Mean cell volume and gamma-glutamyl transferase are superior to carbohydrate-deficient transferrin and hemoglobin-acetaldehyde adducts in the follow-up of pregnant women with alcohol abuse

BACKGROUND AND OBJECTIVE: To compare the usefulness of carbohydrate-deficient transferrin (CDT), the ratio of CDT to total transferrin, and hemoglobin-acetaldehyde adducts with mean cell volume (MCV) and gamma-glutamyl transferase (GGT) in the follow-up of alcohol abuse during pregnancy. METHODS: Forty-four pregnant drug and alcohol abusing female patients attending a special outpatient clinic were followed from the 8th to 24th gestational week onwards. A population of sixty-two healthy pregnant women was recruited to assess the effect of gestation on the markers. RESULTS: Eight of thirteen heavy drinking (> or =8 drinks/week) patients delivered infants with fetal alcohol effects (FAE). MCV and GGT were higher among heavy drinking patients than in moderately drinking (<8 drinks/week) patients (92+/-4 vs 90+/-3 fl and 31+/-34 vs 16+/-10 U/ L, respectively), and in patients delivering infants with FAE compared with patients delivering healthy infants (95+/-3 vs 90+/-3 fl and 34+/-26 vs 15+/-10 U/L, respectively). Hemoglobin-acetaldehyde adducts, CDT, and the ratio of CDT to total transferrin were neither associated with the reported level of alcohol consumption nor with the occurrence of FAE. In the receiver operating characteristics analysis MCV was found to be superior to CDT and the adducts, and GGT superior to the adducts, in identifying heavy drinking and in predicting FAE. In the control population, both CDT and total transferrin were found to rise during pregnancy, whereas the ratio of CDT to total transferrin was found to decline. The upper reference range of 33 U/L for CDT was considerably higher than that of non-pregnant women (26 U/L). CONCLUSION: MCV and GGT appear to be the most efficient laboratory markers for detecting excessive alcohol consumption and the adverse effects of alcohol on the fetus.     

Evaluation of genotype and LiPA MYCOBACTERIA assays for identification of Finnish mycobacterial isolates

Two DNA strip assays, INNO-LiPA MYCOBACTERIA and GenoType Mykobakterien, were evaluated for identification of 81 Finnish mycobacterial isolates. The LiPA assay correctly identified 89.4% of the 66 isolates studied, and the GenoType assay identified 95.1% of 81 isolates. The GenoType assay had a wider selection of species and less stringent temperature requirements.     

Injuries in children associated with the use of nonmotorized scooters

Background/Purpose:

Since 2000, a substantial increase in injuries related to nonmotorized scooters (kickboards) has been observed among children. The authors conducted a population-based prospective study to characterize these injuries in comparison with skateboard-related injuries during the same period.

Methods:

All children (age <16 years) presenting with a scooter-related injury between July and October 2000 in Graz (Austria) and all children presenting with a scooter- or skateboard-related injury between June and September 2001 in Helsinki, Finland were interviewed at the time of seeking medical attention.

Results:

One hundred thirteen patients with scooter injuries and 72 patients with skateboard injuries were recorded. The 4-month calculated incidence in children less than 16 years of age was 0.72 per 1,000 for scooter injuries and 0.68 per 1,000 for skateboard injuries. The scooter injuries accounted for 1.9% and the skateboard injuries for 2.6% of all pediatric traumas within the respective catchment areas. The majority of the patients in both groups were boys. The patients with scooter injuries were younger than the patients with skateboard injuries (mean age 10.2 ± 2.7 v 12.5 ± 2.4 years; P < .001). Most of the scooter-related accidents were claimed to be caused by the wheels of the scooter getting caught by uneven ground, whereas most skateboard accidents occurred during attempted trick maneuvers. Protective gear was seldom used. More than half of the scooter-related injuries were minor bruises, wounds, or contusions. One third of the patients sustained a fracture, usually involving the upper extremity distal to the elbow. The only life-threatening injury was a ruptured spleen in a skateboarder. The injury pattern of scooter and skateboard injuries was similar.

