Is parenting the mediator of change in behavioral parent training for externalizing problems of youth?

Change in parenting behavior is theorized to be the mediator accounting for change in child and adolescent externalizing problems in behavioral parent training (BPT). The purpose of this review is to examine this assumption in BPT prevention and intervention programs. Eight intervention and 17 prevention studies were identified as meeting all criteria or all but one criterion for testing mediation. Parenting behaviors were classified as positive, negative, discipline, monitoring/supervision, or a composite measure. Forty-five percent of the tests performed across studies to test mediation supported parenting as a mediator. A composite measure of parenting and discipline received the most support, whereas monitoring/supervision was rarely examined. More support for the mediating role of parenting emerged for prevention than intervention studies and when meeting all criteria for testing mediation was not required. Although the findings do not call BPT into question as an efficacious treatment, they do suggest more attention should be focused on examining parenting as a putative mediator in BPT.     

Examination of the action of 3,4-methylenedioxymethamphetamine on rat A10 dopamine neurons

Extracellular single cell recording was used to examine the effect of intravenous administration of (−), (+), and (±)-3,4-methylenedioxymethamphetamine (MDMA) on A10 dopamine (DA) neurons in chloral hydrate anesthetized male rats. Both (±)-MDMA and (+)-MDMA inhibited the firing rate of most (79%) A10 DA cells. By contrast, (−)-MDMA induced either no effect or a slight increase in the firing rate of these cells. Analysis of the effects of (±)-MDMA on the firing pattern of the DA cells revealed an overall decrease in the percentage of spikes in bursts but both increases and decreases were seen in the coefficient of variation of interspike intervals. To determine the contribution of 5-HT and DA to the (±)-MDMA-induced inhibition of A10 DA cells rats were pretreated either with the 5-HT synthesis inhibitor p-chlorophenylalanine (PCPA) or the DA synthesis inhibitor α-methyl-p-tyrosine (AMPT). Pretreatment of rats with PCPA did not reduce the ability of (±)-MDMA to inhibit the DA cells. However, in rats pretreated with AMPT, the (±)-MDMA-induced inhibition was blocked and some cells (44%) showed instead an increase in firing rate following administration of (±)-MDMA. The administration of l-3,4-dihydroxyphenylalanine (L -DOPA) to AMPT-treated rats rapidly restored the inhibition of cell firing by (±)-MDMA. In conclusion, the results reported here demonstrate that MDMA has an overall inhibitory effect on A10 DA cells. Despite MDMA's greater potency in releasing 5-HT compared to DA, the inhibitory effect of this drug on A10 DA cells appears to be mediated by the latter transmitter. © 1996 Wiley-Liss, Inc.     

Colonoscopic polypectomy

Despite the frequency with which polypectomy is performed, there is a paucity of information on what technical aspects of polypectomy most effectively remove polyps and minimize complications. The practice of polypectomy is based largely on the observational experience of experts and what gastroenterology fellows have learned from their attending physicians and from experts in postgraduate courses. Moreover, polypectomy technique is not consistent across the United States. In this technique update, the author presents his own methods for treating and observing small, large pedunculated, and large sessile polyps and discusses the advantages, disadvantages, and complications of each technique.     

Melatonin excretion with affect disorders over age 60

Numerous studies have reported low melatonin secretion in depression, but other studies have suggested no deficit or an increase. Alterations of circadian phase or duration of melatonin secretion have also been described. Since melatonin secretion decreases as we age, it seemed interesting to examine melatonin and depression in an aging sample. Volunteers who complained of mood or sleep problems were recruited for studies in which fractional urine specimens were collected for 24 h, both at home and in the laboratory. The major metabolite, 6-sulfatoxymelatonin (aMT6s), was determined by radioimmunoassay. Of 72 volunteers aged 60-78 years, seven had current major depression and 55% had a lifetime history of an affective disorder. A 55-fold range of home aMT6s excretion rates was observed. A lifetime history of any affective disorder was significantly associated with greater log(10)[mesor] aMT6s excretion in home collections and laboratory collections, but current affective disorders were neither significantly related to melatonin excretion nor to aMT6s acrophase timing, onset, offset or duration. These results are only weakly consistent with a photoperiodic hypothesis of depression.     

