Amphetamine-induced locomotor stereotypy in rats is reduced by a D1 but not a D2 antagonist

Amphetamine produces locomotor stereotypy (repetitive routes of locomotion) in an open field. In this research we tested the ability of the D1 antagonist SKF 83566 and the D2 antagonist sulpiride to block the locomotor stereotypy produced by 2 mg/kg amphetamine. SKF 83566 decreased amphetamine-induced locomotor stereotypy; sulpiride had no consistent effect on amphetamine-induced locomotor stereotypy. There was no evidence that either antagonist potentiated the effect of the other.

Osteopathia striata with cranial sclerosis: highly variable phenotypic expression within a family

We report a four-generation family, with five individuals affected by osteopathia striata with cranial sclerosis (OS-CS). The family illustrates the wide spectrum of gene expression in this autosomal dominant condition. Of particular note is the unusually severe expression in the proband, who exhibits virtually all of the reported associations of the syndrome. Proximal osteolysis of the fibula and congenital urological abnormalities, in the proband, and holoprosencephaly sequence, in the proband's sister, have not previously been described in the syndrome.

Improvement in outcome of children with Wilms' tumour in South Australia over the last 30 years

OBJECTIVE

To evaluate the outcome of children with Wilms' tumour over the last 30 years in South Australia. To compare the outcome of children treated before and after 1982, when standard treatment protocols were introduced.

METHODOLOGY

Management approaches, survival rates and side-effects of treatment were identified from case notes. Pathology slides were reviewed to ensure all children were correctly diagnosed with Wilms' tumour.

RESULTS

Children treated for Wilms' tumour prior to 1982 had an overall survival rate of 54%. Since 1982 there has been a significant improvement in outcome and the current survival rate is now 85%. Children treated since 1982 have also experienced fewer treatment related side-effects than children treated prior to 1982.

CONCLUSIONS

There has been substantial improvement in survival from childhood Wilms' tumour over the past 30 years in South Australia. This is likely to be due to a combination of factors including standardization of treatment, tailoring of treatment to stage and histology, improved perioperative care, enhanced radiological techniques and higher levels of collaboration between relevant specialists.

Comparison of two question sequences for assessing pregnancy intentions

Unintended pregnancies can have serious health, social, and economic consequences. Such pregnancies may be unwanted (a baby is not wanted at any time) or mistimed, yet wanted (a baby is wanted eventually). Intended pregnancies are those conceived when desired. Reproductive health survey respondents' understanding of these concepts and validity of survey results may be affected by question order and wording. Using a randomized crossover design, National Survey of Family Growth (NSFG) and Demographic and Health Survey (DHS) intendedness questions were asked in a 1993 survey of Arizona women aged 18-44 years. Of 2,352 ever-pregnant respondents, 25% gave discordant responses to DHS and NSFG questions about the most recent pregnancy. Age, marital status, household income, education, parity, time since pregnancy, and outcome of pregnancy were significantly predictive of discordant responses. DHS and NSFG questions yielded similar prevalence estimates of intendedness and wantedness; but young, unmarried respondents gave more "mistimed" responses on whichever question was asked later. Classifying pregnancies as intended, mistimed, or unwanted may be a problem for women who have not decided on lifetime reproductive preferences. Approaches to improving survey validity include addressing ambivalence, clarifying the definition of "unwanted," and, for young, unmarried women, not attempting to classify unintended pregnancies as mistimed or unwanted.

Identification of cell subsets expressing intracytoplasmic cytokines within HIV-1-infected lymph nodes

OBJECTIVE

To describe the endogenous cytokine profile of HIV-1-infected lymph nodes (LN) and to identify the phenotype of individual cells expressing intracytoplasmic cytokines.

DESIGN AND METHODS

Whole LN biopsies were collected from three HIV-seronegative controls and four HIV-1-positive individuals with persistent generalized lymphadenopathy. Three had established infection (Centers for Disease Control and Prevention 1993 criteria, stages A2, C1 and C3) and one was undergoing seroconversion illness. A combination of three methods was used to assess the impact of HIV-1 on LN architecture and endogenous cytokine expression. Immunocytochemistry was used to locate follicular dendritic cells (FDC), interdigitating cells and T and B cells. Reverse transcriptase-polymerase chain reaction was used to assess mRNA for interleukin (IL)-1 beta, IL-2, IL-4, IL-6, IL-10, tumour necrosis factor (TNF)-alpha and interferon (IFN)-gamma in collagenase-digested LN cells. Three-colour flow cytometry was used to identify intracytoplasmic cytokine expression within cell subsets.

