Maternal mood and anxiety effects on the fetal nonstress test

BACKGROUND

Previous studies have suggested that acute mood states may influence levels of fetal activity. Because the fetal nonstress test relies on markers of fetal activity to suggest fetal wellbeing, its interpretation may be affected by maternal mood.

OBJECTIVE

This study sought to determine if there are differences in nonstress test characteristics between pregnant individuals with and without symptoms of mood disorder.

STUDY DESIGN

In this prospective cohort study, we recruited pregnant individuals undergoing nonstress test in the third trimester and compared the results of the nonstress test between pregnant individuals with scores above and below the cutoff values on validated screening questionnaires for depression and anxiety symptoms, the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7-item scale (GAD-7). Demographic information was collected from each participant at the time of recruitment, and medical information was extracted from the electronic medical record.

RESULTS

A total of 68 pregnant individuals were enrolled, 10 (15%) of which screened positive for perinatal mood disorders. There was no significant difference in means of time to reactivity (15.6 [4.8] minutes vs 15.0 [8.0] minutes, P=.77), number of accelerations (0.16/min [0.08] vs 0.16/min [0.10], P>.95), number of fetal movements (17.0 [14.7] vs 19.7 [20.4], P=.62), heart rate baseline (138.0 [7.5] bpm vs 139.2 [9.0] bpm, P=.67) or variability (8.5 [2.5] bpm vs 9.1 (4.3) bpm, P=.51) between pregnant individuals who screen positive for mood disorders and those who did not.

CONCLUSION

Fetal heart rate patterns are similar in pregnant individuals with and without symptoms of mood disorder. The results provide reassurance that acute symptoms of anxiety and depression do not have significant effects on the fetal nonstress test.

A Case of Hemorrhagic Ovarian Cyst Rupture Necessitating Surgical Intervention

Despite the relatively high incidence of ovarian cysts, particularly in premenopausal women, cyst rupture may on occasion present painfully and require surgical intervention to resolve. Particularly in the case of ruptured hemorrhagic ovarian cysts, resulting hemoperitoneum can create a risk of further adverse events including hypovolemic shock; proper identification and management of such cases are therefore critical. This case focuses on a 22-year-old female that presented to the emergency department (ED) with suprapubic pain in the lower left quadrant of the abdomen. Ultrasonography and computed tomography of the abdomen and pelvis revealed a ruptured hemorrhagic corpus luteum cyst of the left ovary and secondary hemoperitoneum. Patient treatment required laparoscopic left ovarian cyst wall removal, with the removal of hemoperitoneum.

What Do Spanish Speakers Think of the Andar, Hablar, Ojos, Rostro, Ambos Brazos o Piernas (AHORA) Stroke Tool?

AHORA (Andar, Hablar, Ojos, Rostro, Ambos Brazos o Piernas) is a Spanish language tool to identify stroke symptoms. A survey of 300 primarily Spanish-speaking, non-medical professionals was conducted to assess the acceptance of the tool, specifically about ease of understanding and ability to implement it. The overwhelming majority of respondents reacted very positively to the tool, finding it quite easy to learn, teach, and understand. Respondent feedback, pitfalls, and questions for further research are presented.

0394 Differential Role of Sleep Problems on Depression and Suicide in Community Adolescents

Introduction

Sleep changes during adolescence, including “eveningness” or a preference for staying up late, decreased sleep hours, increased daytime sleepiness and irregular sleep patterns, can contribute to adolescent sleep disturbances, such as insomnia, daytime fatigue, and other sleep problems. The goals of the study were; 1) to examine the proportion of adolescents who experienced each type of sleep disturbances based on six sleep problems; and 2) to examine the association between six types of sleep disturbances and concurrent depression, suicide ideation, and suicide attempt at 12th grade.

Methods

Using the data from the Developmental Pathways Project (DPP), a community-based study in adolescence, total 425 students were included. Sequential logistic regression analyses were performed to examine the association between each sleep item and depression, suicide ideation, and lifetime history of suicide attempt.

Results

The most frequently reported sleep problems were ‘overtired without good reason (49.9%)’, ‘sleeps less than most kids (46.8%)’, and ‘sleep more than most kids (46.7%)’. After adjusting for depressive symptoms at baseline, 12th grade reports of ‘overtired without good reason’ (OR = 1.63, 95% CI = 1.22 - 2.17), ‘sleep less’ (OR = 2.03, 95% CI = 1.51 - 2.74), ‘trouble sleeping’ (OR = 1.50 95% CI = 1.10-2.06, p < .05), ‘nightmare’ (OR = 1.51, 95% CI = 1.12-2.02, p < .01) were significantly associated with depression. For suicide ideation (SI) and suicide attempt, ‘nightmare’ (OR = 1.68, 95% CI = 1.15 - 2.48; OR = 2.43 95% CI = 1.30 - 4.53, respectively) was significantly and positively associated with SI and having history of suicide attempt.

