Lack of a relation between human neonatal thyroxine and pediatric neurobehavioral disorders.

The growth and differentiation of the central nervous system are closely related to the presence of iodine and thyroid hormones. It has been hypothesized that neurobehavioral disabilities of childhood, such as attention deficit hyperactivity disorder (ADHD), learning disorders, and autism can be attributed to fetal thyroidal endocrine disruption in utero. To determine whether there is an association between neonatal thyroid status and a subsequent diagnosis of a neurobehavioral disability, neonatal thyroxine (T(4)) levels have been used as the indicator of the presence of intrauterine thyroidal dysfunction. Neonatal T(4) levels were obtained from the neonatal hypothyroidism screening program. All cases were diagnosed at medical school diagnostic clinics, the diagnostic categories being ADHD, autism spectrum disorder, behavioral disorder, cognitive disorder, developmental delay, emotional disorder, learning disability, and speech/language disorder. Conditional logistic regression analysis was performed for each clinical condition. Odds ratios for the conditions ranged from 0.92 to 1.13 with p values ranging between 0.19 and 0.84. No significant differences were detected between neonatal T(4) values of the cases and the controls for any of the neurobehavioral conditions. All neonatal T(4) values were within normal ranges. The data provide no evidence to suggest that intrauterine thyroid status as reflected by the neonatal T(4) values had an impact on the neurologic disorders diagnosed in childhood.     

Test–retest reliability of a self-administered Alcohol,Smoking and Substance Involvement Screening Test (ASSIST) in primary care patients

The time required to conduct drug and alcohol screening has been a major barrier to its implementation in mainstream healthcare settings. Because patient self-administered tools are potentially more efficient, we translated the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) into an audio guided computer assisted self interview (ACASI) format. This study reports on the test–retest reliability of the ACASI ASSIST in an adult primary care population. Adult primary care patients completed the ACASI ASSIST, in English or Spanish, twice within a 1–4 week period. Among the 101 participants, there were no significant differences between test administrations in detecting moderate to high risk use for tobacco, alcohol, or any other drug class. Substance risk scores from the two administrations had excellent concordance (90–98%) and high correlation (ICC 0.90–0.97) for tobacco, alcohol, and drugs. The ACASI ASSIST has good test–retest reliability, and warrants additional study to evaluate its validity for detecting unhealthy substance use.     

The diet-heart situation

Even though some of the questions about the role of diet in heart disease are still unanswered, it is clear that obesity, diabetes, and hyperlipidemia increase the risk of heart disease. Physicians who would prevent arteriosclerosis in their patients are directing attention to dietary modification for young adults and children.     

Poorly controlled type 1 diabetes is associated with altered glutathione homeostasis in adolescents: apparent resistance to N‐acetylcysteine supplementation

Blood glutathione concentrations represent a measure of protection against oxidative damage. In earlier studies, we observed that, in adolescents with poorly controlled type 1 diabetes mellitus (T1DM), blood glutathione is significantly depleted because of increased rates of glutathione utilization. To determine whether increased availability of cysteine – one of the three constitutive amino acids of glutathione – would attenuate the alterations in glutathione metabolism, ten 16 ± 1 yr‐old adolescents with poorly controlled T1DM [hemoglobin A1c (HbA1c): 9.9 ± 1.3%] received 5‐h infusions of l ‐[3,3‐²H₂] cysteine and d ‐[6,6‐²H₂]glucose on two occasions, 3 wk apart, after a 10‐d oral supplementation with (i) N‐acetylcysteine (NAC, 30–45 mg/kg/d) or (ii) l ‐alanine, in randomized order, and with a 3‐wk ‘washout’ interim period. Blood glucose was maintained in the same hyperglycemic range on both infusion study days, using intravenous insulin. Glutathione fractional synthesis rate (FSR) was determined from ²H₂‐cysteine incorporation into blood glutathione. NAC supplementation failed to raise erythrocyte cysteine concentrations (23 ± 6 vs. 17 ± 1 μmol/L, p = 0.853) and did not alter erythrocyte glutathione concentrations (838 ± 106 vs. 793 ± 111 μmol/L, p = 0.220) or glutathione FSR (96 ± 20 vs. 89 ± 19%/d, p = 0.974). We conclude that in adolescents with poorly controlled T1DM, dietary cysteine supplementation alone cannot correct glutathione status. In the presence of relative insulinopenia, either higher amino acid doses or aggressive insulin therapy may be needed to achieve this goal. This would require further study.     

Assessment of OASIS reliability and validity using several methodological approaches

The Outcome Assessment and Information Set (OASIS) plays an essential role in home healthcare. To date, few researchers have investigated the psychometric properties of the OASIS in actual clinical practice. This study used several methodologies to estimate reliability and validity of OASIS when clinicians were conducting assessments as part of the routine care process. Analyses from a delayed assessment approach (n = 259), a simultaneous assessment approach (n = 105) and an assessment of consistency between OASIS and the Centers for Medicare and Medicaid Services (CMS) 485 (n = 141) provided insights into OASIS reliability and validity. Reliability for many items was considerably lower than prior studies and there were notable inconsistencies between several domains of OASIS and the CMS 485. Based on these findings it was also unclear whether prior reliability findings could be generalized to practice because the previous research did not account for the stresses and unpredictability of the home healthcare setting. Further, the inconsistencies between the OASIS and CMS 485 suggested that the OASIS might not truly reflect the patient's condition. Implications for improving the use of the instrument in practice settings are discussed.     

Injection drug users and the provision of hepatitis C-related services in a nationwide sample of drug treatment programs

Drug treatment facilities are important sites for providing targeted prevention and health services to injection drug users (IDUs) who are infected with the hepatitis C virus (HCV). A nationwide survey was conducted to examine whether differences exist in the HCV-related services provided by drug treatment programs that have varying proportions of IDUs among their patients. The results indicate that, overall, drug treatment programs with a greater proportion of IDUs offer significantly more HCV services as compared to programs with a smaller proportion of IDUs. However, important components of hepatitis C-related care, such as universal basic education and counseling about HCV and extensive HCV-antibody testing, are not yet being provided by all programs with a large proportion of IDUs among their patient populations.     

Gaps in the drug-free and methadone treatment program response to Hepatitis C

Drug treatment programs are sites of opportunity for the delivery of hepatitis C (HCV) prevention and care services to drug users. Using data collected from a random nationwide sample (N = 595) of drug treatment programs in the United States, this study compares the provision of HCV services by drug-free and methadone maintenance treatment programs (MMTPs). It then examines and compares perceived inadequacies in this service provision from the perspective of the managers in these two types of programs. Findings indicate that MMTPs are providing more HCV services to their patients, and that a greater proportion of MMTPs are dissatisfied with their current level of HCV service provision. Managers of drug-free programs would like to be offering patients more HCV education, while MMTP managers would like to be providing more HCV testing to their patients, and more support and care for patients who are HCV+.