FETAL ALCOHOL SYNDROME: THE 'AMERICAN PARADOX'

Nearly all cases of fetal alcohol syndrome (FAS) identifiedin prospective epidemiological studies have been conducted inthe United States of America. The very high incidence rate forFAS in the USA and the relatively low rate in other countriesdoes not correspond to measures of alcohol consumption. By analogywith the ‘French paradox’, we have termed the highrate of FAS in the USA coupled with its relatively low levelof alcohol consumption, the ‘American paradox’.     

PREVENTION OF ALCOHOL ABUSE-RELATED BIRTH EFFECTS -- II. TARGETING AND PRICING

Current public health measures to reduce the occurrence of fetalalcohol abuse syndrome (FAAS) and alcohol abuse-related birtheffects (AARBEs) have been ineffective, because they targetalcohol consumption, rather than alcohol abuse. The presentdiscussion contends that the most effective public health strategyfor reducing FAAS and AARBEs is a combination of more specificpublic health messages that target alcohol abuse, coupled withhigher taxes on alcohol beverages. Although alcohol consumptionby alcohol abusers has been thought to be inelastic to pricechanges, recent studies have found that both heavy drinkingand binge drinking are sensitive to alcohol price changes, andprice elasticities are relatively high for heavy drinkers whoare aware of the consequences of their drinking. Although priceincreases may have a disproportionate impact on lower socioeconomicgroups, this article concludes that they are justifiable fromboth a utilitarian and a categorical imperative perspective.     

Drug use contexts and HIV-consequences: the effect of drug policy on patterns of everyday drug use in Rotterdam and the Bronx

Epidemiological data on HIV seroprevalence has been essential in assessing the (future) extent of the AIDS epidemic. By coupling these data with quantifiable variables related to injection drug use (frequency of injecting, number of needle sharing partners) specific ‘risk behaviors’ could be determined, accounting for the rapid spread of the virus in the injecting drug user (IDU) population. Yet, such data give little information on the social mechanisms and setting generating such risk behaviors. In order to understand the transmission of HIV among the IDU population one needs to study the micro settings and social context of drug use. This paper describes and explores certain patterns of drug use, sharing, and natural support systems found amongst IDUs in two very different cities, Rotterdam (The Netherlands) and the Bronx, New York City (USA). By specifying details of the micro-settings of everyday drug use in both locales, it is possible to identify certain common elements and consequences of personal and social behavior driven by drug use per se (e.g. drug preference), and to differentiate these from behaviors and consequences determined by drug policy and the social context in which drug use actually occurs. These policies and the social context they create can in turn be shown to relate to risks for HIV transmission, e.g. the increased likelihood of sharing injection equipment. A more careful ethnographic approach, taking advantage of natural experimental opportunities, comparisons and controls, may be utilized to examine drug-related behaviors in their social context and to better assess their relevance to public health–especially to AIDS     

Neurocardiac Responses to Acute Coronary Balloon Occlusion in Humans

Both cardioinhibitory and sympathoexcitutory responses to transient coronary artery occlusion have been ascribed to activation of cardiac sensory receptors. Using autoregressive modeling, the power spectrum of heart rate variability was determined from continuous ECG records before, during (120 sec) and following coronary balloon occlusion in 17 patients with isolated single vessel coronary artery stenosis; 11 with left anterior descending (LAD) stenoses and 6 with either right coronary artery (RCA; n = 3) or circumflex (Cfx; n = 3) stenoses. There were no significant changes in heart rate or its variance either during balloon occlusion or following releuse for both the LAD and RCA/Cfx groups. However, during LAD occlusion there was a significant 27% increase in the low frequency (LF) power (60.5 ± 15.1 to 82.3 ± 25.4 b/min²/Hz; P < 0.05) and a 37% decrease in the high frequency (HF) power (28.9 ± 13.2 to 18.3 ± 9.7 b/min²/Hz;P < 0.05). An insignificant, but directionally opposite, trend was seen for the LF power during RCA/Cfx occlusions. Neither the presence nor absence of intracoronary collaterds, beta blockade, inflation induced ischemia, or history of previous myocardial infarction appeared to influence the effect of balloon inflation on either LF or HF values. The autospectral changes seen during transient LAD occlusion had not returned to control values within 30 minutes of balloon release. Thus, transient occlusion of an LAD artery stenosis elicits a shift in cardio-sympathovagal balance towards heightened sympathetic modulation of sinus node activity.     

Multiple Chromosomal Aberrations in a Patient with Acute Granulocytic Leukemia Associated with Down's Syndrome and Twinning: Study of a Family with a Possible Tendency to Nondisjunction

1. A case of Down's syndrome (G 21 trisomy) in a boy, age 4, associatedwith twinning and AGL is described. Multiple chromosomal aberrationswere found prior to and during antileukemic chemotherapy.

2. The initial modal number ranged from 47 to 53 and subsequently 49to 53, and 42 to 52 chromosomes respectively. The overwhelming leukemiccell population was represented by 51 chromosomes on three occasions (74.2,80 and 79.5 per cent respectively).

3. The autosomal aberrations—trisomies and polysomies—were constant,involving predominantly the chromosomes of the G, F and D series.

4. Heterokaryotic twinning with one normal and one affected was encountered twice in this family (G 21 trisomy and normal) and (normal andmentally affected) sets of twins.

5. A possible tendency to nondisjunction has been demonstrated in threehealthy members of the family.

6. Multiple mitotic nondisjunction anomalies might be of etiologic importance in the leukemic process.

7. The implication of different injurious agents and factors, such as ionizing radiation, x-ray exposure, chemicals and parental age in the developmentof trisomic syndromes and/or neoplasia are briefly discussed.

Submitted on November 12, 1963 Accepted on January 7, 1964