Liaison and co-operation between paediatrics and mental health

Mental health liaison with paediatrics is vital but often misunderstood. Anxiety about the stigma of a referral to mental health cannot be entirely eradicated. The best antidote to this inevitable tension is to have mental health staff working in the same premises as paediatrics, so that colleagues can get to know and learn from each other. When this is achieved there is a far greater opportunity for enriching the care that children and their families receive in hospitals and clinics, and for promoting liaison more widely. Paediatric liaison is not only for mental health problems.     

Identification of SNPs in the cystic fibrosis interactome influencing pulmonary progression in cystic fibrosis

There is growing evidence that the great phenotypic variability in patients with cystic fibrosis (CF) not only depends on the genotype, but apart from a combination of environmental and stochastic factors predominantly also on modifier gene effects. It has been proposed that genes interacting with CF transmembrane conductance regulator (CFTR) and epithelial sodium channel (ENaC) are potential modifiers. Therefore, we assessed the impact of single-nucleotide polymorphisms (SNPs) of several of these interacters on CF disease outcome. SNPs that potentially alter gene function were genotyped in 95 well-characterized p.Phe508del homozygous CF patients. Linear mixed-effect model analysis was used to assess the relationship between sequence variants and the repeated measurements of lung function parameters. In total, we genotyped 72 SNPs in 10 genes. Twenty-five SNPs were used for statistical analysis, where we found strong associations for one SNP in PPP2R4 with the lung clearance index (P≤0.01), the specific effective airway resistance (P≤0.005) and the forced expiratory volume in 1 s (P≤0.005). In addition, we identified one SNP in SNAP23 to be significantly associated with three lung function parameters as well as one SNP in PPP2R1A and three in KRT19 to show a significant influence on one lung function parameter each. Our findings indicate that direct interacters with CFTR, such as SNAP23, PPP2R4 and PPP2R1A, may modify the residual function of p.Phe508del-CFTR while variants in KRT19 may modulate the amount of p.Phe508del-CFTR at the apical membrane and consequently modify CF disease.     

Diagnostic chorionic biopsies in the first trimester. Report of experiences over a 2 year period

We report about 58 ultrasonographically guided transcervical chorionic villus biopsies from January 1985 to November 1987. Maternal age greater than 35 years (n = 28), followed by trisomy 21 or 18 (n = 10) were the mean indications. Biochemically evaluation of storage diseases (n = 6) and genomically DNA-analysis because of phenylketonuria (n = 2) were combined in each case with cytogenetic diagnosis. In the other cases certain indications were the reasons for biopsy. In 52 of 58 cases we were successful in biopsies and diagnoses. In the other 6 biopsy specimen we didn't found chorionic villi. 3 abortions we observed up to day 3 after operation (n = 3) and after 6 weeks (n = 1). Pathological findings were 1 trisomy 16, 1,47,XYY-karyotype and 1 embryo with phenylketonuria. Another reason for termination of pregnancy was male karyotype in a Morbus Duchenne-risk and 1 risk for Rett-syndrome. Meanwhile 30 healthy babies were born.     

Growth curves and adult height estimation for adolescents

Using data from the large number of adolescents studied in cycle III of the National Health Examination Survey, we utilized a sexual maturity index to develop a set of growth curves that reduce the distortion caused by commingling height data from adolescents maturing at different rates. We also created a set of correction tables to be used with these curves to permit the calculation of an adjusted height percentile that compensates for the effects of the differing rates of pubertal maturation. These adjusted height percentiles should remain more constant throughout puberty than height percentiles obtained from traditional growth curves; they may thus be used to estimate final adult height with only data obtained during routine physical examinations, by assuming that subjects maintain their adjusted height percentile through adolescence to adulthood. Height predictions made in this manner compare favorably with predictions made using two clinically tested algorithms.     

Mothering begets mothering: the transmission of behavior and its neurobiology across generations

Early experiences exert their effects on adult parental behavior in part by altering the development of neurobiological mechanisms that initiate or support the initiation and sustenance of adult parental behavior. The effects of parental behavior on sensory, perceptual and emotional mechanisms in offspring constitute an experientially based mechanism by which neurobiological factors regulating behavior can be transferred from generation to generation somewhat independently of genetic endowment.     

The roles of behavioral health professionals in class action litigation

Class action suits frequently have been used as a strategy for improving the quality of mental health care. Psychiatrists, psychologists, and professionals from related disciplines have been involved in these suits in different roles. This article presents and discusses case examples of these roles, which include the expert witness, court-appointed expert, consulting expert, monitor, special master, receiver, advocate, amicus curiae, plaintiff, and defendant. The authors caution against assuming dual roles and argue that professionals, before beginning to participate in this complex arena, should clarify their functional responsibilities, the legal basis of their involvement, and the ethics principles that will guide their actions.     

Creatine supplementation improves muscular performance in older men

PURPOSE: Creatine supplementation has been shown to enhance muscle strength and power after only 5-7 d in young adults. Creatine supplementation could therefore benefit older individuals because aging is associated with a decrease in muscle strength and explosive power. METHODS: We examined the effects of 7 d of creatine supplementation in normally active older men (59-72 yr) by using a double-blind, placebo-controlled design with repeated measures. After a 3-wk familiarization period to minimize learning effects, a battery of tests was completed on three occasions separated by 7 d (T1, T2, and T3). After T1, subjects were matched and randomly assigned into creatine (N = 10) and placebo (N = 8) groups. After T2, subjects consumed supplements (0.3 g x kg(-1) x d(-1)) for 7 d until T3. All subjects were tested for maximal dynamic strength (one-repetition maximum leg press and bench press), maximal isometric strength (knee extension/flexion), upper- and lower-body explosive power (6 x 10-s sprints on a cycle ergometer), and lower-extremity functional ability (timed sit-stand test and tandem gait test). Body composition was assessed via hydrostatic weighing, and blood samples were obtained to assess renal and hepatic responses and muscle creatine concentrations. RESULTS: No significant increases in any performance measures were observed from T1 to T2 with the exception of isometric right-knee flexion in the placebo group indicating stability in the testing protocols. Significant group-by -time interactions indicated the responses from T2 to T3 were significantly greater (P 相似文献