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AIM: Recent studies suggested a role for IL31 in the pathogenesis of pruritus and disease severity in patients with cutaneous T cell lymphomas (CTCL). However, discrepant results were reported for IL31 serum levels, transcriptional expression levels or immunohistochemistry studies and its relation to pruritus intensity and/or disease severity in CTCL. Most studies did not distinguish between different CTCL variants. We investigated IL31 serum levels in different subtypes of CTCL, including Mycosis Fungoides (MF) (typically not pruritic), Folliculotropic Mycosis Fungoides (FMF) and Sézary syndrome (SS) (both often pruritic). METHODS: From 54 CTCL patients (17 SS, 21 FMF and 16 classic MF) serum samples were analyzed with a high sensitivity V-PLEX immunoassay for IL31. The study group included 35/54 (65%) patients with complaints of pruritus. Thirty-five patients had advanced stage disease (≥stage IIB). A visual analog scale score (VAS score) for pruritus was available in 29 CTCL patients (7 SS, 9 FMF and 13 classic MF) and in other cases complaints of pruritus were retrieved from medical records. qPCR analyses for IL31 expression were performed in lesional skin biopsies from 8 CTCL patients. Serum samples from 4 healthy individuals without pruritus and from 5 atopic dermatitis (AD) patients with severe pruritus were included as controls. RESULTS: In 11/54 (20%) of CTCL patients low serum levels of IL31 were detected (mean 0.48 pg/mL, range 0.20-1.39 pg/mL) including 6/17 (35%) SS patients (mean 0.57 pg/mL) and 5/21 (24%) FMF patients (mean 0.33 pg/mL). All 11 patients with detectable levels of IL31 reported complaints of moderate to severe pruritus and 9/11 patients presented with advanced stage disease (≥IIB). qPCR analyses resulted in lowly expressed IL31 expression levels in 4 of 8 patients; these patients all suffered from pruritus and advanced stage disease. CONCLUSIONS: Translational and transcriptional expression levels of IL31 were very low or undetectable in CTCL patients. Detectable low IL31 serum levels were exclusively observed in SS and FMF patients and not in patients with classic MF. However, these marginal IL31 levels in a small proportion of CTCL patients do not support an essential role for IL31 in CTCL patients.

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BACKGROUND: Information on TB drug resistance profiles and its' associated risk factors are scarce in Nigeria despite the large burden of disease in the country. The study was designed to report drug resistance profiles of new- and previously treated patients with pulmonary tuberculosis (TB) in Ibadan, Nigeria. METHOD: Sputum from consenting pulmonary TB patients were collected and cultured for Mycobacterium tuberculosis (Mtb) at the TB laboratory of the University College Hospital, Ibadan, Nigeria using standard method. Mtb were stored and sent for drug susceptibility testing against first and second-line anti-TB drugs at the MRC Unit, The Gambia and at the Institute of Tropical Medicine, Antwerp, Belgium using BACTEC MGIT 960 and proportion method on solid medium respectively. RESULTS: Of 238 Mtb collected, 124 (52.1%) were viable, 102 (59.65%) non-viable while 12 (7.02%) were contaminated. About half (58.87%) of the Mtb were from previously treated patients, 40 (32.26%) were from new patients while treatment history of 1.1 (8.87%) were unknown. Forty-seven (37.90%) of the 124 Mtb. tested were multidrug resistant (MDR) out of which, 40 (85.10%) were from previously treated patients.. HIV prevalence was 8.69%. Of the 17 MDR-TB from previously treated cases tested for second-line drugs, four (23.53%) were resistant to fluoroquinolones or injectable agents, 13 (76.47%) were susceptible while none was resistant to both of these classes of drugs. CONCLUSION: MDR-TB in Ibadan already demonstrates resistance to second line anti-TB drugs hence management of MDR-TB patients should be strengthened to prevent emergence of extensively drug-resistant TB (XDR-TB).

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This study examined the effectiveness of Baby Think It Over (BTIO; Jurmaine, 1994), an infant simulation program that seeks to modify attitudes toward teen pregnancy and teen parenting. As in the study by Saltz, Perry, and Cabral (1994), the premise was that teens engage in unprotected sex because of a personal fable concerning pregnancy: "It can't happen to me." It was expected that participation in BTIO, a form of role-play, would encourage teens to acknowledge their own personal vulnerability to an unplanned pregnancy, and provide them with some insight into the experience of adolescent parenting. One hundred fourteen eleventh-grade students participated. After two to three days' experience with BTIO, teens in the intervention group were more likely to accurately assess their personal risk for an unplanned pregnancy than were teens in the comparison group. Qualitative analyses revealed that teens in the intervention group were significantly more likely to produce concrete examples of activities and consequences related to child-rearing than were teens in the comparison group. Findings of this study are discussed from the perspective of the health belief model (Rosenstock, 1974), and suggestions for further research with BTIO are made.