Conclusion

‘Nightmare’ has the strongest association with depression, suicide ideation, and suicide attempt. To disentangle the mechanism of the association between nightmares and mental health issues, longitudinal studies examining causal or bidirectional relationships of the mechanism are warranted.

Support

National Institutes of Mental Health and Drug Abuse, Nesholm Family Foundation, Seattle Children’s Hospital Outcomes Research Steering Committee, Loeb Family Foundation, Seattle Children’s Research Institute, University of Washington Office of the Provost, AETNA Foundation.

Disorders of Sex Development (DSD): Peer Relations and Psychosocial Well-Being

Social and emotional development is shaped by familial and extra-familial experiences especially interactions with peers. Children and adolescents with physical, behavioral or developmental differences, such as youth with disorders of sex development (DSD), may not benefit to the same degree as other children and adolescents from experiences with peers. This paper reviews current thinking about the features and effects of experiences with peers and the potential challenges of peer interactions for children and adolescents with DSD. We review findings from studies of adjustment for individuals with DSD. We finish the paper with a brief outline of a research agenda to promote the understanding of adjustment of individuals with DSD.

Heel bone densitometry: device specific thresholds for the assessment of osteoporosis

A diagnosis of osteoporosis is facilitated by bone mineral density (BMD) measurement of the lumbar spine and hip using dual energy X-ray absorptiometry (DXA), interpreted in accordance with criteria published by the World Health Organization (WHO). The use of peripheral DXA is growing in primary care and guidance on its use has recently been published by the National Osteoporosis Society (NOS), recommending a triage approach using thresholds specific to each type of peripheral device. However, no data currently exist for the Norland Apollo heel densitometer (Cooper Surgical, Trumbull, USA). 215 women between 50 years and 75 years of age (mean age 64.6 years) referred for hip and spine BMD measurements also had a heel BMD measurement. Device specific upper and lower thresholds were calculated for the Norland Apollo heel densitometer to give a 90% sensitivity and 90% specificity for osteoporosis at the hip or spine. Patients with a heel T-score of above -1.2 are very likely to have normal bone density on axial densitometry, whilst patients with heel T-score of below -2.2 are very likely to have osteoporosis at the hip or spine. Patients whose measurements lie between the thresholds should be referred for axial DXA.

Single-species models for many-species food webs

Most species live in species-rich food webs; yet, for a century, most mathematical models for population dynamics have included only one or two species. We ask whether such models are relevant to the real world. Two-species population models of an interacting consumer and resource collapse to one-species dynamics when recruitment to the resource population is unrelated to resource abundance, thereby weakening the coupling between consumer and resource. We predict that, in nature, generalist consumers that feed on many species should similarly show one-species dynamics. We test this prediction using cyclic populations, in which it is easier to infer underlying mechanisms, and which are widespread in nature. Here we show that one-species cycles can be distinguished from consumer resource cycles by their periods. We then analyse a large number of time series from cyclic populations in nature and show that almost all cycling, generalist consumers examined have periods that are consistent with one-species dynamics. Thus generalist consumers indeed behave as if they were one-species populations, and a one-species model is a valid representation for generalist population dynamics in many-species food webs.

Breast milk activity during early lactation following maternal 99Tcm macroaggregated albumin lung perfusion scan

A breast feeding infant may receive a radiation dose from ingestion of breast milk following the administration of a radiopharmaceutical to the mother. The Administration of Radioactive Substances Advisory Committee recommendation to interrupt breast feeding may not necessarily apply in the period of early lactation when colostrum is being produced. Following a lung scan using 99Tcm macroaggregated albumin (MAA) on a patient approximately 15 h post partum, radioactivity within breast milk was measured. Milk was expressed approximately every 4 h during the day and samples were counted. The sample radioactivity concentration peaked at 15 h and decayed monoexponentially (half clearance time was approximately 4.8 h). The estimated effective dose to the infant from ingestion alone, had breast feeding not been interrupted, was approximately 0.02 mSv. These data suggest that interruption to breast feeding may not be necessary following administration of up to the diagnostic reference level of 99Tcm MAA during early lactation.