RESULTS

Germinal center (GC) hyperplasia was observed in LN from two patients with established HIV-1 infection, and the third, coinfected with Mycobacterium tuberculosis, showed extensive necrosis. In the patient undergoing seroconversion, there was an extensive FDC network within the expanded and confluent GC which covered expansive areas of the LN. There was varied expression of IL-1 beta, IL-4, IL-6, IL-10 and TNF-alpha mRNA from the four HIV-1-infected LN and the patient undergoing seroconversion showed evidence for a mixed cytokine profile, which also included IL-2 and IFN-gamma. Flow cytometry revealed intracytoplasmic IL-1 beta protein restricted to cells expressing CD19, CD21 and CD38 antigens.

CONCLUSIONS

Cytokines were detected in freshly isolated HIV-1-infected LN cells without requiring an exogenous stimulus. Seroconversion was associated with an expanded FDC network within enlarged GC, bounded by defined mantle zones containing B cells. There was diverse cytokine mRNA expression and IL-1 beta protein was restricted to cells expressing B-cell-associated antigens.

Chronic flexor tenosynovitis: missed diagnosis for a decade

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Pregnancy, abortion, and birth rates among US adolescents--1980, 1985, and 1990

OBJECTIVE

To analyze pregnancy, abortion, and birth rates among US adolescent girls in 1980, 1985, and 1990.

DESIGN

Retrospective analysis of trends in data on pregnancies, abortions, and births.

POPULATION

US adolescent girls aged 13 to 19 years.

MAIN OUTCOME MEASURES

Pregnancy, abortion, and birth rates (with and without adjustment for sexual experience) among teenaged girls aged 15 to 19 years and girls under 15 years.

RESULTS

Although pregnancy rates among all teenaged girls 15 to 19 years old remained fairly stable from 1980 to 1985, they increased by 9% during the last half of the decade, totaling 95.9 pregnancies per 1000 teenaged girls 15 to 19 years old by 1990. Because rates of sexual experience increased even faster, pregnancy rates among sexually experienced teens aged 15 to 19 actually declined between 1980 and 1990 by approximately 8%. Abortion rates among these teens remained stable during the 1980s, with 35.8 and 36.0 abortions per 1000 in 1980 and 1990, respectively. As with overall pregnancy rates, abortion rates among these sexually experienced teenaged girls declined during the 1980s. Between 1980 and 1985, birth rates among teenaged girls aged 15 to 19 years declined by 4%, but they increased by 18% during the latter half of the decade, totaling 59.9 births per 1000 in 1990. Among these sexually experienced teenagers, birth rates also declined between 1980 and 1985 and then increased over the next 5 years. In 1990, pregnancies and abortions among girls younger than 15 years accounted for only 3% of all adolescent pregnancies and abortions. However, the number of births among these younger adolescents increased by 15% over the decade. In that age group, trends in pregnancy, abortion and birth rates over the decade were similar to those for older teens. However, during the late 1980s, the abortion rate declined and the pregnancy rate remained stable, resulting in a 26% increase in the birth rate.

CONCLUSIONS

Despite efforts to reduce adolescent pregnancy in the United States, pregnancy and birth rates for that group continue to be the highest among developed countries. Considering that 95% of adolescent pregnancies are unintended, increased efforts to prevent these pregnancies are warranted.

Effects of crack cocaine on neurocognitive function

Because crack cocaine appears to have a preferential effect on the metabolic and electrophysiological activity of the frontal and temporal regions of the brain (Pascual-Leone et al., 1991a, 1991b; Volkow, 1992), we hypothesized that cognitive measures of those regions would be impaired in crack cocaine users relative to measures in normal volunteers. We used logistic regression to determine the relationship of cocaine usage to neuropsychological test performance. We compared 38 patients with an average of 3.6 (SD = 2.5) years of crack cocaine use and 24.5 (SD = 28.1) days of abstinence to 54 normal volunteers on a battery of neuropsychological tests. Statistical adjustments were made for the effects of age, education, socioeconomic class, and level of depression. Our findings were mixed with regard to purported measures of executive/frontal functioning, with worse performance associated with cocaine usage on the Booklet Categories Test, but better performance associated on others (number of categories on the Wisconsin Card Sorting Test, Controlled Oral Word Association). Cocaine usage was associated with impairment on measures of spatial, but not verbal memory, confrontation naming, and Trail-making Test, Part B, a measure of perceptual-motor speed and cognitive flexibility. In summary, it appears that continuous crack cocaine use produces a dissociative pattern in neuropsychological test performance with improvement on some measures, but deterioration on others. The permanence of these effects remains to be determined with longitudinal studies.

