Attention,Externalizing, and Internalizing Problems of Youth Exposed to Parental Incarceration

Few studies have examined the effects of parental incarceration (PI) on outcomes above and beyond other risk and adverse childhood experiences (ACEs). The objectives of this study were to (1) the associations between PI and mental health problems (attention, externalizing, internalizing, and total behavioral problems) and (2) the mediating role of current socioeconomic status and cumulative ACEs. An observational and cross-sectional design was employed. Analyses included hierarchical multivariable linear regression modeling. The analytic sample included 613 adolescents (11–17?years). On average, youth exposed to PI experienced three times as many ACEs compared with youth unexposed. Youth exposed to PI were more likely to have behavioral problems than their unexposed peers. The main effect for all models was attenuated by current economic hardship as well as exposure to increasing numbers of ACEs. Exposure to PI can be viewed as a marker of accumulative risk for intervention since youth impacted by PI are more likely to experience behavioral difficulties and associated adverse childhood experiences. Due to the associated adversity that impact youth exposed to PI, mental health providers need to be able to identify and screen for symptoms associated with trauma.     

Parental alcohol use and brain volumes in early- and late-onset alcoholics.

BACKGROUND: Studies have shown that alcoholics have smaller brain volumes than non-alcoholic cohorts, but an effect of family history (FH) of heavy drinking on brain volume has not been demonstrated. We examined the relationship between an FH of heavy drinking and both brain shrinkage as measured by the ratio of brain volumes to intracranial volume (ICV) as well as maximal brain growth as measured by ICV in early-onset and late-onset alcoholics. METHODS: With T1-weighted resonance imaging, we measured ICV, brain volume, and white and gray matter volume in adult treatment-seeking late-onset and early-onset alcoholics with either a positive or a negative FH of heavy alcohol use, and in healthy control subjects. We also calculated brain shrinkage using a ratio of soft tissue volumes to ICV. RESULTS: The FH positive alcoholic patients had significantly smaller ICVs than FH negative patients, suggesting smaller premorbid brain growth. Brain shrinkage did not correlate with FH. Late-onset alcoholics showed a greater difference in ICV between FH positive and FH negative patients than early-onset alcoholics. Late-onset FH positive patients also had significantly lower IQ scores than late-onset FH negative patients, and IQ scores were correlated with ICV. CONCLUSIONS: These data provide evidence that parental alcohol use might increase risk for alcoholism in offspring in part by a genetic and/or environmental effect that might be related to reduced brain growth.     

Does Supplementary Prenatal Nursing and Home Visitation Support Improve Resource Use in a Universal Health Care System? A Randomized Controlled Trial in Canada

ABSTRACT: Background: The addition of supplementary prenatal support may improve the health and well‐being of high‐risk women and families. The objective of this randomized controlled trial was to examine the impact of supplementary prenatal care on resource use among a community‐based population of pregnant women. Methods: Pregnant women from three urban maternity clinics were randomized (a) to current standard of physician care, (b) to current standard of care plus consultation with a nurse, or (c) to (b) plus consultation with a home visitor. Participants were 1,352 women who received 3 telephone interviews. The primary outcome was resource use (e.g., attended prenatal classes, used nutritional counseling). Results: Overall, those in the nurse intervention group were more likely to attend an “Early Bird” prenatal class and parenting classes, and to use nutrition counseling and agencies that assist with child care. Women provided with extra nursing and home visitation supports were more likely to use a written resource guide, nutrition counseling, and agencies that assist with child care. Among women at higher risk (e.g., language barriers, young maternal age, low income), the nurse intervention significantly increased use of early prenatal classes, whereas the nurse and home visitor intervention significantly increased use of the written resource guide and nutrition counseling. The intervention substantially increased the amount of information received on numerous pregnancy‐related topics but had little impact on resource use for mental health and poverty‐related needs. Among those with added support, resource use among low‐risk women was generally greater than among high‐risk women. Conclusions: Additional support provided by nurses, or nurses and home visitors, can successfully address informational needs and increase the likelihood that women will use existing community‐based resources. This finding was true even for high‐risk women, although this intervention did not reduce the difference in resource use between high‐ and low‐risk women. (BIRTH 33:3 September 2006)     

Pediatric Nursing Comes Full Circle

Role Play is an issues-related forum to engender dialogue about the roles assumed by nurses who care for children and their families.     