Evaluation of blood vessels and edema in the airways of asthma patients: regulation with clarithromycin treatment

BACKGROUND: Although airway angiogenesis and edema have been proposed to contribute to the airway remodeling process in patients with asthma, there are few studies looking at these structural components in the airway tissue of asthma patients. Mycoplasma infection may be associated with chronic asthma and has been shown to induce angiogenesis and edema in a murine model. Participants and measurements: We evaluated blood vessels and edema by immunohistochemistry in endobronchial biopsy samples from 10 normal control subjects and 15 patients with mild-to-moderate asthma before and after a 6-week treatment with clarithromycin (n = 8) or placebo (n = 7). Type IV collagen and alpha(2)-macroglobulin were used to identify blood vessels and edema in the tissue, respectively. Mycoplasma pneumoniae was evaluated by polymerase chain reaction. SETTING: National Jewish Medical and Research Center. RESULTS: At baseline, the vascularity, the number of blood vessels, and the edematous area in the airway tissue were not significantly different between asthmatic patients and normal control subjects. However, asthmatic patients demonstrated increased blood vessel size compared with normal control subjects (p = 0.03). After clarithromycin treatment in asthmatic patients, the number of blood vessels was increased (p = 0.02), while edema decreased (p = 0.049). Asthmatic patients who tested positive for M pneumoniae showed a significant increase in vascularity than asthmatic patients who tested negative for M pneumoniae (p = 0.02). CONCLUSION: Our data suggest that angiogenesis and edema may not be significant features of airway remodeling in patients with chronic, mild-to-moderate asthma. Clarithromycin treatment in asthmatic patients could reduce the edematous area as identified by alpha(2)-macroglobulin staining, which may lead to airway tissue shrinkage and cause an artificial increase in the number of blood vessels.     

A novel technique to study the brain's response to pain: proton magnetic resonance spectroscopy

Glutamate, a major excitatory neurotransmitter, has been implicated as an important mediator in the neurotransmission, potentiation, and negative affect associated with pain. We present results showing that a painful stimulus elicits a dynamic increase in glutamate (9.3% from baseline) concentrations in the anterior cingulate cortex, detectable using proton Magnetic Resonance Spectroscopy ((1)H-MRS). Increases in glutamine levels were also seen, which correlate strongly with the subjective level of pain experienced by participants (r(2) = 0.58, P < 0.01). These novel findings are the first time a dynamic change in glutamate and glutamine levels from baseline in response to an external stimuli has been measured in a single proton MRS scanning session. As such, this report demonstrates the efficacy of (1)H-MRS as a non-invasive tool for the study of neural responses to pain in vivo. The paradigm used in this study demonstrates that dynamic glutamate/glutamine changes due to stimulation are measurable by proton MRS, and could provide a means of testing novel pharmaceutical agents and other treatments for chronic pain.     

Prevalence,awareness, treatment,and control of hypertension in Nigeria in 1995 and 2020: A systematic analysis of current evidence

Improved understanding of the current burden of hypertension, including awareness, treatment, and control, is needed to guide relevant preventative measures in Nigeria. A systematic search of studies on the epidemiology of hypertension in Nigeria, published on or after January 1990, was conducted. The authors employed random‐effects meta‐analysis on extracted crude hypertension prevalence, and awareness, treatment, and control rates. Using a meta‐regression model, overall hypertension cases in Nigeria in 1995 and 2020 were estimated. Fifty‐three studies (n = 78 949) met our selection criteria. Estimated crude prevalence of pre‐hypertension (120‐139/80‐89 mmHg) in Nigeria was 30.9% (95% confidence interval [CI]: 22.0%‐39.7%), and the crude prevalence of hypertension (≥140/90 mmHg) was 30.6% (95% CI: 27.3%‐34.0%). When adjusted for age, study period, and sample, absolute cases of hypertension increased by 540% among individuals aged ≥20 years from approximately 4.3 million individuals in 1995 (age‐adjusted prevalence 8.6%, 95% CI: 6.5‐10.7) to 27.5 million individuals with hypertension in 2020 (age‐adjusted prevalence 32.5%, 95% CI: 29.8‐35.3). The age‐adjusted prevalence was only significantly higher among men in 1995, with the gap between both sexes considerably narrowed in 2020. Only 29.0% of cases (95% CI: 19.7‐38.3) were aware of their hypertension, 12.0% (95% CI: 2.7‐21.2) were on treatment, and 2.8% (95% CI: 0.1‐5.7) had at‐goal blood pressure in 2020. Our study suggests that hypertension prevalence has substantially increased in Nigeria over the last two decades. Although more persons are aware of their hypertension status, clinical treatment and control rates, however, remain low. These estimates are relevant for clinical care, population, and policy response in Nigeria and across Africa.