Disability and health: perceptions of a sample of elderly people

The background to this work was the expected increase in the proportion of elderly people in the population, giving rise to a greater demand for services at a time of scarcity of healthcare resources. The aims of the study were to investigate disability and health in a sample of elderly people living at home in the community. We wished to obtain detailed information about physical disability and health then to explore individual perceptions of health and disability and, finally, to examine relationships between the objective assessments and individual, subjective perceptions. The results reported here represent only part of the work of a larger study which also investigated the use of health and social services in this sample of elderly people. In-depth interviews were undertaken with a random stratified population sample of 200 elderly people living at home. Analysis of interview data showed that, by use of a multidimensional scale of disability, just over one-third of the sample could be classified as 'disabled'. The mobility status of the sample was, in general, good with only small numbers spending most of their time in a wheelchair. The total sample scored highly on activities of daily living, though those classified as disabled were significantly less independent. The mean number of reported health conditions was less than might have been expected in an elderly population. One-third of the subjects in the sample showed discrepancies between their own assessment of their disability and objective assessments. These discrepancies could partly be explained by a combination of individuals' assessment of their own abilities and their beliefs about factors influencing disability. Measures of disability, or activity associated with daily living, were related to perceptions of health, whereas the number of current health problems was not. The factors which determined perceptions of health or disability were: walking unaided and general levels of activity. Health was perceived in terms of what one could do rather than the presence of current diseases or conditions. The results suggested that when planning treatment for elderly people, physiotherapists and others should consider individual variability in perceptions of disability and health, as well as objective assessments. The importance of locomotion in the value systems of elderly people emphasises the high profile of physiotherapy in the care of elderly people.

A second case of microcephaly, microphthalmia, ectrodactyly (split-foot) and prognathism (MMEP)

In 1993, Viljoen and Smart described a woman with ectrodactyly of the feet, midline facial cleft, microphthalmia, and mental retardation in association with a de novo chromosome 6;13 translocation. We present a man with similar features who had a normal karyotype.

Comparative study of safety and efficacy of IUD insertions by physicians and nursing personnel in Brazil

To assess whether trained nursing personnel could provide IUD services as safely and effectively as physicians in Brazil, an experimental study was conducted at the main clinic of the Center for Research on Integrated Maternal and Child Care in Rio de Janeiro. From November 1984 through April 1986, a total of 1,711 women who requested IUD insertion at the clinic were randomly assigned to have a Copper-T 200 IUD inserted by one of the clinic's 11 physicians or 13 nurses. All of the physicians and nursing staff members who provided these services had taken the Center's standard clinical family planning training course. Of 860 insertions attempted by the physicians and nurses, 1.3% and 3.3%, respectively, were unsuccessful. Statistically, this difference was very significant (P < 0.01). Also, mainly because the cervix was small and undilated, nulliparous women had a relatively high insertion failure rate of 8.0%, as compared to 1.5% for primiparas and 1.0% for multiparas. The overall rate of complications at insertion was 1.8%, these complications including diaphoresis, vomiting, syncope, cervical laceration, and one case of perforation of the uterus; no significant difference was found between the complication rates for insertions performed by physicians as compared to nurses. However, 9.0% of the study subjects reported severe pain during IUD insertion, with significantly higher percentages reporting pain if the IUD was inserted by a physician, or if the subject was nulliparous, had preinsertion symptoms, or had a history of pelvic inflammatory disease (PID) or sexually transmitted disease (STD). It was also found that the nurses had a dramatically high insertion failure rate (11.6%) with nulliparous subjects, while the physicians' failure rate with such subjects was a significantly lower 3.4%. No significant difference was found in the groups served by nurses and physicians with regard to postinsertion complaints or termination of use within 12 months of insertion. These findings suggest that future training, besides preparing nursing personnel in IUD insertion, should emphasize preparation in taking the client's medical history and diagnosing existing medical symptoms that could be associated with IUD insertion complications. In addition, if a nulliparous woman requests an insertion, it should be performed by a physician or more experienced nursing staff member with close medical supervision. Because of high rates of reported pain at insertion, such women, as well as those with medical symptoms associated IUD insertion complications and those with a history of PID or STD, should be considered candidates for extra care and counseling.(ABSTRACT TRUNCATED AT 400 WORDS)

