategies and to experience fewer psychophysiological symptoms when faced with a patient's death. Implications of these findings for further research and treatment are discussed.
Adult↗
Detection of cocaine and its metabolites in amniotic fluid and umbilical cord tissue.
The increased use of cocaine by women of child-bearing age has left many health care scientists searching for improved methods of detecting prenatal cocaine exposure. To that end, a study of the determination of cocaine and its metabolites in amniotic fluid and umbilical cord tissue was undertaken. Amniotic fluid (n = 32) and umbilical cord tissue (n = 70) specimens were collected from pregnant subjects admitted to labor and delivery at Shands Hospital at the University of Florida (Gainesville, FL). Subjects were interviewed regarding drug use during each trimester. Subjects reporting cocaine use were designated as target subjects, and those denying use were control subjects. The specimens were subjected to solid-phase extraction and analyzed for cocaine and its metabolites by gas chromatography-mass spectrometry. Cocaine analytes (predominantly benzoylecgonine) were detected in 28.1 and 18.5% of the amniotic fluid and umbilical cord tissue specimens, respectively. Other cocaine analytes frequently detected included ecgonine methyl ester and m-hydroxy-benzoylecgonine in amniotic fluid specimens and ecgonine methyl ester, norcocaine, and m-hydroxybenzoylecgonine in umbilical cord tissue specimens. This study has shown that cocaine and its metabolites are readily detected in specimens of maternal and fetal origin.
Adolescent↗
Meconium passage in very-low-birth-weight infants.
The timing of the first meconium stool has been considered a marker for proper gastrointestinal functioning in the term infant. There is limited information on the meconium passage patterns of very-low-birth-weight infants of less than 32 weeks' gestation. It is unknown whether feeding practices influence the timing of the first stool in these infants. We retrospectively studied 47 very-low-birth-weight infants with birth weights of 1250 g or less who were previously enrolled in a study of gastrointestinal (GI) priming. Infants whose mothers desired to breast feed (n = 7) were given GI priming with their own mother's milk. The remaining infants had been randomly assigned to receive total parenteral nutrition alone (n = 21) or GI priming with infant formula (n = 19) during the first 14 days of life. We attempted to advance all infants to full enteral nutrition by 21 days of age. There was no statistically significant difference in timing of the first stool among the three groups. The overall median age at first stool was 43 hours, and the 75th percentile was 10 days. The range was 1/2 hour to 27 days. There was no concordance between time of first stool and birth weight within the range studied. There was no concordance between time of first stool and necrotizing enterocolitis, although there was little statistical power to detect this. There was also very little concordance with feeding tolerance. Other than necrotizing enterocolitis, no significant GI disease developed in any of the infants studied.(ABSTRACT TRUNCATED AT 250 WORDS)
Birth Weight↗
Clinical benefits of a combined hospital and home-based exercise programme over 18 months in patients with severe COPD.
BACKGROUND: Long-term exercise training is capable of improving exercise performance and quality of life in patients with severe COPD. In the present study we examined the effects of an 18-month home-based training on the rate of hospital admissions and bronchodilator use as primary end-points. Secondary end-points were exercise capacity and quality of life. METHODS: The study comprised 26 patients with severe COPD (20m/6f; mean +/- SD FEV1, 37 +/- 6% pred) who were recruited in a previous trial and randomised into a training (n = 14) and a control group (n = 12). After initial recovery from an exacerbation the training group had performed a 10-day walking training in the hospital. This was followed by 18 months of individually defined, supervised training at home that was integrated into the patients' daily activities. The control group had no exercise programme, neither in hospital nor at home. RESULTS: During the 18-month period patients of the training group showed a lower number of hospital admissions (total, n = 3 vs n = 14, p = 0.026; disease-related, n = 3 vs n = 12, p = 0.050) and used less short-acting beta 2-agonists (mean [95% CI], 2.4 [1.4-3.4] vs 5.7 [4.2-7.2] puffs per day; p < 0.001) than the control group. Furthermore, the improvements in 6-min treadmill distance and quality of life (CRQ) achieved in the hospital were fully maintained in the training group, whereas the control group did not show significant improvements at any time but a tendency toward deterioration. CONCLUSIONS: Our data indicate that an individually defined, home-based, long-term walking programme initiated by a short hospital-based training can reduce disease-related medical consumption, in addition to sustained benefits in exercise performance and quality of life.
Adrenergic beta-2 Receptor Agonists↗
Effect of nonnutritive sucking on behavioral state in preterm infants before feeding.
To describe the effect of nonnutritive sucking (NNS) on behavioral state (BSt) in preterm infants before feedings 24 preterm infants were randomly assigned and studied before each of their first 16 bottle feedings. Twelve received NNS by pacifier for 5 minutes; 12 did not receive a pacifier. BSt was measured with a 12-category scale for 30 seconds before the 5-minute period (BSt1) and for 30 seconds after (BSt2). Sleep states decreased for both groups. BSts considered more optimal for feeding increased more during NNS (86 vs. 46). Restless states were three times less frequent after NNS (23 vs. 68). Differences between groups were nonsignificant at BSt1, but were significant at BSt2, p less than .001. In the absence of self-regulatory feeding policies based on early hunger cues, NNS for 5 minutes prefeeding is simple, brief, and suitable for implementation in busy neonatal intensive care units. Nonnutritive sucking was an effective modulator of behavioral state for this sample.
Child Behavior↗