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OBJECTIVE: To gain insight into the attitude and experiences of parents concerning the death of children in a paediatric surgical intensive care unit of a University Children's hospital. DESIGN: Retrospective evaluation of records from 1988-1992, supplemented with semistructured interviews in the second half of 1992. SETTING: Sophia Children's Hospital-University Hospital Rotterdam. PATIENTS AND METHODS: The evaluation concerned 104 children. In 36 children death was a direct consequence of their illness, 11 died unexpectedly after an unsuccessful attempt at resuscitation, and in the remaining 57 treatment had not been initiated or had been withdrawn. Six months after the death of their child, twenty couples of parents of 20 children were asked after their experiences before, during, and after this death; in addition they were asked whether they would appreciate a longer contact with the hospital. RESULTS: Most parents chose to be present at the moment of dying. The parents generally highly appreciated the talks about the decision-making process and about coming to terms with the loss of their child, both with doctors and nurses. Most also appreciated a talk at some later time. CONCLUSION: The results from this study indicate that structured guidance of parents concerning their child's death in the form of a counselling programme, is advisable.

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General practitioners often have difficulty in dealing with dissatisfied patients. One underlying reason could be the disturbed relationship between the doctor and the dissatisfied patient. A training course has been developed taking the relationship as a starting-point. Based on Watzlawick et al.'s theory on communication GPs have been trained to react to a dissatisfied patient on a relational level ('Are you dissatisfied with my treatment?') rather than on a contents level ('How long have you been suffering from this?'). This method seeks to improve the relationship and the satisfaction of both doctor and patient. Three types of initial reaction to dissatisfied patients were offered to four groups of GPs (19 trainees in general practice and 19 trainers in general practice). Pre- and post-measurement were executed by means of registering the initial reactions on videorecorded vignettes of re-enacted dissatisfied patients. Subsequently the reactions were categorized blind by two judges. The 12 possible categories can be subdivided into categories primarily aimed at the contents or primarily aimed at the relationship. The results show that, as compared to the pre-measurements, GPs more frequently use empathic reactions and reactions in which they bring their own actions up for discussion. The number of responses in which doctors ask a further clinical question or in which GPs expect a solution whether from themselves or from others, decrease. It is concluded that the course appears to change for the better the GPs' initial reaction to dissatisfied patients.

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Quality of Life (QL) is hard to assess and seldom measured in patients having carcinomas with an unfavourable prognosis. Oesophageal cancer is one of the malignancies with a low 5-year survival rate. Dysphagia (problems in swallowing food) is considered to be the most important indicator of QL in patients with oesophageal carcinoma. Moreover, the psycho-social aspects and subjective QL in cancer have recently gained importance. The present study investigated QL in a 132 patients with oesophageal cancer. Eighty-three of them had a surgical operation (removal of part of the oesophagus and part of the stomach, followed by a reconstruction of the digestive tract). Sixty-seven patients filled in questionnaires before and after the operation. Complete sets of data were obtained from 62 patients. Time interval between operation and postoperative assessment varied from 3 to 7 months. Indicators of QL were: Psychological Distress, Physical Symptoms, Global Evaluations, Activity Level, Swallowing Problems and Food Intake. Swallowing Problems showed moderate correlations with the other QL indicators. Physical Symptoms increased, whereas the Activity Level, Psychological Distress, and Swallowing Problems decreased; Global Evaluations remained unaltered.

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Carrying out the intention to breast-feed was assessed in 185 mothers divided into four groups according to whether labour was spontaneous, with or without oxytocin augmentation, or induced, either by their own choice or on the advice of their obstetrician. Intention to breast-feed was abandoned most frequently by women in whom labour had been electively induced. As the difference with the other groups could not be explained by obstetric factors, it is concluded that motivational factors may have played a part.

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The cellular intermediate EAC14 was successfully prepared by incubating optimally sensitized sheep erythrocytes (EA) with normal serum diluted in complement diluent buffer containing suitable amounts of inhibitors of EAC142 formation from EAC14 and C2, namely polymyxin E and polymyxin B. EAC14 cells could also be prepared by incubating EA with normal serum diluted in Mg2+ free complement diluent buffer in the presence or absence of sucrose. The cellular intermediates prepared by these methods exhibited characteristic EAC142 formation and decay profiles and were found to be suitable for C2 estimations.

