Steven Rubinstein

PSYCHOLOGICAL FACTORS IN FATAL CHILDHOOD ASTHMA

A review of three recent cases of death due to childhood asthma revealed consistent themes of depression, emotional precipitation of attacks, unsupportive families, and a tendency to deny asthma symptoms. Possible psychosomatic mechanisms are identified as potentially important for the interaction of emotions and asthma.

The Effect of Nutritional Additives on Anti-Infective Factors in Human Milk

It has become a common practice to supplement human milk with a variety of additives to improve the nutritive content of the feeding for the premature infant. Twenty-two freshly frozen human milk samples were measured for lysozyme activity, total IgA, and specific IgA to Escherichia coli serotypes 01, 04, and 06. One mL aliquots were mixed with the following: 1 mL of Similac, Similac Special Care, Enfamil, Enfamil Premature Formula, and sterile water; 33 mL of Poly-Vi-Sol, 33 mg of Moducal, and 38 mg of breast-milk fortifier, and then reanalyzed. Significant decreases (41 % to 74%) in lysozyme activity were seen with the addition of all formulas; breast-milk fortifier reduced activity by 19%, while no differences were seen with Moducal, sterile water, or Poly-Vi-Sol. No differences were seen in total IgA content, but some decreases were seen in specific IgA to E. coli serotypes 04 and 06. E. coli growth was determined after 3 1/2 hours of incubation at 37°C after mixing. All cow-milk formulas enhanced E. coli growth; soy formulas and other additives preserved inhibition of bacterial growth. Nutritional additives can impair anti-infective properties of human milk, and such interplay should be considered in the decision on the feeding regimen of premature infants.

The young Damocles. The adolescent at high risk for serious or fatal status asthmaticus.

The most vulnerable population in the recent increase in morbidity and mortality in asthma is the preteen and teenaged group. This particular group, remarkably resistant to outside input, would seem the most likely audience for programs dealing with asthma self-care. We have postulated 4 problem areas for this group that may be important in patients who have severe or refractory disease. These problems involve physiology, noncompliance with the medical regimen, stress, and depression and suicide. Each problem requires a specific intervention strategy and should be amenable to treatment in a comprehensive management plan.