Evidence-based Intervention with Women Pregnant after Perinatal Loss

Purpose: To test the feasibility and acceptability of a caring-based nurse home visit intervention for women pregnant after perinatal loss (PAL), the goal of which was to provide a safe, supportive environment, normalize the pregnancy after loss, reduce anxiety and depression through stress reduction skills, and facilitate prenatal attachment. Study Design and Methods: This mixed methods study was conducted in two phases: Phase I, to determine the components of the intervention, and Phase II, a randomized trial that used the revised intervention components. Pregnant women with a history of at least one perinatal loss (9 in Phase I and 24 in Phase II) were recruited from obstetrical practices. Phase II sample size was adequate to detect group differences. Background measures of demographics, obstetrical history, and meaning of past losses were collected at baseline. Measured at three points across pregnancy were threat appraisal of pregnancy; and emotional states: anxiety (pregnancy, state, trait), depression, self mastery, prenatal attachment, and satisfaction with social support. The caring-based nurse home visit intervention included activities aimed to reduce anxiety and promote prenatal attachment. The control group were sent pregnancy information booklets that coincided with their gestational age. Qualitative and quantitative evaluations were obtained. Results: In Phase I, 8 women received the intervention; in Phase II, 13 received the intervention and 11 were in the control group. No baseline between-group differences were found. The intervention group had significantly higher satisfaction with social support over time. Women's evaluations were very positive; home visits were rated most liked and helpful. They appreciated a knowledgeable nurse who knew their story, listened, normalized the PAL experience, and was there with nonjudgmental support. Clinical Implications: The intervention is both feasible and acceptable. Most women felt that they could reduce their own anxiety using the tools and skills they were provided. Healthcare providers should consider past history's impact on current pregnancy experiences and incorporate process and content of the intervention into their practice

Autoreactive T Cells in Human Smokers is Predictive of Clinical Outcome

Cross-sectional studies have suggested a role for activation of adaptive immunity in smokers with emphysema, but the clinical application of these findings has not been explored. Here we examined the utility of detecting autoreactive T cells as a screening tool for emphysema in an at-risk population of smokers. We followed 156 former and current (ever)-smokers for 2 years to assess whether peripheral blood CD4 T cell cytokine responses to lung elastin fragments (EFs) could discriminate between those with and without emphysema, and to evaluate the relevance of autoreactive T cells to predict changes during follow-up in lung physiological parameters. Volunteers underwent baseline complete phenotypic assessment with pulmonary function tests, quantitative chest CT, yearly 6-min walk distance (6MWD) testing, and annual measurement of CD4 T cell cytokine responses to EFs. The areas under the receiver operating characteristic curve to predict emphysema for interferon gamma (IFN-γ), and interleukin 6 (IL-6) responses to EFs were 0.81 (95% CI of 0.74–0.88) and 0.79 (95% CI of 0.72–0.86) respectively. We developed a dual cytokine enzyme-linked immunocell spot assay, the γ-6 Spot, using CD4 T cell IFN-γ and IL-6 responses and found that it discriminated emphysema with 90% sensitivity. After adjusting for potential confounders, the presence of autoreactive T cells was predictive of a decrease in 6MWD over 2 years (decline in 6MWD, −19 m per fold change in IFN-γ; P = 0.026, and −26 m per fold change in IL-6; P = 0.003). In support of the human association studies, we cloned CD4 T cells with characteristic T helper (Th)1 and Th17 responses to EFs in the peripheral blood of ever-smokers with emphysema, confirming antigenicity of lung elastin in this population. These findings collectively suggest that the EF-specific autoreactive CD4 T cell assay, γ-6 Spot, could provide a non-invasive diagnostic tool with potential application to large-scale screening to discriminate emphysema in ever-smokers, and predict early relevant physiological outcomes in those at risk

Increasing incidence of skin disorders in children? A comparison between 1987 and 2001

BACKGROUND: The increasing proportion of skin diseases encountered in general practice represents a substantial part of morbidity in children. Only limited information is available about the frequency of specific skin diseases. We aimed to compare incidence rates of skin diseases in children in general practice between 1987 and 2001. METHODS: We used data on all children aged 0–17 years derived from two consecutive surveys performed in Dutch general practice in 1987 and 2001. Both surveys concerned a longitudinal registration of GP consultations over 12 months. Each disease episode was coded according to the International Classification of Primary Care. Incidence rates of separate skin diseases were calculated by dividing all new episodes for each distinct ICPC code by the average study population at risk. Data were stratified for socio-demographic characteristics. RESULTS: The incidence rate of all skin diseases combined in general practice decreased between 1987 and 2001. Among infants the incidence rate increased. Girls presented more skin diseases to the GP. In the southern part of the Netherlands children consulted their GP more often for skin diseases compared to the northern part. Children of non-Western immigrants presented relatively more skin diseases to the GP. In general practice incidence rates of specific skin diseases such as impetigo, dermatophytosis and atopic dermatitis increased in 2001, whereas warts, contact dermatitis and skin injuries decreased. CONCLUSION: The overall incidence rate of all skin diseases combined in general practice decreased whereas the incidence rates of bacterial, mycotic and atopic skin diseases increased

Outbreak of Tinea capitis by Trichophyton tonsurans and Microsporum canis in Niterói, RJ, Brazil

18 girls from an orphanage (Orfanato Santo Antônio) in Niterói presented tinea capitis due to Trichophyton tonsurans (15 cases - 83.3%) and Microsporum canis (3 cases - 26.7%). Comments are made about clinical, mycological and therapeutic aspects of this microepidem

Failure to Thrive (Child)

Childhood failure to thrive (FTT) or weight faltering are terms used to define inadequate growth or the inability to sustain growth, usually related to inadequate nutrition (Cole & Lanham, 2011; Shields, Wacogne, & Wright, 2012). Currently there is no generally accepted definition of FTT. The common factor is poor growth and weight gain, which led to the recent use of the term weight faltering. The diagnosis of FTT requires a detailed history, as well as a psychosocial and environmental assessment, and a thorough physical examination. The anthropometric measures for diagnosing FTT are normally used by mapping a child\u27s growth on a standardized growth chart over more than one physician visit (Olsen et al., 2007). To identify children in jeopardy of developing FTT, it is recommended that more than one anthropometric standard be used, such as body mass index for age less than the fifth percentile, length for age less than the fifth percentile, and weight deceleration crossing two major percentile lines (deOnis, Garza, Onyango, & Borghi, 2007; “Failure to Thrive,” 2003; Olsen et al., 2007)

Kawasaki Disease With an Exanthem Limited to the Diaper Area

This department of AJDC is reserved for comment, criticism, observation, and discussion of "issues of current concern and importance for children's health." The Editor encourages our readers to express themselves on a variety of topics and issues. Further, we encourage the submission of unique and brief clinical and scientific observations that do not fulfill the criteria for original articles.Sir.—The occurrence of a rash, usually described as truncal, is one of the major criteria for the diagnosis of Kawasaki disease.1 The exanthem may appear morbilliform or scarlatiniform or may be composed of erythematous plaques or papules, thereby simulating urticaria or erythema multiforme.1,2 Less frequently, vesicles, pustules, or petechiae may be observed.1 Recently, three groups of investigators have described patients with Kawasaki disease in whom the exanthem either began or was most prominent in the diaper area.2-4 We report a 21-month-old child with Kawasaki disease whos