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Sensitized erythrocytes carrying the first and fourth components of complement (EAC14) were prepared by incubating optimally sensitized sheep erythrocytes with normal serum appropriately diluted in Mg2+-free diethylbarbiturate buffer containing Ca2+. EAC14 cells so prepared were found to be suitable for use in estimating the second component of complement (C2) in human serum, and the method is described here.

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Personal characteristics of healthy term pregnant women who chose elective induction or spontaneous onset of labour and the motives for their choice were assessed. Almost 50% of 237 women with uncomplicated pregnancies opted for elective induction when offered the opportunity. These women appeared to have had more complaints during their pregnancy and menstrual periods, more complications in their obstetrical history and to be more anxious about their labour than women who chose a spontaneous onset of labour. Predominant motives were a feeling of safety and the desire to shorten the duration of pregnancy. These characteristics and motives seem to reflect a lack of trust in physical reproductive functions. It is concluded that in evaluating effects of elective induction of labour, pre-existing differences between women who choose elective induction and women who opt for a spontaneous onset must be taken into account.

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Elective induction of labor is still a controversial obstetric procedure. The safety of the procedure and the possibility to program labor during daytime is an often heard argument in favor of it. Also the possibility to prevent term intrauterine fetal death of unknown cause and the possibility to apply fetal monitoring from the beginning of labor are put forward as arguments in favor of elective induction of labor. Feelings of unnaturalness and the dangers of prematurely induced delivery are the most often heard arguments against it. We performed a prospective study to determine the differences between elective induction of labor and spontaneous labor. During 17 consecutive months a group of 184 elective inductions was studied in the Department of Obstetrics, University Hospital - Dijkzigt, Rotterdam. Only healthy women with an uncomplicated pregnancy were included in the study group and all women were allowed a free choice of elective induction or spontaneous labor. The reference group was composed by a system of "matched controls". For induction of labor a standard technique including artificial rupture of the membranes and constant intrauterine fetal monitoring was used. Oxytocin was administered intravenously in an incremental dose. After delivery the acid-base status of the newborns was determined, and part of the newborns were subjected to a neurological screening according to Prechtl. The developments of the infants was followed during one year using a "psychomotor development scheme 0-15 months".(ABSTRACT TRUNCATED AT 250 WORDS)

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Several authors have stated that induction of labor may have deleterious psychological effects on women's experiences of labor and early mother-infant interaction. Research on this subject is scarce and in most cases no distinction is made between elective induction and induction for medical reasons. For that reason the observed effects may also have been caused by the medical complications that led to the induction. Differences in experience of labor may also be in part explained by differences in personal characteristics between women choosing or rejecting induction of labor. Influences of induction of labor can only be reliably assessed in prospective studies. In the present study of 271 women with an uncomplicated pregnancy, data regarding their experiences of pregnancy and their expectations of labor and motherhood were collected before labor. In 72 women labor was electively induced, and 199 women had a spontaneous onset of labor. Of 33 women, 19 with spontaneous labor and 14 with elective induction, the first contact with their newborn was observed. All women who could be contacted were interviewed about their experience of labor and the first contact with their infant. Six months after delivery the mothers were questioned about the state of health of mother and infant and about nursing the infant. Mothers with induced labor were rated as being generally less emotionally involved in the first contact with their newborn than mothers with spontaneous labor, but the differences were not significant (Fig. 1). The duration of spontaneous labor was longer, but the subjective time experience did not differ between groups. Women with spontaneous labor were more tired during labor.(ABSTRACT TRUNCATED AT 250 WORDS)

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In this article a training programme is described for improving interviewing skills of students in the fifth year (junior clerkship) of the medical curriculum. Two interviews with a 'simulated mother' form the core of the programme. The interviews are immediately followed by a feedback session in which the simulated mother discusses the strong and the weak points of the interview. In the feedback she makes use of a checklist with relevant points concerning the content and the process of the interview. Where required the comments are substantiated with fragments of the videotaped interview. In a 2-hour theoretical session, students are told how to prepare themselves for the interview. The learning effects of the training programme using simulated mothers were evaluated in order to determine: (1) the subsequent improvement in interviewing skills; and (2) the effect of the feedback session. It was found that students' interviewing skills improved significantly on the content and the process aspects after one or two interviews. In addition the feedback sessions proved very helpful, although no significant differences were revealed, when comparing the mean group scores for students who had had feedback sessions with the scores for those who had not. The results also revealed that two interviews were insufficient and that the training should include at least three interviews. This was borne out by the large number of students who asked for more interviews with simulated mothers. In the training programme the simulated mothers perform two functions: (1) playing the role of the mother of a sick child; and (2) giving feedback to students regarding their interviewing skills.(ABSTRACT TRUNCATED AT 250 WORDS)

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