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The purpose of this study was to demonstrate that a simple submaximal "step-test" could be used as an exercise challenge to identify elementary school students with suspected but undiagnosed asthma. This article also describes a protocol for exercise testing that can be used in epidemiological evaluations. School age children grades 1-4 with suspected but undiagnosed asthma were identified by a 12-item questionnaire completed by a parent or guardian. Only students identified with suspected asthma by questionnaire were exercise challenged on a step-test it baseline spirometry was normal and there was no contraindication for intense aerobic activity. Possible asthma was defined as a 15% or greater decrease in FEV1 or a 25% or greater decrease in FEF25-75 from baseline at either 3 or 10 minutes. The exercise protocol included spirometry before and after stepping continuously for 5 minutes at an exercise intensity sufficient to maintain a heart rate between 150 and 200 beats per minute. Heart rate was continuously monitored throughout the exercise period. Testing was completed at school. No complications occurred during the exercise testing. Exercise testing was completed on 548 students with suspected undiagnosed asthma. Thirty students (6%) had exercise test changes in pulmonary function that met established criteria for suspecting asthma. A board-certified pediatric allergist/immunologist or private physician examined 26 of the 30 students with positive exercise testing. Asthma was diagnosed in 23 (88.89%) of these students. All students with impaired pulmonary function after exercise were able to return to class after a short period of observation. In conclusion, a simple, reproducible school-based exercise protocol can be used to identify students with suspected undiagnosed asthma.

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This study examined the sources of parenting stress among mothers from Israel, Japan, Jordan, and the United States who had a young child with a chronic illness. The results indicated mothers from all four countries experienced high levels of child-focused and parent-focused stress that indicated a need for nursing intervention.

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The purpose of this study was to examine mothers' perceptions of discrimination experienced by chronically ill school-age children. Discrimination was seen to originate within the school system, peer group, and community and governing institutions. Several demographic and child factors were found to significantly predict mothers' perceptions of discrimination. Nursing implications addressing discrimination for chronically ill children and families are addressed.

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Insulin administered in eyedrop from with a surfactant agent has been shown to be clinically effective in treating diabetes in animal models. Concentrations of insulin as high as 100 U/ml in saline were shown to produce no detectable clinical toxicity to human eyes in single-dose administration. We sought to investigate the local toxicity of insulin in human eyes during long-term, multidose administration. A prospective, randomized, placebo controlled, double-masked study was conducted involving eight healthy volunteers. Subjects were given 50 microliters sterile saline containing 100 U/ml crystalline porcine insulin randomized to one eye and 50 microliters placebo (sterile saline) to the fellow eye administered twice daily for 8 weeks. Subjective ocular irritation and visual acuity and objective assessment of the eyelids, conjunctiva, cornea, anterior chamber, crystalline lens, pupil size, and intraocular pressure were evaluated. Blood D-glucose levels were monitored to assess glycemic levels. There was no statistically significant difference (p > 0.05) observed between insulin-treated and placebo-treated eyes. Eyedrops containing insulin were subjectively as comfortable and objectively as clinically innocuous as sterile saline alone. The results of this study demonstrate that insulin (100 U/ml) in saline is nontoxic to the human eye after long-term, multi-dose exposure. Topical administration of insulin combined with an absorption-promoting agent may be a practical and feasible alternative to multiple daily subcutaneous injections or implanted pump devices currently used in the long-term treatment of diabetes mellitus if a nonirritating absorption-promoting agent can be identified.(ABSTRACT TRUNCATED AT 250 WORDS)

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Animal studies have shown that insulin eyedrops containing an absorption-enhancing agent can have a significant effect on blood glucose levels. When formulated as a topical solution, insulin might potentially be used to treat or augment the treatment of diabetes mellitus in humans. We sought to investigate the feasibility of using insulin eyedrops in humans by studying the local toxicity and efficacy of insulin administered without surfactant to the eyes of healthy volunteers. A prospective, randomized, placebo-controlled, single-masked study was conducted in which 8 subjects were given 50 microliters of sterile normal saline containing varying insulin concentrations randomized to one eye, and 50 microliters of placebo (sterile normal saline) to the fellow eye. Subjective ocular irritation was evaluated, and the eyelids, conjunctiva, cornea, and anterior chamber were examined objectively with slit lamp biomicroscopy. Subjects were evaluated for 2 hours following administration of a single dose of insulin. There was no statistically significant difference (P > 0.05) in toxicity observed by any parameter evaluated between eyes receiving insulin and placebo. No systemic absorption of insulin was observed; blood glucose levels and serum immunoreactive insulin levels were unchanged. The results of this study suggest that single-dose insulin in concentrations up to 100 U/ml formulated in saline has no detectable clinical toxicity to the anterior structures of the human eye.

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The self-care (or latchkey) arrangement for children with a chronic illness is an important topic for pediatric nurses. This article reviews the impact of self-care for children's development, examines the effectiveness of teaching self-care skills to latchkey children, and provides assessment and intervention information to help pediatric nurses who are working with parents and children with chronic illness who are in self-care.

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Environment plays a critical role in supporting families, but the influence of the environment on families with a chronically ill child has remained relatively unexplored. This paper presents a study that examined the role of the environment in families with a chronically ill child. This study, using a secondary analysis of two existing data bases (Holaday & Turner-Henson, 1991; U.S. Bureau of the Census, 1980), examined the influence of selected environmental factors on mothers' perceptions of the environment as supportive, resourceful, safe, and accessible. A presentation of the study findings, as well as implications for nursing practice, is presented.

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The sampling of general populations of individuals or households for survey research is well described. However, much of the focus of pediatric nursing research is on special or rare populations. This article presents techniques that may be used to locate rare populations for pediatric nursing research. Additionally, development and analysis of one technique used to locate a sample frame for a survey of time use of chronically ill school-age children is discussed.

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School-age children may have low levels of response stability on many questions asked in survey research. This article incorporates evidence from a three-wave panel study into a discussion of some possible causes of low stability. In general, children's responses to questions of fact were more stable than responses to questions of opinion. The findings suggest that when questionnaires are carefully developed, school-age children are reliable respondents.

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The concept of normalization is examined in relation to chronically ill children. From this conceptual base, the responses of 365 parents in a survey of chronically ill children's use of time out of school, were analyzed to determine the normalization strategies used pertaining to the life of the child and family. This article discusses the appropriateness and importance of normalization, and presents implications for the professional nurse working with families of chronically ill children.

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