Psychosocial development in adolescents with Turner syndrome

Turner syndrome is a genetic condition in which part or all of the second X chromosome is missing. Our goal in this study was to examine the psychosocial adjustment of a sample of adolescent girls with Turner syndrome. Subjects included 122 girls with a diagnosis of Turner syndrome (TS) and a control group of 108 girls with no genetic disorder or chronic illness. Subjects were 13 to 18 years of age. A battery of questionnaires assessing social, academic, school, and behavioral functioning was administered. TS girls were seen as having significantly more problems in terms of social relationships and school progress and were more likely to meet criteria for attention-deficit hyperactivity disorder than control girls. The TS girls were also rated by a parent as less socially competent (e.g., fewer friends, less time with friends) than the control group. Social difficulties appear to be an area of vulnerability for TS girls. Counseling individuals with Turner syndrome and their families about the need to carefully develop and nurture social skills and relationships may prove useful in advancing the social adaptation of these young women.

The discovery of sulfonylated dipeptides as potent VLA-4 antagonists

Directed screening of a carboxylic acid-containing combinatorial library led to the discovery of potent inhibitors of the integrin VLA-4. Subsequent optimization by solid-phase synthesis afforded a series of sulfonylated dipeptide inhibitors with structural components that when combined in a single hybrid molecule gave a sub-nanomolar inhibitor as a lead for medicinal chemistry. Preliminary metabolic studies led to the discovery of substituted biphenyl derivatives with low picomolar activities. SAR and pharmacokinetic characterization of this series are presented.

Habitat structure and population persistence in an experimental community

Understanding spatial population dynamics is fundamental for many questions in ecology and conservation. Many theoretical mechanisms have been proposed whereby spatial structure can promote population persistence, in particular for exploiter-victim systems (host-parasite/pathogen, predator-prey) whose interactions are inherently oscillatory and therefore prone to extinction of local populations. Experiments have confirmed that spatial structure can extend persistence, but it has rarely been possible to identify the specific mechanisms involved. Here we use a model-based approach to identify the effects of spatial population processes in experimental systems of bean plants (Phaseolus lunatus), herbivorous mites (Tetranychus urticae) and predatory mites (Phytoseiulus persimilis). On isolated plants, and in a spatially undivided experimental system of 90 plants, prey and predator populations collapsed; however, introducing habitat structure allowed long-term persistence. Using mechanistic models, we determine that spatial population structure did not contribute to persistence, and spatially explicit models are not needed. Rather, habitat structure reduced the success of predators at locating prey outbreaks, allowing between-plant asynchrony of local population cycles due to random colonization events.

Multiple dynamics in a single predator-prey system: experimental effects of food quality

Recent work with the freshwater zooplankton Daphnia has suggested that the quality of its algal prey can have a significant effect on its demographic rates and life-history patterns. Predator-prey theory linking food quantity and food quality predicts that a single system should be able to display two distinct patterns of population dynamics. One pattern is predicted to have high herbivore and low algal biomass dynamics (high HBD), whereas the other is predicted to have low herbivore and high algal biomass dynamics (low HBD). Despite these predictions and the stoichiometric evidence that many phytoplankton communities may have poor access to food of quality, there have been few tests of whether a dynamic predator-prey system can display both of these distinct patterns. Here we report, to the authors' knowledge, the first evidence for two dynamical patterns, as predicted by theory, in a single predator-prey system. We show that the high HBD is a result of food quantity effects and that the low HBD is a result of food quality effects, which are maintained by phosphorus limitation in the predator. These results provide an important link between the known effects of nutrient limitation in herbivores and the significance of prey quality in predator-prey population dynamics in natural zooplankton communities.

Autonomy and relatedness in family interactions with depressed adolescents

This study investigated family interaction patterns associated with adolescent depression. Twenty adolescent-mother dyads with clinically depressed adolescents participated in the study. Twenty dyads with externalizing youths and 20 nonclinic dyads were included as controls. Dimensions of autonomy and relatedness were rated during a videotaped mother-adolescent problem-solving task. Adolescent perceptions of parent attachment were also evaluated. Results indicated that depressed adolescents and their mothers did not differ in their behavior compared with nonclinic adolescents. Dyads with externalizing adolescents showed the highest impairment in autonomy and relatedness. Depressed adolescents perceived the quality of their relationships with their parents to be impaired relative to nonclinic dyads, as did externalizing adolescents.