Extraanatomical bypass procedures

Those extraanatomical bypass procedures which are useful for revascularization of the lower extremities include femorofemoral, axillofemoral, and iliofemoral transobturator bypass. All of these procedures became firmly established during the 1960's, and have added greatly to the armamentarium of the vascular surgeon. The absolute indication for extraanatomical bypass is infection, which precludes the placement of a graft in a conventional location in a patient who requires revascularization to save life or limb. Relative indications for extraanatomical bypass exist when the risk of standard operations is high because of associated disease or anticipated technical problems. The most common indication is to provide revascularization of ischemic extremities in patients who are high-risk for conventional operations. Utilization of axillofemoral graft to bypass aortic aneurysms is a most controversial indication. Occasionally, there is an extremely high-risk patient who has symptomatic abdominal aortic disease who may benefit from the potential for staging the operation. Axillofemoral bypass can be done as one procedure and proximal or distal ligation of the aneurysm can be carried out simultaneously or at a later date with less stress on the patient. Important technical requirements of axillofemoral graft which will ensure optimal results are: (a) to place the proximal anastomosis on the first portion of the axillary artery, (b) to tunnel the graft well laterally so that it lies in the plane of flexion of the body, (c) to use an externally supported graft, (d) to ensure optimal outflow by using a femorofemoral graft in conjunction with axillofemoral bypass. The technical problems with the femorofemoral graft are relatively few: (a) the anastomoses should be placed in such a direction so as to avoid kinking, (b) the graft may be placed in a subcutaneous or subfascial position depending on the degree of obesity of the patient and the presence of preexisting scars. Technical aspects necessary for obturator bypass involve using whatever is the most accessible proximal vessel—usually the common iliac. The graft should be carried through the obturator membrane at its anterior medial portion, avoiding injury to the obturator nerve. The distal anastomosis is carried out in the low thigh. The results of axillofemoral graft vary greatly in individual reports. The 1-year patency for these grafts varies from a low of 50% to a high of 87%, with 5-year patencies varying from a low of 25% to a high of 76%. Regarding femorofemoral grafts, the literature documents 1-year patency rates as varying between 82% and 93%, with 5-year patency rates at approximately 75%, varying from 56% to 86.4%. Results for obturator bypass are not available since no one center has more than a limited experience with these operations.

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Resumen Las derivaciones vasculares utilizadas en la revascularización de las extremidades inferiores incluyen los injertos femorofemorales, axilofemorales, e iliofemorales a través del foramen obturador. Todos estos procedimientos quedaron firmemente establecidos en los años 1960's y han venido a representar una notable adición al arsenal terapéucíco del cirujano vascular.La indicación absoluta para la realization de una derivación extraanatómica es la infección, la cual impide la colocación de un injerto de ubicación convencional en pacientes que requieran revascularización como medida salvadora de la vida o salvadora de una extremidad isquémica. Las indicaciones relativas para derivaciones extraanatómicas se presentan cuando el riesgo de una operación estándar es alto debido a enfermedad asociada o porque se preven problemas técnicos. En efecto, su indicación más frecuente es la revascularización de extremidades en pacientes de alto riesgo frente a operaciones convencionales. La utilización de un injerto axilofemoral para hacer el bypass de un aneurisma aórtico es una indicación en extremo controvertida. Ocasionalmente puede presentarse un paciente con enfermedad abdominal aórtica sintomática y riesgo de grado extremo que pueda beneficiarse de una operación realizada en etapas. En tal situación se puede hacer una derivación axilofemoral como el procedimiento inicial, y luego, con menor estrés para el paciente, la etapa abdominal para ligar los extremos proximal y distal del aneurisma a través de una pequeña incisión en el cuadrante superior derecho.Los siguientes son importantes detalles técnicos que deben ser tenidos en cuenta para lograr óptimos resultados con la construccíon de un injerto axilofemoral: (a) ubicación de la anastomosis proximal sobre la primera porción o segmento de la arteria axilar, aquel que se extiende entre la clavícula y el tendón del pectoral menor, (b) tunelización lateral del injerto con el objeto de que descanse sobre el piano de flexión del cuerpo, para lo cual debe dirigirse hacia la línea axilar media a nivel del reborde costal, para luego hacer una curva y dirigirse hacia la espina iliaca anterior y la arteria femoral; estos requiere una pequeña contraincisión en el apex de la curva, (c) utilización de una prótesis con anillos de soporte externo, (d) construcción de un injerto femorofemoral concomitante, proximal a la anastomosis axilofemoral, para asegurar un flujo óptimo a través del injerto.Los problemas técnicos pertinentes a una derivación arterial femorofemoral son relativamente pocos: (a) la anastomosis debe ser realizada en tal forma que evite dobleces que puedan obstruirla; puesto que el injerto queda paralelo al pliegue de flexión del cuerpo, raramente se trombosa; (b) el injerto puede ser colocado bien en una posición subcutánea en individuos obesos, o bien subfascial en personas delgadas o con cicatrices preexistentes.Sobre los aspectos técnicos relativos a una derivación a través del foramen obturador: el procedimiento, que es subutilizado, implica el uso del vaso arterial proximal que sea más accesible, el cual generalmente viene a ser la arteria ilíaca primitiva. El injerto debe ser colocado a través de la membrana del agujero obturador sobre la región interna o medial, evitando lesión del nervio obturador. La anastomosis se realiza a nivel del tercio distal del muslo.Los resultados de los injertos axilofemorales varían mucho en los diferentes reportes. La tasa de permeabilidad a 1 año oscila entre 50% y 87%, con tasas a 5 años desde 25% hasta 76%.En cuanto a los injertos femorofemorales, la literatura informa tasas de permeabilidad a 1 año entre 82% y 93%, con tasas a 5 años de aproximadamente 75%, con rango entre 56% y 86.4%. No se dispone de resultados con el injerto a través del foramen obturador, pues ningún centro posee más que una limitada experiencia con este procedimiento.

