Maternal hypertensive disorders of pregnancy and depression or anxiety in adolescence: Findings from the Millennium Cohort Study

BACKGROUND

The short-term effects of hypertensive disorders of pregnancy (HDP) on the health of the fetus are well known; however, their impacts on the risk of mental health in the exposed offspring are not fully understood. Our aim was to examine the association between HDP and depression/anxiety at age 17 years.

METHODS

We used data from The Millennium Cohort Study, a nationally representative longitudinal study of children born in the United Kingdom. Data on HDP and potential confounders were collected when children were 9-months. Data on depression and anxiety were collected as one variable when children were aged 17 years using self-reported doctor diagnosis, and reclassified as depression/anxiety (overall), depression/anxiety with treatment, and depression/anxiety without treatment. Crude and adjusted logistic regression models were performed to examine the association between HDP and depression/anxiety, adjusting for several maternal and socio-economic factors.

RESULTS

There were 9517 singleton mother-child pairs included in the analyses. Adjusted logistic regression suggested an association between HDP and depression/anxiety (adjusted odds ratio, (aOR):1.30 [95 % CI, 1.02-1.66]) at age 17 years. A similar association was observed for HDP and depression/anxiety with treatment (aOR:1.33 [95 % CI, 1.01-1.73]) and HDP and depression/anxiety without treatment (aOR: 1.30 [95 % CI, 0.80-2.12]), although the latter did not reach statistical significance.

LIMITATIONS

Data on severity and classifications of HDP were not available.

CONCLUSION

Exposure to HDP may be associated with an increased likelihood of depression or anxiety at age 17 years. Future research should consider severity and different classifications of HDP.

321 UNMET NEEDS AFTER STROKE

Background

Unmet needs, such as lack of access to rehabilitation, support and information, are experienced by a high proportion of stroke survivors after discharge from acute and rehabilitation services. The UK guidelines on stroke (2016) recommend that all patients should be offered a structured health and social care review at 6 months post-stroke. However, no such clinics exist to date in Ireland. We aimed to explore the extent of unmet needs in the catchment area of a large teaching hospital.

Methods

A random selection of patients 6-months post-stroke were contacted by telephone and unmet needs were assessed using a validated tool, Post-Stroke Checklist. Following analysis of data, the need for a pilot clinic was identified. A separate random selection of patients discharged from acute services 6 months previously were invited to attend a review clinic. Patients were assessed using an adapted version of the Greater Manchester Stroke Assessment Tool. Assessments were conducted jointly by a physiotherapist and a speech and language therapist, and appropriate onward referrals were made.

Results

Telephone clinic: 51 patients completed the checklist. The most prevalent symptoms reported were fatigue (75%), reduced participation in hobbies and activities, decline in cognition (61%) and mobility problems (59%). Review clinic: 21 patients attended. The most prevalent symptoms reported were reduced memory/concentration (71%), low mood (71%), unintentional weight loss/gain (62%), and reduced mobility (43%). Onward referrals were made for in 16/21 (76%) cases; physiotherapy (n=12), occupational therapy (n=7), speech and language therapy (n=7), clinical nutrition (n=5), social work (n=7), psychology (n=5).

Conclusion

Data from this exploratory study supports previous research indicating a high number of stroke survivors with unmet needs. This highlights the importance of establishing post-acute stroke review clinics and pathways in the Irish setting.

The effect of photoperiod on life history and blood-feeding activity in Aedes albopictus and Aedes aegypti (Diptera: Culicidae)

Several studies have examined how climatic variables such as temperature and precipitation may affect life history traits in mosquitoes that are important to disease transmission. Despite its importance as a seasonal cue in nature, studies investigating the influence of photoperiod on such traits are relatively few. This study aims to investigate how photoperiod alters life history traits, survival, and blood-feeding activity in Aedes albopictus (Skuse) and Aedes aegypti (Linnaeus). We performed three experiments that tested the effects of day length on female survival, development time, adult size, fecundity, adult life span, and propensity to blood feed in Ae. albopictus and Ae. aegypti. Each experiment had three photoperiod treatments: 1) short-day (10L:14D), 2) control (12L:12D), and 3) long-day (14L:10D). Aedes albopictus adult females were consistently larger in size when reared in short-day conditions. Aedes aegypti adult females from short-day treatments lived longer and were more likely to take a blood meal compared to other treatments. We discuss how species-specific responses may reflect alternative strategies evolved to increase survival during unfavorable conditions. We review the potential impacts of these responses on seasonal transmission patterns, such as potentially increasing vectorial capacity of Ae. aegypti during periods of shorter day lengths.