Nutritional constraints in terrestrial and freshwater food webs

Biological and environmental contrasts between aquatic and terrestrial systems have hindered analyses of community and ecosystem structure across Earth's diverse habitats. Ecological stoichiometry provides an integrative approach for such analyses, as all organisms are composed of the same major elements (C, N, P) whose balance affects production, nutrient cycling, and food-web dynamics. Here we show both similarities and differences in the C:N:P ratios of primary producers (autotrophs) and invertebrate primary consumers (herbivores) across habitats. Terrestrial food webs are built on an extremely nutrient-poor autotroph base with C:P and C:N ratios higher than in lake particulate matter, although the N:P ratios are nearly identical. Terrestrial herbivores (insects) and their freshwater counterparts (zooplankton) are nutrient-rich and indistinguishable in C:N:P stoichiometry. In both lakes and terrestrial systems, herbivores should have low growth efficiencies (10-30%) when consuming autotrophs with typical carbon-to-nutrient ratios. These stoichiometric constraints on herbivore growth appear to be qualitatively similar and widespread in both environments.

Family reinforcement of illness behavior: a comparison of adolescents with chronic fatigue syndrome, juvenile arthritis, and healthy controls

Parental encouragement of illness behavior is hypothesized to correlate with psychosocial dysfunction in adolescents with chronic illness. To explore this hypothesis, adolescents aged 11 to 17 years with chronic fatigue syndrome (CFS) (n = 10), juvenile rheumatoid arthritis (JRA) (n = 16), and healthy adolescents (n = 14) were recruited for the study. Measures included the Achenbach parent and youth self report forms, the Family Adaptability and Cohesion Evaluation Scale-II (FACES II), the Children's Depression Rating Scale, and number of days absent from school. The Illness Behavior Encouragement Scale (IBES) generated measures of parental reinforcement of illness behavior. As predicted, the teens with CFS scored statistically higher on measures of depression, total competence, and number of days of school missed in the previous 6 months (mean = 40). Children with JRA scored significantly lower than the CFS group on the measure of parental reinforcement of illness behavior. The healthy group produced intermediate scores. Results and implications for future clinical and research activity are discussed.

Neurodevelopmental and psychosocial aspects of Turner syndrome

Turner syndrome (TS) is the complex phenotype of human females with complete or partial absence of the second sex chromosome, or monosomy X. A characteristic neurocognitive and psychosocial profile has also been described in TS females. Typically, specific deficits in visual-spatial/perceptual abilities, nonverbal memory function, motor function, executive function, and attentional abilities occur in TS children and adults of varying races and socioeconomic status. TS-associated psychosocial difficulties occur in the areas of maturity and social skills. We hypothesize that a subset of the neurocognitive deficits (visual-spatial/perceptual abilities) are genetically determined and result from abnormal expression of one or more X chromosome genes. In addition, a different subset of these neurocognitive deficits (memory, reaction time, and speeded motor function) result from estrogen deficiency and are at least somewhat reversible with estrogen treatment. The TS-associated psychosocial problems are most likely linked to these core neurocognitive deficits and do not reflect a separate and independent component of the syndrome. Turner syndrome research has progressed significantly over the last decade. The field has moved from descriptive reports based on single individuals or small clinical samples to the use of experimental designs with larger, more diverse and representative samples. This degree of variability among individuals with Turner syndrome in all domains (karyotype or genetic constitution, physical attributes, neurocognitive and social functioning) suggests the need to identify risk and protective factors contributing to the heterogeneity in the phenotype. Active education about TS and participation in patient advocacy groups such as the Turner Syndrome Society of the United States (http://www. turner-syndrome-us.org/) has provided new information for TS adults and families as well as a supportive peer group. MRDD Research Reviews 2000;6:135-141.

Changes in esophageal function after vertical banded gastroplasty as demonstrated by esophageal scintigraphy

BACKGROUND

The effects of surgery for morbid obesity on the function of the upper gastrointestinal (GI) tract are of interest to bariatric surgeons. This study was undertaken to determine any changes in esophageal function, following vertical banded gastroplasty (VBG) in morbidly obese patients, as detected by esophageal scintigraphy.

METHODS

Ten consecutive morbidly obese patients (six female and four male) underwent preoperative esophageal scintigraphy and upper GI endoscopy. These investigations were repeated 12 months after VBG to coincide with expected appreciable weight reduction. The results were tabulated together with body mass indices, crude weights and percentage excess weight lost.

RESULTS

Before VBG one patient gave a history of mild heartburn, one had mild dyspepsia and the remaining eight patients had no GI symptoms. No patient had a hiatus hernia or endoscopic evidence of reflux esophagitis. Preoperatively all patients had abnormal scintiscans. The abnormalities were esophageal retention (all) and intraesophageal reflux (five out of 10 patients). Gastroesophageal reflux was not identified in any patient. Postoperatively scintiscans were normal or improved in six out of 10 patients and unchanged in four out of 10 patients. In three patients the scans were normal and three showed overall improvement in esophageal function, although in one of these latter patients gastroesophageal reflux was observed.

