The risk of birth defects in children born after assisted reproductive technologies

PURPOSE OF REVIEW: This review addresses the question of whether there is evidence of an increased risk of birth defects in children born following assisted reproductive technologies compared with spontaneously conceived children. RECENT FINDINGS: Three recent studies added relatively little new information given their modest size (56-472 assisted reproductive technology children). We therefore considered all published papers that compared birth defects in children born following assisted reproductive technologies with those in children born following spontaneous conception. Overall, only six of the 26 relevant papers concluded there was an increased risk of birth defects following assisted reproductive technologies. The interpretation of many studies was based on statistical significance testing alone. When results showed a greater proportion of defects in the assisted reproductive technology group compared with the spontaneous group, but the results were not statistically significant, this was often interpreted as showing no increase in risk, rather than an increase in risk that may have been due to chance. The vast majority of individual studies were too small to have sufficient power to detect, as statistically significant, clinically relevant results. We found that although only eight (30%) of the studies had statistically significant results, 24 (89%) had an odds ratio estimate comparing assisted reproductive technology with spontaneously conceived children of over 1.0; 19 (70%) had an estimate of 1.20 or greater; and 14 (52%) had an estimate of 1.5 or greater. SUMMARY: Current evidence suggests there is an elevated risk of birth defects in children born following assisted reproductive technologies. Whilst others may disagree with our interpretation, one certainly cannot exclude this possibility on the basis of the current evidence.     

The deleterious G15498A mutation in mitochondrial DNA-encoded cytochrome b may remain clinically silent in homoplasmic carriers

We report on a patient with severe growth retardation and IgF1 deficiency, in which a mitochondrial abnormality was suspected. An isolated mitochondrial respiratory chain complex III deficiency was found in blood lymphocytes and skin fibroblasts. Sequence analysis of the cytochrome b, which is the only mitochondrial DNA-encoded subunit of complex III, revealed a homoplasmic G15498A mutation, resulting in the substitution of a highly conserved amino acid (glycine 251 into an aspartic acid). The mutation was found to be homoplasmic in all tissues examined from the mother and her brother (lymphocytes, fibroblasts, hair roots and buccal cells). Complex III deficiency was also demonstrated in these cells. Nevertheless, the mother and the brother were asymptomatic. This mutation had been considered as a cardiomyopathy-generating mutation in a previously reported case, and its pathogenicity has been demonstrated recently in yeast. However, it seems not to fulfil the classical criteria for pathogenicity of a mitochondrial DNA mutation, especially the heteroplasmic status, and to be clinically silent, albeit present, in nonaffected relatives. We suggest that other factors are contributing to the clinical variability expression of the G15498A mtDNA mutation.     

A comprehensive professional evaluation of the program Obesity in French Polynesia

A professional evaluation of the program of the fight against obesity set up by the French Polynesian Health Board for a five-year period was carried out in 2001. A comprehensive evaluation was favoured so that adjustments could be better established. Its principle is based on qualitative analysis of the speech of the 27 actors belonging to all levels of intervention and decision in the program. It aims to highlight the convergences and the deviations between what the program produced on the socio-cultural environment and their institutional or professional references. Semi-directive interviews were carried out. The results highlighted a state of uncertainty in the management of human, financial and material resources linked to the political context--awarding the necessary means for implementing the program remains unpredictable. A lack of human resources, problems of collaborating with other sectors, shortcoming skills, and structures around a methodology and forecast indicators were identified. The objectives (media campaigns, improvement in medical practice, and adaptation of a healthy and balanced food environment) were partially carried out. After a year and a half, the most remarkable result is finally that obesity problem is recognised as a public health priority by the population, professionals and decision-makers.     

Irish nursing students' changing levels of assertiveness during their pre-registration programme

BACKGROUND: Stress and bullying have been found to be common problems in a number of studies of Irish nursing and midwifery. Victims of bullying need high levels of assertiveness to enable them to withstand the stress of victimization. It was deemed important to measure nursing students' level of assertiveness prior to, and near completion of, their pre-registration education programme. Aim. To ascertain nursing students' perceived levels of assertiveness prior to, and nearing the completion of, their three-year pre-registration programme. METHODS: Ethical approval was given. The students commencing general nurse education programmes in two schools in Southern Ireland agreed to take part (n=72). A questionnaire adapted from a number of assertiveness scales, and tested for validity and reliability in this population, was used to collect data. RESULTS: In general, students' reported assertiveness levels rose as they approached completion of their three-year education programme. DISCUSSION: The resource constrained health service of the 21st century requires nurses who are assertive to meet the needs of its users. Nursing students' assertiveness skills could be augmented through concentrated efforts from nurse educationalists and clinicians to reduce the communication theory practice gap in nurse education today. To address the multi-dimensional nature of assertiveness, strategies to increase assertiveness should operate at the individual, interface and organisational level. CONCLUSIONS: The students in this study reported an increase in levels of assertiveness as they approached completion of their three-year education programme. To function as effective, safe practitioners registered nurses need to be assertive, therefore education in assertiveness should be an integral part of their preparation. The precise composition and mode of delivery of this education requires exploration and evaluation.     

