Clinical, sociodemographic, and systems risk factors for attrition at a child guidance clinic were identified. All patients who completed the intake process were followed through various clinic phases. Lower socioeconomic status and low family cohesion predicted dropout. Dropouts and continuers were equally psychiatrically impaired. The Family Environment Scale was the only standardized measure that distinguished between dropouts and continuers.
ABSTRACT. This study examined the morphologic features of the parietal peritoneal membranes of 130 patients undergoing peritoneal dialysis (PD) and compared them with the features of the peritoneal membranes of normal individuals, uremic predialysis patients, and patients undergoing hemodialysis. The median thickness of the submesothelial compact collagenous zone was 50 μm for normal subjects, 140 μm for uremic patients, 150 μm for patients undergoing hemodialysis, and 270 μm for patients undergoing PD (P < 0.001 for all versus normal subjects). Compact zone thickness increased significantly with the duration of PD therapy [0 to 24 mo, 180 μm (n = 58); 25 to 48 mo, 240 μm (n = 24); 49 to 72 mo, 300 μm (n = 13); 73 to 96 mo, 750 μm (n = 16); >97 mo, 700 μm (n = 19)]. Vascular changes included progressive subendothelial hyalinization, with luminal narrowing or obliteration. These changes were absent in samples from normal subjects but were present in 28% of samples from uremic patients and 56% of biopsies from patients undergoing PD. In the PD group, the prevalence of vasculopathy increased significantly with therapy duration (P = 0.0001). The density of blood vessels per unit length of peritoneum was significantly higher for patients with membrane failure and was correlated with the degree of fibrosis (P = 0.01). For the first time, a comprehensive cross-sectional analysis of the morphologic changes in the peritoneal membranes of patients undergoing PD is provided. The infrequency of fibrosis in the absence of vasculopathy suggests that vasculopathy may predispose patients to the development of fibrosis. This study provides a sufficiently large cohort of samples to allow structure-function relationships to be established, as well as providing a repository of tissue for further studies.
End-stage renal disease is a chronic condition which reduces the life-span of its victims. At present there is no cure. Renal transplantation, currently the treatment of choice for many patients, is potentially associated with a number of drawbacks: constant risk of rejection, especially during the first six months, the need to comply with a complex regime of medication capable of producing pronounced side-effects and need for ongoing medical supervision. Despite these problems, little research has been undertake with patients following renal transplantation. The aim of the small-scale, exploratory study reported here was to explore patients' perceptions of stress and quality of life at different stages following a first, functioning renal graft: within six months, between one and five years and over five years later (n = 10 in each group). From the results it became apparent that patients had a number of concerns, of which fear of rejection was the most frequently mentioned, followed by stress generated through altered body image (a product of immunosuppressive therapy). Nevertheless, all reported a significant increase in quality of life after transplantation, although improvement was least marked in patients in the intermediate group (1-5 years after surgery) who also experienced most stress. A larger scale study is recommended to increase the validity of findings which clinicians could then use to design patient interventions to enhance quality of care and quality of life.
Objective: To assess progress in the protection, promotion and support of breastfeeding in Europe. Results: The number of countries with national policies complying with WHO recommendations increased. In 2007, six countries lacked a national policy, three a national plan, four a national breast-feeding coordinator and committee. Little improvement was reported in pre-service training; however, the number of countries with good coverage in the provision of WHO/UNICEF courses for inservice training increased substantially, as reflected in a parallel increase in the number of Baby Friendly Hospitals and the proportion of births taking place in them. Little improvement was reported as far as implementation of the International Code on Marketing of Breastmilk Substitutes is concerned. Except for Ireland and the UK, where some improvement occurred, no changes were reported on maternity protection. Due to lack of standard methods, it was difficult to compare rates of breast-feeding among countries. With this in mind, slight improvements in the rates of initiation, exclusivity and duration were reported by countries where data at two points in time were available. Conclusions: Breast-feeding rates continue to fall short of global recommendations. National policies are improving slowly but are hampered by the lack of action on maternity protection and the International Code. Pre-service training and standard monitoring of breast-feeding rates are the areas where more efforts are needed to accelerate progress.
The perilymphatic spaces of guinea pig cochleae were perfused with artificial perilymph, with and without drug, at a rate of 2.5 microliters/minute for 10 minutes. The compound action potential of the auditory nerve, cochlear microphonics, and the summating potential evoked by 10 kHz tone bursts of varying intensities were recorded from a wire inserted in the basal turn scala vestibuli. The endocochlear potential was recorded from the scala media. Sodium salicylate (1.25 to 10 mmol/L) reduced the magnitude of the compound action potential evoked by low-sound intensities without affecting the compound action potential evoked by high-sound intensities. Sodium salicylate also reduced cochlear microphonics and had no effect on summating potential. Cochlear perfusions of prostaglandin synthesis inhibitors, mefenamate (200 mumol/L), and meclofenamate (200 mumol/L), had no effect on the cochlear potentials. Quinine (10 to 100 mumol/L) reduced the compound action potential input-output function in a parallel fashion rather than selectively affecting the low-intensity compound action potential. Quinine (100 mumol/L) reduced cochlear microphonics and summating potential. Neither quinine (100 mumol/L) nor salicylate (5 mmol/L) affected endocochlear potential. These results suggest that salicylate-induced hearing loss is not caused by either antagonism of the hair cell transmitter or cyclooxygenase inhibition, nor is it caused by the same mechanism that causes quinine-induced hearing loss.
End stage renal disease (ESRD) inevitably reduces the life-span of its victims. The treatment of choice for many patients is transplantation but this does not effect a cure. Its aim is to improve renal function and thus to enhance the patient's ability to enjoy as full a life as possible. However, surprisingly little research has been concerned with quality of life after transplantation. A small-scale, exploratory study employing a qualitative design was undertaken to compare stress and quality of life between five patients with ESRD awaiting transplantation and five patients who had received a graft within the previous 6 months. The desire to undergo transplantation was fuelled by patients' perceived need to 'get off dialysis' and to 'lead a normal life'. All patients had received abundant technical information about renal transplantation and pre-operative preparation but information concerning the negative effects of transplantation, including the side-effects of medication appeared lacking. It was not possible to determine whether this information had not been supplied or had been offered but forgotten or denied. For pre-transplantation patients the main sources of stress were the need to undergo dialysis, awaiting the summons to hospital and the social isolation imposed by having a chronic condition such as constant fatigue. Post-transplantation patients were remarkably free of anxiety considering the impositions placed upon them by frequent clinic attendance to monitor their condition. Quality of life improved dramatically after transplantation despite the persistence of renal symptoms and patients felt privileged to have been offered this treatment option.
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