Pupils with special needs: a Scottish perspective

The distinction between ordinary and special schooling in Scotland was effectively erased by the Education (Scotland) Act of 1981. This Act recognizes that any pupil who requires extra support to succeed in a regular classroom is a child who has special education needs. Presently, all pupils who, for whatever reason, do not cope successfully at school are collectively referred to as children with learning difficulties. The term "learning difficulties" reflects a broader spectrum of problems than those characteristically found in the category of learning disabilities used in the United States. In cases of dyslexia, the term "specific learning difficulties" (a subgroup of learning difficulties) is also used. All special education provision in based on individual needs. A child's needs are interpreted in relation to a continuum of special education needs and in the context of his or her unique environment. For pupils with learning difficulties, the needs-assessment process is typically informal and rarely results in an official record of need being opened for them. A description of Grampian Region, one of the largest administrative units in northern Scotland, reveals how special educational practice is organized to respond to pupils with learning difficulties in the current educational climate.

The impact of recent policy changes on fertility, abortion, and contraceptive use in Romania

A national household survey of 4,861 women aged 15-44 on reproductive health issues was conducted in Romania in 1993. The survey provided the opportunity to study the impact of policy changes by comparing selected aspects of fertility, abortion, and contraceptive use before and after the December 1989 revolution, when the laws restricting abortion and contraceptive use were abolished. After abortion became legal, the total fertility rate dropped to below replacement level, while the induced abortion rate doubled. Contraceptive prevalence increased 20 percent, but augmentation of the use of traditional methods, rather than the change in legislation, accounted for 70 percent of the increase. Limited sex education and contraceptive information, mistrust and misinformation about modern methods, a lack of adequately trained providers, and a shortage or uneven distribution of contraceptive supplies are major reasons for the continued high rates of unintended pregnancy.

Unintended pregnancy and sex education in Chile: a behavioural model

This study analysed factors associated with unintended pregnancy among adolescent and young adult women in Santiago, Chile. Three variations of a behavioural model were developed. Logistic regression showed that the effect of sex education on unintended pregnancy works through the use of contraception. Other significant effects were found for variables reflecting socioeconomic status and a woman's acceptance of her sexuality. The results also suggested that labelling affects measurement of 'unintended' pregnancy.

Intravenous injection of irradiated Leishmania major into susceptible BALB/c mice: immunization or protective tolerance

It is well established that BALB/c mice can be protected from fatal infection with Leishmania major by prophylactic intravenous (i.v.) immunization with irradiated parasites. Protection is critically dependent on the route of injection with i.v. injection being protective and subcutaneous injection not protective. We used this BALB/c-L. major model system to investigate this phenomenon. We analyzed quantitatively the parasite-specific, CD4+ T cell mediated immune responses by limiting dilution. Subcutaneous vaccination resulted in priming of CD4+ precursor T cells, whereas i.v. vaccination was ineffectual. Moreover, i.v. injection prevented the increase in the number of specific precursor cells induced by infection of normal mice during the first weeks post-challenge with virulent parasites. We show here that this was not due to the elimination of the virulent challenge parasites as a result of immunity nor to inefficient antigen presentation of the irradiated organisms after i.v. injection. The data presented here suggest that i.v. injection results in tolerization rather than immunization. Tolerization as a mechanism of host protection is consistent with earlier observations that transient immunosuppression results in cure of L. major infection in BALB/c mice. Transfer of antigen presenting cells (APC) isolated from spleens of mice injected previously with irradiated parasites mimicked to some extent the effect of i.v. immunization with irradiated parasites. The possible involvement of these APC in decreasing the parasite-specific T cell response is discussed.

Gene for familial psoriasis susceptibility mapped to the distal end of human chromosome 17q

A gene involved in psoriasis susceptibility was localized to the distal region of human chromosome 17q as a result of a genome-wide linkage analysis with polymorphic microsatellites and eight multiply affected psoriasis kindreds. In the family which showed the strongest evidence for linkage, the recombination fraction between a psoriasis susceptibility locus and D17S784 was 0.04 with a maximum two-point lod score of 5.33. There was also evidence for genetic heterogeneity and although none of the linked families showed any association with HLA-Cw6, two unlinked families showed weak levels of association. This study demonstrates that in some families, psoriasis susceptibility is due to variation at a single major genetic locus other than the human lymphocyte antigen locus.