CONCLUSIONS

In this series of morbidly obese patients, esophageal function as assessed by scintigraphy was abnormal. Following VBG it improved in six out of 10 patients and was unchanged in four out of 10. However, in one patient, who had shown an overall improvement in esophageal function, gastroesophageal reflux was demonstrated when it had not been seen preoperatively. This was asymptomatic. Thus, adverse changes in esophageal function after VBG were uncommon.

Pattern Formation and the Spatial Scale of Interaction between Predators and Their Prey

We study interactions of predators and prey that are characterized by a scale difference in their use of space. Prey are assumed to occupy patches, forming a metapopulation with low migration among patches. Predators are homogeneously distributed over these patches, due to broad-scale foraging behavior or long-range juvenile dispersal. The predator population thus exerts a globally uniform predation pressure on the prey subpopulations. Under these conditions a nonlinear predator functional response depending on local prey density leads to multiple equilibria that can occur for the same parameter values. These equilibria differ in the fraction of prey patches that are (nearly) empty. Equilibria with a larger fraction of empty prey patches are more stable. The system tends to approach equilibria with a sufficiently high number of empty prey patches, so that local and global population dynamics are stable. If unstable dynamics are observed at all, the fluctuations in local prey density exhibit predictable characteristics. Our main conclusion is that a nonlinear functional response of the predator to local prey density can induce the formation of static patterns in prey density and, hence, lead to stable local and global dynamics. It is shown that these results are sufficiently general to carry over to situations in which prey migration between patches does occur or the spatial domain occupied by the prey population is continuous instead of subdivided into patches. Copyright 1998 Academic Press.

Oestrogens and psychological well-being

The last decade has seen increased interest in the role of hormones, including oestrogens, not only in regulating growth, sexual development and reproduction but in maintaining a sense of psychological well-being. Episodes of change in oestrogen levels, whether increasing or decreasing, are high-risk periods for the emergence of psychological symptoms in some women. This may be due to a 'kindling effect' for women with previous psychological disturbance, an effect on circadian rhythm activity and therefore altered neurovegetative functions, or an effect on central rhythmic functioning between the hypothalamus and the cerebral cortex, all mediated by effects on neurotransmitter systems. Data supporting these hypotheses come from animal studies as well as converging research in several areas including the study of psychological side-effects of oral contraceptives, the study of mood and cognitive disturbances related to the menstrual cycle, the studies of states of hormonal change such as pregnancy and the menopause and, of course, studies of women with psychiatric disorders such as major depression, seasonal affective disorder and dementia. Improvement in such symptoms via hormonal therapies or other interventions will probably lead to better quality of life for women and may actually impede the deterioration associated with ageing and certain medical illnesses. Current data support a relationship between oestrogen and psychological well-being.

Active-site structure analysis of recombinant human inducible nitric oxide synthase using imidazole

Nitric oxide synthase catalyzes the pyridine nucleotide-dependent oxidation of L-arginine to nitric oxide and L-citrulline. It is a specialized cytochrome P450 monooxygenase that is sensitive to inhibition by imidazole. Steady-state kinetic studies on recombinant human inducible nitric oxide synthase (rH-iNOS) demonstrate that imidazole and 1-phenylimidazole are competitive and reversible inhibitors versus L-arginine. Structure-activity relationship and pH dependence studies on the inhibition suggest that the neutral form of imidazole may be the preferred species and that the only modifications allowed without the loss of inhibition are at the N-1 position of imidazole. Optical spectrophotometric studies of rH-iNOS with imidazole and 1-phenylimidazole yielded type II difference spectra exhibiting Kd values of 63 +/- 2 and 28 +/- 3 microM, respectively. These values were in good agreement with the steady-state Ki of 95 +/- 10 and 38 +/- 4 microM, respectively, and confirms the site of binding is at the sixth axial ligand of the heme. Imidazole (2.2 mM) also perturbed the Kd of L-arginine from 3.03 +/- 0.45 to 209 +/- 10 microM. The observed increase in the Kd for L-arginine is consistent with imidazole being a competitive inhibitor versus L-arginine. The IC50 values of imidazole and 1-phenylimidazole were lower in the absence of exogenous BH4, and both inhibitors also competitively inhibited the BH4-dependent activation of the enzyme. These data taken together suggest that the L-arginine, dioxygen, and the BH4 binding sites are in close proximity in rH-iNOS. Furthermore, these studies demonstrate the usefulness of imidazole compounds as active site probes for recombinant human iNOS.