Conclusions:

Public awareness of the potential dangers related to scooter riding should be increased and the use of protective gear encouraged.     

Laboratory and field testing of particle size-selective sampling methods for mineral dusts

The performances of eight sampling devices were tested with mineral dusts in the laboratory and in a talc production plant. The IOM sampler was chosen as the reference method for inhalable dust, and the IOM samplers provided with the porous plastic foam media were used as the reference methods for both the thoracic and respirable aerosols. The other size-selective instruments tested included the Respicon virtual impactor, the optical GRIMM aerosol monitor, and a two-stage cascade impactor with cut points of 10 and 4 microm. The 37-mm cassettes were also included both as open- and closed-face versions. The study confirmed the usability of the IOM samplers for mineral dust, not only in its original version for the inhalable fraction but also its modified versions for the thoracic and respirable fractions. A high correlation with the two-stage impactor results is an indication of good reproducibility. The results increased the evidence that the 37-mm cassette is a poor indicator of inhalable aerosol. The concentrations obtained with both cassette methods were not only systematically too low but also showed large collection efficiency variability. Therefore, the results cannot be corrected by using correction factors. The concentrations of inhalable aerosol measured with the Respicon were generally low, but its performances for the thoracic and respirable fractions were closer to those for the reference samplers. The results also indicate that the GRIMM monitor is well-suited for such mineral dust determinations when very good accuracy is not required, but the immediate availability of the result is more important.     

Alcohol and substance abuse identified during pregnancy: maternal morbidity, child morbidity and welfare interventions

Aim: To study the relations between postnatal maternal morbidity, child morbidity and welfare interventions in families with prenatal alcohol or substance abuse. Methods: A register‐based longitudinal retrospective cohort study. The exposed cohort included 638 children born to 524 women followed‐up during pregnancy for alcohol or substance abuse 1992–2001. Non‐exposed children (n = 1914) born to control women were matched for maternal age, parity, number of foetuses, month of birth and delivery hospital of the index child. Perinatal and follow‐up data of both cohorts were collected from national registers until 2007. Results: Postnatal maternal abuse‐related healthcare utilization and use of medication were associated with child out‐of‐home care. Significant differences were in particular observed in the categories of maternal mental and behavioural disorders caused by psychoactive substance use as well as injury and poisoning. Maternal inpatient care for mental and behavioural disorders peaked at the time of child out‐of‐home care. Maternal abuse‐related healthcare utilization was associated with early child healthcare utilization and use of medication for mental and behavioural disorders. These associations were largely explained by the association with child out‐of‐home care. Conclusions: Postnatal maternal abuse‐related morbidity is associated with significant early child morbidity, use of medication and timing of out‐of‐home care.     

Risk factors for out-of-home custody child care among families with alcohol and substance abuse problems

AIM: To study the risk of children to mothers with alcohol and/or substance abuse related problems for early childhood out-of-home care in Finland. METHODS: A population-based cross-sectional retrospective analysis of 526 pregnant women attending special outpatient clinics during 1992-2001 and their 626 offspring, with out-of-home care data until 2003 provided by the National Child Welfare Register. RESULTS: Fifty percent (95% confidence interval 46-54%) were at some point and 38% (34-42%) by the age of two years, in out-of-home care. Out-of-home care was associated with maternal care for substance abuse after delivery, nonemployment, housing, daily smoking during pregnancy, increasing number of previous births, mother in custody in her childhood, maternal education, previous child in custody, drug in urine during pregnancy, unplanned pregnancy, partner with significant abuse, regular health-care contact for abuse, daily alcohol consumption before and/or during pregnancy, newborn not discharged with mother, neonatal abstinence symptoms (NAS), intensified perinatal surveillance or NICU, and delayed discharge from hospital. CONCLUSIONS: There is a substantial risk of children born to mothers with significant alcohol and/or substance abuse related problems for out-of-home care during early childhood. Factors identified during the pre- and perinatal period are associated with this risk.     