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Résumé Les pontages extra-anatomiques les plus utilisés pour la revascularisation des membres inférieurs sont les pontages fémorofémoral, axillofémoral, et iliofémoral par le trou obturateur. Tous ces procédés ont été élaborés pendant les années 60, et ont bien trouvé leur place dans l'arsenal thérapeutique du chirurgien vasculaire.L'indication absolue d'un pontage extra-anatomique est l'infection particulairemet lorsqu'il faut réaliser une revascularisation pour sauvegarder la vie ou un membre. Les indications relatives sont les revascularisations standards lorsque le patient est à haut risque, et celles où on prévoit un problème technique. L'indication la plus fréquente est la revascularisation des extrémités ischémiques chez les patients à haut risque. L'utilisation d'un pontage axillofémoral pour exclure un anévrysme aortique est une indication très discutée. Rares sont les exemples où un patient à haut risque, présentant un anévrisme symptomatique, peut tirer profit d'une intervention en plusieurs temps. Si on le fait, on pratique alors le pontage axillofémoral dans un premier temps et la ligature proximale ou distale d'anévrisme dans la même opération ou à une date ultérieure.Les détails techniques importants pour assurer les meilleurs résultats du pontage axillofémoral sont: (a) pratiquer l'anastomose proximale sur le premier segment de l'artère axillaire, (b) choisir un trajet très latéral, de façon à ce que la prothèse soit dans l'axe de flexion du corps, (c) utiliser une prothèse annelée, (d) améliorer le lit d'aval en lui associant systématiquement un pontage fémorofémoral.Les problèmes techniques d'un pontage fémorofémoral sont peu nombreux: (a) il faut placer les anastomoses de sorte qu'il n'y ait pas de plicature, (b) la prothèse peut être placée en position sous-cutanée, ou sous-aponévrotique selon l'obésité du patient, et la présence de cicatrices antérieures.Le principal aspect technique du pontage par le trou obturateur est l'utilisation du vaisseau proximal le plus accessible, habituellement l'artère iliaque commune. La prothèse doit traverser la membrane obturatrice dans sa portion antérointerne, en évitant de blesser le nerf obturateur. L'anastomose distale se situe dans la partie inférieure de la cuisse.Les résultats des pontages axillofémoraux varient beaucoup d'un auteur à l'autre. Les taux de perméabilité à 1 an de ces pontages varient de 50% pour le plus mauvais à 87% pour le meilleur, alors que ceux à 5 ans varient de 25% à 76%.En ce qui concerne les pontages fémorofémoraux, on trouve dans la littérature un taux de perméabilité à 1 an entre 82 et 93%, alors qu'à 5 ans, ces taux varient de 56 à 86.4%, la moyenne étant 75% environ. Les résultats des pontages obturateurs ne sont pas disponibles, puisqu'aucun centre ne possède une expérience très importante.

     

Defects in regulation of apoptosis in caspase-2-deficient mice

During embryonic development, a large number of cells die naturally to shape the new organism. Members of the caspase family of proteases are essential intracellular death effectors. Herein, we generated caspase-2-deficient mice to evaluate the requirement for this enzyme in various paradigms of apoptosis. Excess numbers of germ cells were endowed in ovaries of mutant mice and the oocytes were found to be resistant to cell death following exposure to chemotherapeutic drugs. Apoptosis mediated by granzyme B and perforin was defective in caspase-2-deficient B lymphoblasts. In contrast, cell death of motor neurons during development was accelerated in caspase-2-deficient mice. In addition, caspase-2-deficient sympathetic neurons underwent apoptosis more effectively than wild-type neurons when deprived of NGF. Thus, caspase-2 acts both as a positive and negative cell death effector, depending upon cell lineage and stage of development.