Individual Energetics and the Equilibrium Demography of Structured Populations

This paper considers the relationship between the demographic mechanisms of population control and the energetics of the individuals who comprise the population. We examine the equilibrium properties of a class of structured population models in which individuals compete for some environmental resource (such as food) and demonstrate that population demography is independent of the nature of the feedback loop which establishes the equilibrium state. We thus derive general insights into the influence exerted by individual energetic and allocation strategies on population average demographic characteristics. We show that models of individual energetics which produce apparently very similar predictions at the individual level can result in very different behaviour at the population level. In addition, we observe that different models of individual mortality can imply marked differences in population demography and that the common assumption of constant mortality can be responsible for potentially unrealistic model behaviour. Our results emphasise the substantial data requirements for parameterising and testing individual-based models.

Self-concept and behavior in adolescent girls with Turner syndrome: potential estrogen effects

Data on self-concept and behavior were gathered from 31 girls with Turner syndrome (TS) followed longitudinally between the ages of 12 and 16 and from 89 normal control girls recruited from public schools and assessed cross-sectionally. The two groups of girls were similar in age and racial composition. The girls with TS were treated with estrogen replacement therapy in increasing doses between the ages of 12 and 16 (100-400 ng/kg-day ethinyl estradiol). Their self-reported self-esteem and psychological well-being (Piers-Harris Self-Concept Scale) revealed significant improvement over time for most scales as well as the total score (P < 0.001). Parents reported improvement in problem behaviors, as reflected in the Child Behavior Checklist (CBCL) scales: Behavior Total, Externalizing Behavior, Aggressive Behavior, and Social Problems Behavior scales (all P < 0.001). Analysis of covariance comparing normal controls to the TS subjects revealed that at age 12 yr, TS and normal subjects differed significantly for the School Social Competency sub-scale and the Social Problems Behavior subscale (all P < 0.001). Girls with TS resembled the normal controls on all CBCL scales by ages 14-15 yr. Thus, we found improved self-concept both by self- and parental report in estrogen-treated girls with TS followed longitudinally through adolescence. An analogous correlation with age was not seen in the cross-sectional normal control sample. These findings support positive effects of estrogen on psychological well-being in girls with TS and underscores the need to initiate estrogen replacement therapy by ages 12-14 yr in this population.

Oxandrolone therapy in constitutionally delayed growth and puberty. Bio-Technology General Corporation Cooperative Study Group

BACKGROUND

Male adolescents with constitutional delay of growth and puberty may have significant psychosocial difficulties related to their sexual immaturity and short stature. The purpose of this study was to test the hypothesis that 1 year of oxandrolone therapy would increase growth velocity and thereby improve psychosocial functioning in boys with constitutional delay of growth and pubertal development.

METHODS

Forty boys (ages 11 to 14.7 years) with delayed pubertal development and short stature were recruited from the pediatric endocrine clinics of 14 medical centers. The boys were randomized using a block design stratified for age to receive either oxandrolone (0.1 mg/kg daily for 1 year) or an identical-appearing placebo tablet, using a double-masked design.

RESULTS

Growth velocity in the oxandrolone-treated boys was significantly greater than in the control boys (9.5 vs 6.8 cm/y). Likewise, the mean height SD score increased 0.41 in the oxandrolone group, whereas it decreased 0.03 in the control group. Those in the oxandrolone group gained 2.4 kg more than those in the placebo group. Mean predicted adult heights did not change in either group. The mean rates of pubertal progression were equivalent in both groups. Self-image (Piers-Harris Self Concept Scale) and social competence (Child Behavior Profile) were normal at baseline in both groups and did not change significantly over the course of the study in either group. No complications of oxandrolone therapy were identified.

CONCLUSIONS

This randomized, placebo-controlled trial demonstrates that low-dose oxandrolone can increase both height and weight velocity in boys with delayed puberty safely. Under the conditions of this study, however, the increased growth velocity in the oxandrolone-treated boys was not associated with a greater improvement in psychosocial status compared with the control boys.

Self-esteem and behavior in girls with Turner syndrome

Data on social competence, behavior, and self-esteem were gathered from a large sample of girls with Turner syndrome to determine whether psychological difficulties were associated with Turner syndrome. Subjects included 97 girls with Turner syndrome, 7 to 14 years of age, and 93 girls without Turner syndrome recruited from public schools. The two groups of girls were similar in age, verbal intelligence scores, and racial composition. The girls with Turner syndrome were found, based on both parental and self-report, to be more immature than the girls in the comparison group, with weaker social relationships, school performance, and self-esteem. A decline in self-esteem was also documented for the girls with Turner syndrome, but not the comparison group, as they moved into early adolescence. Although the findings support an increased risk for subtle behavioral problems among girls with Turner syndrome, in most cases the problems endorsed were not severe enough to suggest clinical impairment.