Staphylococcus aureus isolates with reduced susceptibility to glycopeptides belong to accessory gene regulator group I or II

We used multiplex PCR to determine the agr group membership of 18 European glycopeptide heterointermediate and intermediate-resistant Staphylococcus aureus strains. Of the 15 agr group I strains, 13 were resistant and 2 were susceptible to methicillin. The remaining three strains, like the United States and Japanese control strains, belonged to agr group II.     

Animal and human faces in natural scenes: How specific to human faces is the N170 ERP component?

The N170 is an event-related potential component reported to be very sensitive to human face stimuli. This study investigated the specificity of the N170, as well as its sensitivity to inversion and task status when subjects had to categorize either human or animal faces in the context of upright and inverted natural scenes. A conspicuous N170 was recorded for both face categories. Pictures of animal faces were associated with a N170 of similar amplitude compared to pictures of human faces, but with delayed peak latency. Picture inversion enhanced N170 amplitude for human faces and delayed its peak for both human and animal faces. Finally, whether processed as targets or non-targets, depending on the task, both human and animal face N170 were identical. Thus, human faces in natural scenes elicit a clear but non-specific N170 that is not modulated by task status. What appears to be specific to human faces is the strength of the inversion effect.     

Attenuation by a sigma1 (sigma1) receptor agonist of the learning and memory deficits induced by a prenatal restraint stress in juvenile rats

1. Stress during pregnancy results in complex neurochemical and behavioral alterations throughout the offspring lifetime. We here examined the impact of prenatal stress (PS) on memory functions in male and female offspring and report the efficacy of a selective sigma(1) (sigma(1)) receptor agonist, igmesine, in alleviating the observed deficits. 2. Dams received an unpredictable 90-min duration restraint stress from gestational day E17 to E20. Learning was examined in offspring between day P24 and P36 using spontaneous alternation in the Y-maze, delayed alternation in the T-maze, water-maze learning and passive avoidance. 3. Both male and female PS rats showed impairments of spontaneous and delayed alternation performances. Acquisition of a fixed platform position in the water-maze was unchanged in PS rats, but the probe test revealed a diminution of time spent in the training quadrant. Acquisition of a daily changing platform position demonstrated impaired working memory for male and female PS rats. Finally, passive avoidance deficits were observed. 4. Pretreatment with the selective sigma(1) agonist igmesine (1-10 mg x kg(-1) i.p.) reversed the PS-induced learning deficits in offspring rats for each test. The sigma(1) antagonist BD1063 failed to affect performances alone but blocked the igmesine effect, confirming the involvement of the sigma(1) receptor. 5. PS thus induces delayed memory deficits, affecting spatial and nonspatial, short- and long-term memories in juvenile male and female offspring rats. Activation of the sigma(1) neuromodulatory receptor allows a significant recovery of the memory functions in PS rats.     

Perceived inspiratory difficulty in neuromuscular patients with primary muscle disorders

Intensity of perceived inspiratory difficulty was investigated in 17 patients with severe respiratory insufficiency due to muscle disease, compared with healthy matched controls. Subjects breathed through a threshold valve generating a constant inspiratory negative pressure proportional to their maximal inspiratory pressure. Four load levels ranging from 10 to 40% of the maximal inspiratory pressure were applied in random order. Patients had significantly less perceived inspiratory difficulty than controls at each load level expressed as a percentage of maximal inspiratory pressure P < 0.001. However, when the load was expressed as the absolute value, the slope of the Borg scale score versus mouth pressure was similar in the two groups (P = 0.11). The ventilatory pattern remained unchanged in each group as the load increased. We conclude that in patients with myopathy, loads leading to respiratory muscle fatigue (40% of maximal inspiratory pressure) may fail to produce perceived inspiratory difficulty.     

Explicit and objective scoring criteria for the taylor complex figure test

The Rey and Taylor figures are two constructional and visual memory tests used interchangeably. The purpose of this study was to develop a scoring system for the Taylor figure based on the explicit guidelines established by Meyers and Meyers (1995) for the Rey figure. Younger (n = 97; mean age = 21 years) and older (n = 61; mean age = 72 years) participants' performance on the Taylor figure was scored according to the proposed scoring system and the original scoring system devised by Taylor (1989). Both scoring systems yielded comparable scores on the Taylor figure as well as comparable patterns of validity and good interrater reliabilities (0.85-0.98). Although the present system does not further improve scoring reliability, it renders both tests similar in methodology and simplifies training to evaluate the two figures. The present study also reveals the limitations of the use of the Taylor and the Rey in test-retest situations but suggests that administering the Taylor first would improve the comparability of the two figures in a test-retest situation.