Managing boxer's fracture: a literature review

Boxer's fractures are commonly seen in emergency departments (EDs) but how these injuries are managed varies widely. This article reports on the results of a literature review of management strategies and the development of a boxer's fracture care pathway in a London ED.

ATLANTIC DIP: pregnancy outcomes for women with type 1 and type 2 diabetes

ATLANTIC DIP prospectively evaluated the perinatal and maternal outcomes of pregnancies complicated by Type 1 and Type 2 diabetes during 2006/2007 in 5 antenatal centres. All women with established diabetes for at least 6 months prior to the index pregnancy and booking for antenatal care between 1/1/2006 and 31/12/2007 were included in the study. Results were collected electronically via the DIAMOND Diabetes Information System. Pregnancy outcome was compared with that of the background population receiving antenatal care in the region during the same time. There were 104 singleton pregnancies during the period of study. The stillbirth rate (SBR) of 25/1000 was 5 times greater than that reported in the background population at 5/1000 and the perinatal mortality rate (PMR) of 25/1000 was 3.5 times greater than background 7/1000. The congenital malformation rate (CMR) of 24/1000 was twice that observed in the background population. Women were not well prepared for pregnancy with 28% receiving pre pregnancy care (PPC), 43% receiving pre pregnancy folic acid and 51% achieving a HbA1C < = 7% at first antenatal visit. Pregnancy induced hypertension (PIH) and/or pre eclampsia toxaemia (PET) were three times more common than in women in the background population. In conclusion women are not well prepared for pregnancy. Maternal and infant morbidity and infant mortality are greater in women with diabetes. A regional pre pregnancy care (PPC) programme and centralised glucose management are urgently needed.

Bringing “simple steps” -a multimedia package for autism specific behaviour therapy- to Europe

Individualised behavioural interventions are known to promote development, enhance skills and communication and reduce rigid and stereotypical patterns in children with autism spectrum disorder especially if they start in early pre-school age and are offered in high intensity. In many countries, however, these interventions are not available to families with autistic children. This may be due to lack of funding, lack of qualified staff and/or insufficient traditions of evidence-based procedures in institutions working with autistic children.

Facing this situation, the European Union Leonardo Transfer of Innovation Programm funded the adaptation and localisation of a highly successful Northern Irish multimedia tool for England and Scotland, Norway, Spain and Germany.

The multimedia package consists of a brochure with basic information on ASD, diagnostics and intervention. In addition, a DVD offers expert interviews, parents’ testimonials and an introduction to autism specific behavioural therapy, well established as Autism Applied Behaviour Analysis in the anglo-american countries. An accompanying CD-ROM contains additional background information and practical tools for therapy implementation.

It can be used by parents, kindergarten and school special needs staff and therapeutic institutions for education and for therapy planning and evaluation. In Germany, Spain, Norway and the UK it is offered free of charge under EU funding.

FC05-03 - Bringing “simple steps” -a multimedia package for autism specific behaviour therapy- to Europe

Individualised behavioural interventions are known to promote development, enhance skills and communication and reduce rigid and stereotypical patterns in children with autism spectrum disorder especially if they start in early pre-school age and are offered in high intensity. In many countries, however, these interventions are not available to families with autistic children. This may be due to lack of funding, lack of qualified staff and/or insufficient traditions of evidence-based procedures in institutions working with autistic children.

Facing this situation, the European Union Leonardo Transfer of Innovation Programm funded the adaptation and localisation of a highly successful Northern Irish multimedia tool for England and Scotland, Norway, Spain and Germany.