Psychosocial and sexual functioning in women with Turner syndrome

Survey data on the sexual and social functioning of 80 adult women with Turner syndrome are described, as well as data regarding health status and self-concept. Each woman completed the Tennessee Self-Concept Scale, sections of the Derogatis Sexual Functioning Inventory, and a questionnaire covering a wide range of demographic and medical information. The women with Turner syndrome reported lower self-concept compared to a normative sample. Sexual attitudes, gender role identity, and body image were assessed. The women with Turner syndrome tended to exhibit more conservative sexual attitudes and a more negative body image. In contrast to a normative sample, the women with Turner syndrome were less likely to have been sexually active. In addition, those currently involved in a stable relationship reported a lower frequency of sexual intercourse compared to a normative sample, although they generally reported moderate to high levels of sexual satisfaction. Regression analyses revealed that health status was associated with self-concept, and that sexual satisfaction was related to both a higher frequency of intercourse and a higher self-reported health status.

Food-dependent aggregation and mobility of the water fleas Ceriodaphnia dubia and Daphnia pulex

In this paper, we show that two freshwater cladoceran zooplankters (Ceriodaphnia dubia and Daphnia pulex) differ in swimming speed and ability to locate local regions of high food concentration in a flow-through circular chamber. This comparison is of general interest, since models of spatially structured predator–prey dynamics have predicted that differences in individual mobility and foraging behaviour may affect spatial distributions and, consequently, population dynamics. Daphnia pulex was more mobile than C. dubia, and also located the high end of a food gradient while C. dubia did not. It seems likely that the mechanisms used by D. pulex to locate these regions are related to ingestion and (or) filtering rates. It was hypothesized that individuals reduce their swimming speed in order to linger in regions of high food concentration. Differences in mobility and behaviour between C. dubia and D. pulex were used to generate hypotheses about the distribution and stability of their respective populations. Specifically, it was predicted that C. dubia populations would have a more aggregated and, consequently, a more stable population in smaller environments than D. pulex.

L-741,494, a fungal metabolite that is an inhibitor of interleukin-1 beta converting enzyme

gamma-Pyrone-3-acetic acid (L-741,494) is a novel metabolite produced by a culture of the fungal genus Xylaria. This substance is a water-soluble, competitive, irreversible inhibitor of Interleukin-1 beta Converting Enzyme that is inactive against papain and trypsin. It has a mol wt of 154 and an empirical formula of C7H6O4. We propose the name xylaric acid for this compound.

Depression in young people: initial presentation and clinical course

OBJECTIVE

This project was designed to provide prospective data on the clinical presentation and longitudinal course of depression in children and adolescents.

METHOD

Children and their parent(s) completed a structured diagnostic interview (Schedule for Affective Disorders and Schizophrenia for School Age Children) at intake, and then yearly for 3 years. Collateral data were collected on school, social, and family functioning.

RESULTS

Mean length of initial depressive episode was 35.6 weeks, SD of 26 weeks. Of the 65 depressed youths who completed the 3-year follow-up, 35 (54%) disclosed another episode of depression. Demographic, family-environment, and diagnostic variables were explored as predictors of characteristics of initial episode, recurrence of depression, and psychosocial competence at follow-up. Female gender and presence of a coexisting anxiety disorder were significantly related to severity of initial depression. Family environment was the only predictor significantly related to overall psychosocial competence over 3 years.

CONCLUSIONS

The findings confirm depression in youth as a valid clinical phenomenon, with substantial risk of recurrence. Increased levels of stress in the family environment were associated with poorer overall outcomes.

The 3-year longitudinal course of suicidality and predictive factors for subsequent suicidality in youths with major depressive disorder

This study followed the course of suicidal thoughts and behaviors in youths 7 to 17 years of age who recently experienced an episode of major depression. Suicidal was expressed by 72% of the youths at some time during the study. These predominantly outpatient youths tended to be suicidal on multiple occasions, but their severity of suicidality did not increase over time. Three variables at presentation predicted later suicidality: severity of initial suicidality, anger, and age. These results suggest that milder forms of suicidality represent a feature of depression rather than characterizing a subgroup of high-risk depressed youths. The results also suggest that suicidality and anger may mark a predominantly irritable form of depression as youths mature.

The role of somatic complaints in the diagnosis of depression in children and adolescents

The question of whether somatic complaints are a significant feature of depression independent of anxiety was explored. Structured interview (Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children) and Child Behavior Checklist data from depressed and nondepressed psychiatric controls were analyzed to explore the interaction of somatic complaints, anxiety, and depression. Seventy percent of the children who met criteria for depression also had significant somatic complaints in contrast to 34% of the controls. Findings revealed that frequency of somatic complaints increased with severity of depression regardless of coexisting anxiety.

