The Relationship between maternal education and mental retardation in 10-year-old children

We conducted a case-control study of mental retardation (MR) in which case children (aged 10 years) were identified from existing records at multiple sources, primarily the public school systems. Control children were drawn from a roster of public school students not receiving special education services. We found that maternal educational level at the time of delivery was strongly and inversely related to a form of MR not accompanied by other serious neurologic conditions. For this isolated form of MR, maternal educational level was by far the most important predictor from among seven sociodemographic variables examined. There was a significant race-education interaction that indicated a steeper gradient in risk among white mothers than among black mothers. Relative to children of white mothers with 12 years of education, all children of black mothers, except those whose mothers had 16 or more years of education, were at increased risk. The results may be useful as a guide for selecting high-risk groups as candidates for early childhood intervention programs.     

Psychiatric disorders in adopted children: a profile from the Ontario Child Health Study.

Studies of clinical populations suggest that adopted children are overrepresented among children using mental health facilities, whereas studies using non clinical populations of adopted children have reached mixed conclusions about whether or not there is an increased psychological risk associated with adoption. Data from the Ontario Child Health Study, a community survey of children aged four to 16 years, which included a subpopulation of adopted children, were used to: 1. profile the characteristics of adoptive families; 2. examine the strength of adoptive status as a marker for psychiatric and educational morbidity; and 3. determine the extent to which adoptive status has an independent relationship with psychiatric and educational morbidities. The findings were: 1. adoptive mothers were significantly older than non adoptive mothers, but otherwise adoptive families did not differ significantly from non adoptive families, 2. adoption in boys, but not in girls, was a significant marker for psychiatric disorder and poor school performance; adoption in adolescent girls was a significant marker for substance use; and 3. multivariate analyses demonstrated no independent effect of adoption on psychiatric disorder or poor school performance; for adolescents, adoptive status did have an independent relationship with substance use for girls. The implications of these findings will be discussed.     

Ontario Child Health Study follow-up: evaluation of sample loss

This article presents an analysis of sample loss in a 4-year follow-up of children aged 4 to 12 who participated in the Ontario Child Health Study in 1983. Of the 1,617 children participating in the original Ontario Child Health Study, 1,172 (72.5%) were located and enlisted at follow-up in 1987. Based on wave-one assessments, nonparticipants at follow-up tended to have higher levels of psychopathology and family risk variables. Respondents were matched with nonparticipants and differentially weighted to compensate for selective loss. In comparing estimates based on actual (observed) and weighted responses in the follow-up sample, it was found that the effects of sample loss depended on the analytical focus. Evaluations of outcome of disorder and risk for disorder were not affected by sample loss. Evaluation of variables that predict persistence of disorder (prognosis) was affected by a bias toward the null.     

Region-specific constitutive gene expression in the adult porcine meniscus.

The knee meniscus exhibits extensive spatial variations in native healing capacity, biochemical composition, and cell morphology that suggest the existence of distinct phenotypes for meniscus cells. Constitutive gene expression levels of appropriate extracellular matrix proteins may serve as useful molecular markers of cellular phenotypes; however, relatively little is known of variations in the gene expression for meniscus cells of different regions of the tissue. The objective of the present study was to evaluate constitutive differences between radial inner and outer regions in gene expression for extracellular matrix proteins relevant to the meniscus. A secondary objective was to determine if these region-specific differences in gene expression are maintained after periods of monolayer culture. The innermost regions of the meniscus were found to constitutively express higher mRNA levels for proteins highly expressed in articular cartilage, including aggrecan, type II collagen, and NOS2. In contrast, the outer meniscus was found to contain higher gene expression for proteins associated with fibrous tissues including type I collagen, and the proteases MMP2 and MMP3. Isolated inner and outer meniscus cells maintained these region-specific gene expression patterns for collagens and proteoglycans during short-term monolayer culture. The results provide new information that suggests the utility of constitutive gene expression levels as molecular markers to distinguish tissue and cells of the inner and outer meniscus.     

Acute marijuana effects on human risk taking.