The multimedia package consists of a brochure with basic information on ASD, diagnostics and intervention. In addition, a DVD offers expert interviews, parents' testimonials and an introduction to autism specific behavioural therapy, well established as Autism Applied Behaviour Analysis in the anglo-american countries. An accompanying CD-ROM contains additional background information and practical tools for therapy implementation.

It can be used by parents, kindergarten and school special needs staff and therapeutic institutions for education and for therapy planning and evaluation. In Germany, Spain, Norway and the UK it is offered free of charge under EU funding.

A transfer of functions through derived arbitrary and nonarbitrary stimulus relations

During Experiments 1 and 2, subjects were trained in a series of related conditional discriminations in a matching-to-sample format (A1-B1, A1-C1 and A2-B2, A2-C2). A low-rate performance was then explicitly trained in the presence of B1, and a high-rate performance was explicitly trained in the presence of B2. The two types of schedule performance transferred to the C stimuli for all subjects in both experiments, in the absence of explicit reinforcement through equivalence (i.e., C1 = low rate and C2 = high rate). In Experiment 2, it was also shown that these discriminative functions transferred from the C1-C2 stimuli to two novel stimuli that were physically similar to the C stimuli (SC1 and SC2, respectively). For both these experiments, subjects demonstrated the predicted equivalence responding during matching-to-sample equivalence tests. In Experiments 3 and 4, the conditional discrimination training from the first two experiments was modified in that two further conditional discrimination tasks were trained (C1-D1 and C2-D2). However, for these tasks the D stimuli served only as positive comparisons, and ND1 and ND2 stimuli served as negative comparisons (i.e., C1 x ND1 and C2 x ND2). Subsequent to training, the negatively related stimuli (ND1 and ND2) did not become discriminative for the schedule performances explicitly trained in the presence of B1 and B2, respectively. Instead, the ND1 stimulus became discriminative for the schedule performance trained in the presence of B2, and ND2 became discriminative for the schedule performance trained in the presence of B1. All subjects from Experiment 4 showed that the novel stimulus SND1, which was physically similar to ND1, became discriminative for the same response pattern as that controlled by ND1. Similarly, SND2, which was physically similar to ND2, became discriminative for the same response pattern as that controlled by ND2. Subjects from both Experiments 3 and 4 also produced equivalence responding on matching-to-sample equivalence tests that corresponded perfectly to the derived performances shown on the transfer of discriminative control tests.

Separating response dependency and response-reinforcer contiguity within a recycling conjunctive schedule

A procedure is described which disrupts response-reinforcer contiguity and response dependency and which demonstrates how the location of the response dependency in interval schedules can be regarded as a controlling variable in its own right. Rats' lever pressing produced sucrose on a recycling conjunctive fixed-time 30-second fixed-ratio 1 schedule of reinforcement. Reinforcement occurred only at the end of the fixed-time component on this schedule and only if a response had occurred during that component. This produced a pause-respond-pause pattern during the interreinforcer interval for all animals. When the location of the response dependency was then restricted to a 10-second period in the middle of the fixed-time component, the pattern was accentuated and response rates increased for all animals, while postreinforcement pauses decreased sharply for two animals. When responding was required in the first 10 seconds of the fixed-time component, responding peaked earlier in the interval for all animals. Response rates were slightly below those in the previous conditions, while postreinforcement pauses were between 2 and 6 seconds across animals.

Varying response-reinforcer contiguity in a recycling conjunctive schedule

Three experiments describe the effects of manipulating the frequency of response-reinforcer contiguity in a recycling conjunctive schedule. The schedule arranged that a reinforcer was delivered after 30 s provided at least one response had occurred; otherwise the next cycle started immediately. In Experiment 1, this schedule produced the typical pause-respond-pause pattern, with most responses at mid-interval; and, when a limited number of contiguities between responses and food delivery were added, the pattern became more like the monotonic scallop seen on fixed-interval schedules. In Experiment 2, the schedule was initially presented with an additional contingency that allowed contiguity on every trial. Fixed-interval-like behavior occurred and tended to persist as contiguities were gradually eliminated. In Experiment 3, the recycling conjunctive schedule alternated with a condition in which a large number of contiguities occurred. The pause-respond-pause pattern and fixed-interval-like performance occurred with few or many contiguities, respectively. The results of all three experiments illustrate how contiguity interacts with a small number of other variables to determine performance on interval schedules and illuminate previous findings with fixed-interval and fixed-time schedules.