Risks for suicidality in major depressive disorder

This investigation developed a hierarchical multiple regression model to assess the potential risk factors for suicidality in youths 7 to 17 years old. Variables were assessed in three domains: self-perceptions, demography and diagnosis, and home/environment. The model controlled for major depressive disorder (MDD), which has confounded previous investigations, by evaluating potential risks in a diagnostically heterogenous sample, and then evaluating these risks in a subsample with MDD. Conduct problems and depressive thinking emerged as the most powerful predictors in both samples. Hopelessness, life stress, and maternal psychopathology predicted suicidality only in the total sample. Separation anxiety protected MDD youths. These results suggest that suicidal MDD youths may comprise a distinct subgroup of depressed youths.

Parent and peer attachment in early adolescent depression

Insecure attachment relations have been theorized to play a significant role in the development of depressogenic modes of adaptation and to thus form a vulnerability factor for the emergence of depressive disorder in children. This study examined security of parent and peer attachment among four groups of early adolescents: clinically depressed, nondepressed psychiatric controls, nonpsychiatric controls, and adolescents with resolved depression. Depressed adolescents reported significantly less secure parent attachment than either of the control groups, and less secure peer attachment than the nonpsychiatric control group. Attachment security of adolescents with resolved depression was on a par with the nonpsychiatric control group. Among all psychiatric patients, security of attachment to parents was negatively correlated with severity of depression according to interview and self-report ratings. Less secure attachment to parents, but generally not to peers, was also related to more maladaptive attributional styles, presence of separation anxiety disorder, and history of suicidal ideation.

Disorders of sexual differentiation and development. Psychological aspects

Children with abnormalities in sexual differentiation and development can have a smooth course of psychosocial development in spite of the significant risks and challenges they face. Chances for a positive emotional outcome are made more likely by the careful handling of these patients at the time of first presentation. Parents' unambiguous acceptance of the child's sex of rearing and early surgical intervention to normalize the child's external genital appearance are critical elements in a positive outcome. Further, the patterns of behavior documented in the materials reviewed in this article suggest difficulties of immaturity and social development rather than significant psychopathology. Parent-child interactions were repeatedly found to be central to the child's emotional well-being, underscoring the need to provide parents with adequate counsel and support. These patterns, however, represent findings across groups of patients and cannot predict the emotional, social, or academic functioning of any individual. Within all these clinical syndromes there is great individual variation in social, emotional, and physical presentation. Finally, rather than minimizing problems, physicians need to educate parents so they can be active advocates for their children in the educational and social arenas.

Psychopathology in parents of depressed children and adolescents

One hundred and seventeen biological mothers and 63 biological fathers of depressed and nondepressed, psychiatrically disturbed children and adolescents were interviewed with the Schedule for Affective Disorders and Schizophrenia-Lifetime Version. Diagnostic information was also obtained on 54 biological fathers who were unavailable for interview. Histories of depressive disorders and other forms of psychopathology were reported at high rates in the parents. Major depression was the most commonly reported disorder in interviewed parents of both sexes, but it was reported more often in mothers. Substance abuse and antisocial pathology was more prevalent in fathers. Depression in parents did not distinguish depressed from nondepressed probands, but maternal history of anxiety disorders, alcoholism and/or drug abuse, and suicidality did. Depressed probands were more likely than their nondepressed peers to have two parents with histories of depression. Mothers of younger patients had more substance abuse and suicidality in their histories than mothers of adolescents. They also reported earlier age of onset of depression and earlier age of entry into treatment.

The Turner syndrome: cognitive deficits, affective discrimination, and behavior problems

Individuals with sex chromosomal anomalies are known to be at increased risk for learning problems and in some cases social or behavioral problems. Girls with an absent or structurally abnormal second sex chromosome (the Turner syndrome) have been found to have cognitive problem solving deficits and immature, inadequate social relationships. The present study attempted to link cognitive and social problems by assessing the girls' ability to process affective cues. 17 girls with karyotypes consistent with a diagnosis of Turner syndrome were compared to a group of 16 short-stature girls of comparable age, verbal intelligence scores, height, and family socioeconomic status on the Affective Discrimination Task, which required interpretation of affective intention from facial expression. The results revealed that the Turner syndrome girls were less accurate at inferring facial affect than the short-stature controls. Analyses revealed that the Turner syndrome girls performed more poorly on spatial, attentional, and short-term memory cognitive tasks and had more psychosocial problems than the short-stature controls. Ability to discriminate facial affect may be another area of cognitive weakness for girls with the Turner syndrome and may underlie the psychosocial problems found in this sample.