Maternal welfare, morbidity and mortality 6-15 years after a pregnancy complicated by alcohol and substance abuse: A register-based case-control follow-up study of 524 women

Background

A register-based retrospective case-control study to investigate the long-term morbidity, mortality, and welfare among women with alcohol and/or substance misuse identified during pregnancy.

Methods

Cohort of 524 women followed-up ante- and perinatally 1992-2001 at special out-patient clinics of maternity hospitals in the capital area of Finland. The control group of 1792 women with no evidence of alcohol or substance misuse was matched for maternal age, parity, date of birth and hospital of index delivery. Both groups were followed-up until end of 2007.

Results

7.9% (42/524) of the cases and 0.2% (4/1792) of the controls had died by the end of the median follow-up of 9 years (OR 38, 95% CI 14-108). The cases displayed significant morbidity requiring in-patient care in the areas of mental disorders (AOR 8.8, 95% CI 6.5-11.9), viral (AOR 23.5, 95% CI 8.8-62.7) and bacterial (AOR 6.1, 95% CI 3.5-10.4) infections, skin diseases (AOR 3.9, 95% CI 2.0-7.8) and injury and poisoning (AOR 4.2, 95% CI 3.1-5.6). The cases displayed more out-patient visits (OR 2.7, 95% CI 2.7-2.8). Their mean length of hospital stay was longer compared to controls (10.3 vs. 4.4 days, p < 0.001). The risk of pension granted due to a disorder, disease or disability (OR 8.8, 95% CI 6.0-13.0) and the risk for minimum unemployment benefit were higher compared to controls (OR 2.1, 95% CI 1.8-2.5).

Conclusions

These women display significant long-term morbidity, mortality and loss of productivity after delivery. The results emphasize the importance of adequate postnatal follow-up and treatment for misuse.     

Prospective evaluation of the GenoType Assay for routine identification of mycobacteria

In order to evaluate the proficiency of the GenoType Mycobacteria strip hybridization assay (Hain Lifescience, Nehren, Germany) for the routine identification of mycobacteria, the assay was used to identify 178 clinical isolates during a 6-month prospective study. The GenoType results were compared to the identification results obtained with AccuProbe (GenProbe, San Diego, CA, USA) or 16S rDNA sequencing, and an overall agreement of 89.3% between GenoType and the two reference methods was reached. The GenoType assay is, thus, a rapid and reliable method for the identification of clinically important mycobacteria, and it is well suited for use in a routine laboratory.     

Effect of 4-methylpyrazole on endogenous plasma ethanol and methanol levels in humans

BACKGROUND: Endogenous methanol and ethanol levels are found in human blood. It is assumed that these compounds are derived mainly from microflora in the gastrointestinal tract and that the small amounts formed are consequently eliminated, mainly in the liver, by the alcohol dehydrogenase (ADH) pathway. The objective of the present study was to investigate the effect of 4-methylpyrazole (4-MP), a specific ADH inhibitor, on endogenous plasma methanol and ethanol levels in healthy women and men. METHODS: A double-blind placebo-controlled interventional study was carried out. RESULTS: A significant elevation in plasma endogenous ethanol and methanol levels was observed after intake of 4-MP (10-15 mg/kg p.o.). For methanol levels, a linear increase from 20 +/- 14 micromol/l before intake to 39 +/- 22 micromol/l at 420 min from intake of 4-MP (levels 20 +/- 14 micromol/l and 14 +/- 9 micromol/l during the corresponding placebo time points) was found. For ethanol, concentrations increased from levels below detection limit (i.e., < 5 micromol/l, determined by headspace gas chromatography) before intake to 30 +/- 20 micromol/l at 195 min from intake of 4-MP. A small increase in ethanol levels, to 13 +/- 8 micromol/l, but not in methanol levels, was observed after the intake of lingonberry juice containing no ethanol or methanol. No sex differences in the ethanol and methanol levels before or after the intake of 4-MP were found. CONCLUSIONS: The present study provides conclusive evidence for a constant endogenous production as well as clearance of ethanol and methanol in humans. In addition, the study shows that the ethanol and methanol produced are, at least in part, eliminated by the ADH pathway.