Recent progress in the development of subtype selective nicotinic acetylcholine receptor ligands

Nicotinic acetylcholine receptors (nAChRs) are pentameric ligand gated ion channels, which are found at the neuromuscular junction and in the central and peripheral nervous systems. The channels can be assembled from fourteen known subunits. The exact combination and function of all the channels are still not determined but in the CNS certain combinations have been identified which appear to modulate the release of specific neurotransmitters. Non-specific nAChR agonists like nicotine and epibatidine, have been shown to have interesting pharmacology but their clinical value is limited by their undesirable side effects. Selective ligands for different receptor subtypes have been reported and these compounds are probably the best tools for determining the function of the subtypes. The expectation is that some receptor subtype selective nAChR ligands will be clinically useful for the treatment of a broad range of CNS disorders. The development of stable cell lines functionally expressing specific combinations of subunits has greatly improved our understanding of ligand specificity. There have also been advances in the modelling of the ligand binding site, thanks to the discovery of a homologous snail ACh binding protein the X-ray structure of which was determined in 2001. These techniques should lead to rapid advances in the development of truly subtype selective ligands. In this review we describe recent progress in the area and describe the first 1000 fold selective low molecular weight ligands from the AstraZeneca group. We also comment on the first subtype specific channel modulators.

The regioselective aminohydroxylation of allylic carbamates

The synthesis and aminohydroxylation of a series of acyclic allylic carbamates is described: the formation of a putative O=Os=NR linkage between the transition metal and substrate is proposed to account for the high levels of regioselectivity that were observed; proof of the structure of one of the aminohydroxylation products was obtained through X-ray crystallography.

Developing fluency and endurance in a child diagnosed with attention deficit hyperactivity disorder

We examined the effect of a teaching method on skill fluency and on-task endurance of a 9-year-old boy who had been diagnosed with attention deficit hyperactivity disorder. An academic task that occurred at low fluency during 10-min baseline sessions was taught to fluency. When responding was not yet fluent, brief reversals to baseline showed that the learner's rate of responding decreased and that he did not spend entire sessions on task. However, once a fluency goal had been reached, responding remained fluent and he remained on task in the third reversal condition.

Treatment of allergic asthma by targeting janus kinase 3-dependent leukotriene synthesis in mast cells with 4-(3', 5'-dibromo-4'-hydroxyphenyl)amino-6,7-dimethoxyquinazoline (WHI-P97)

4-(3',5'-Dibromo-4'-hydroxyphenyl)amino-6,7-dimethoxyquinazoline (WHI-P97) is a rationally designed potent inhibitor of Janus kinase (JAK)-3. Treatment of mast cells with WHI-P97 inhibited the translocation of 5-lipoxygenase (5-LO) from the nucleoplasm to the nuclear membrane and consequently 5-LO-dependent leukotriene (LT) synthesis after IgE receptor/FcepsilonRI crosslinking by >90% at low micromolar concentrations. WHI-P97 did not directly inhibit the enzymatic activity of 5-LO, but prevented its translocation to the nuclear membrane without affecting the requisite calcium signal. WHI-P97 was very well tolerated in mice, with no signs of toxicity at dose levels ranging from 5 microg/kg to 50 mg/kg, and LD(10) was not reached at a 50 mg/kg dose level when administered as a single i. p. or i.v. bolus dose. Therapeutic WHI-P97 concentrations, which inhibit mast cell leukotriene synthesis in vitro, could easily be achieved in vivo after the i.v. or i.p. administration of a single nontoxic 40 mg/kg bolus dose of WHI-P97. Notably, WHI-P97 showed promising biological activity in a mouse model of allergic asthma at nontoxic dose levels. Treatment of ovalbumin-sensitized mice with WHI-P97 prevented the development of airway hyper-responsiveness to methacholine in a dose-dependent fashion. Furthermore, WHI-P97 inhibited the eosinophil recruitment to the airway lumen after the ovalbumin challenge in a dose-dependent fashion. Further development of WHI-P97 may therefore provide the basis for new and effective treatment as well as prevention programs for allergic asthma in clinical settings.