Previous studies have established a relationship between marijuana use and risky behavior in natural settings. A limited number of laboratory investigations of marijuana effects on human risk taking have been conducted. The present study was designed to examine the acute effects of smoked marijuana on human risk taking, and to identify behavioral mechanisms that may be involved in drug-induced changes in the probability of risky behavior. Using a laboratory measure of risk taking designed to address acute drug effects, 10 adults were administered placebo cigarettes and three doses of active marijuana cigarettes (half placebo and half 1.77%; 1.77%; and 3.58% Delta9-THC) in a within-subject repeated-measures experimental design. The risk-taking task presented subjects with a choice between two response options operationally defined as risky and nonrisky. Data analyses examined cardiovascular and subjective effects, response rates, distribution of choices between the risky and nonrisky option, and first-order transition probabilities of trial-by-trial data. The 3.58% THC dose increased selection of the risky response option, and uniquely shifted response probabilities following both winning and losing outcomes following selection of the risky option. Acute marijuana administration thereby produced measurable changes in risky decision making under laboratory conditions. Consistent with previous risk-taking studies, shifts in trial-by-trial response probabilities at the highest dose suggested a change in sensitivity to both reinforced and losing risky outcomes. Altered sensitivity to consequences may be a mechanism in drug-induced changes in risk taking. Possible neurobiological sites of action related to THC are discussed.     

Inappropriate Vancomycin Prescribing Based on Criteria from the Centers for Disease Control and Prevention

Increasing reports of vancomycin resistance have raised concerns about the future effectiveness of this drug in treatment of critically ill patients with gram-positive infections. Due to these concerns the Centers for Disease Control and Prevention (CDC) recently published criteria that delineate the prudent use of vancomycin. Using these criteria, we attempted to determine the appropriateness of vancomycin prescribing patterns at our institution. A retrospective chart review was performed for 135 hospitalized patients treated between May 1993 and April 1994. Inappropriate empiric vancomycin use was documented in 81 (60%) of these patients. When culture results were available, 28 (21%) patients inappropriately received the drug. Results of this study are similar to those of other studies of vancomycin use in hospitals based on non-CDC criteria. If CDC criteria are to have a positive impact on physicians' vancomycin prescribing patterns, significant educational efforts will be required.     

An Integrated Psychotherapy Approach to the Management of Self-Destructive Behavior in Eating Disorder Patients with Borderline Personality Disorder

The management of self-destructive behavior in eating disorder patients with borderline personality is a genuine therapeutic challenge. We present an integrated psychotherapy appproach that we utilize in the context of an extended therapeutic milieu. This treatment model enables coordinated intervention to occur in three different arenas: individual psychotherapy, group psychotherapy, and consultation intervention. The paper closes with a discussion of the limitations of this approach.     

Randomized clinical trial of tacrolimus- vs cyclosporine-based immunosuppression in pediatric heart transplantation: preliminary results at 15-month follow-up.

BACKGROUND: While Tacrolimus (Tac) and Cyclosporine (Cya) immunosuppression are used after cardiac transplantation (tx), few studies have evaluated their use in pediatric patients. METHODS: We randomized 26 heart transplant recipients (pts) in a prospective, open-label trial to Tac (n = 14) or Cya (n = 12) to compare their efficacy and side-effects. Mean age at tx was 4.2 years for Tac and 5.8 years for Cya. Mean follow-up was 26 months (range: 11-39 months) for Tac and 24 months for Cya (range: 33-13 months). RESULTS: Our data suggest that both regimens are efficacious in the pediatric population. Conversion from Cya to Tac was useful for dealing with persistent rejection, although this sample did not suggest lower incidence of acute cellular rejection in the Tac group. CONCLUSIONS: Further studies are required to establish pharmacokinetic parameters to enhance therapeutic monitoring of these patients to minimize side effects and enhance outcomes.     

MRI assessment of the bony pelvis may help predict resectability of rectal cancer

OBJECTIVE: The outcome after surgical treatment of rectal cancer may be influenced by the technical difficulty of the operation, which is thought to be affected by pelvic size. The aim of this study was to examine the association between bony pelvic dimensions and CRM involvement. PATIENTS AND METHODS: All patients with primary rectal cancer between December 1999 and January 2002 were studied. Staging was performed by pelvic MRI. Nine pelvic dimensions were measured from the MR images on a workstation. Pathology reports were obtained for all patients and the mesorectal specimen was examined. Technical difficulty was assessed by circumferential resection margin (CRM) involvement. RESULTS: Of 126 patients with primary rectal cancer, 88 had staging MRI and rectal excision; there were significant differences between the sexes in all 9 pelvic dimensions (P < 0.05). In females, the interspinous diameter was significantly shorter in patients with CRM involvement compared with patients with a negative CRM. In female patients predicted to have a negative CRM, the anteroposterior diameter of the inlet, the anteroposterior diameter of the midplane and the transverse diameter of the midplane (interspinous distance) were significantly shorter in patients who actually had a positive CRM compared with those in whom the CRM was negative. In male patients, there was no correlation between pelvic dimensions and CRM status. CONCLUSIONS: In certain patients with rectal cancer, CRM positivity may be predicted from pre-operative MRI pelvic measurements. This may influence the choice of adjuvant therapy.