Independent use of activity materials by the elderly in a residential setting

A lottery was implemented to encourage the elderly clients of a residential home to use activity materials any time they wished, independently of staff intervention and the institutional routine of the home. During baseline, there were minimal levels of independent use of activity materials by residents. Various conditions were implemented but only the introduction of a ł20 lottery prize brought about a significant increase in the frequency of independent use of activity materials. A follow-up suggested that the reinforcing properties of the activity materials themselves eventually maintained the target behavior.

Glowing jellyfish, luminescence and a molecule called coelenterazine

Luminescence has assumed an important role in analytical biochemistry and molecular biology as an extremely sensitive method for determining the concentration of specific ions and molecules. The luminescent system of the jellyfish Aequorea victoria consists of the photoprotein aequorin, which contains the molecule coelenterazine as a prosthetic group and shows considerable potential in this area.

An inhibitor of the sodium pump obtained from human placenta

BACKGROUND

Much effort has been expended in the search for an endogenous inhibitor of the cellular sodium/potassium pump, a compound of major physiological importance, which has been implicated in the mechanism of essential hypertension. Others have suggested that ouabain or an isomer of ouabain may be the endogenous pump inhibitor. Neonatal cord serum contains an inhibitor of the sodium pump; we attempted to isolate and characterise this substance from human placentas.

METHODS

Homogenised placentas were dialysed and the resulting solutes were trapped on octadecylsilyl silica and then separated by high-performance liquid chromatography. Measurement of the activity of the sodium pump of human leucocytes was used to test each fraction for the presence of the inhibitor.

FINDINGS

An inhibitor of the sodium pump was obtained by this technique in a mass spectrometrically pure form with a mass of 370 Da, an empirical formula of C24H34O3 and only one hydroxyl group. The characteristic fragmentation pattern observed in negative-ion mass spectrometry was compared with those of various model compounds; this comparison suggested that the active material was a dihydropyrone-substituted steroid.

INTERPRETATION

These results suggest that a dihydropyrone-substituted steroid is an endogenous regulator of the sodium pump in humans and, presumably, other mammals. Proof of the endogenous origin will require the demonstration of a previously unrecognised biosynthetic pathway.

The psychoeducational profile of boys with Klinefelter syndrome

Klinefelter syndrome (KS) affects about 1 in 900 males due to an extra X chromosome. Although there are no obvious physical features associated with childhood KS, many boys demonstrate a cognitive deficit in verbal processing. The first section of this article integrates the extant literature on intelligence and achievement outcomes in boys with KS. The second section presents our findings from a 20-year study involving one of the largest unselected cohorts of boys with KS. We followed 36 boys with KS and 33 sibling controls from 6 until 20 years of age. Boys with KS are shown to demonstrate a verbal cognitive deficit and significant underachievement in reading and spelling, as well as in arithmetic. These problems, which are evident from early school years, increase with age such that by late adolescence, boys with KS are four to five grade levels behind. In addition, we also found that they were most likely to have a generalized type of learning disability, with very few boys indicating a pure reading or pure arithmetic problem. They also showed deficits in written language skills and acquisition of knowledge-based subject material were also problematic. Despite significant underachievement and frequent grade failure, many boys with KS had completed high school, and a few were also pursuing postsecondary educations. The discussion section examines how their language-based disability affects comprehension and learning, leading to underachievement.

Intelligence and achievement in children with extra X aneuploidy: a longitudinal perspective

Forty-seven children (35 male, 12 female) identified as having a supernumerary X chromosome by neonatal screening were studied psychologically from childhood to late adolescence. This paper compares their findings relative to sibling controls on tests of intelligence and achievement collected over a 14-year period. Children with a supernumerary X chromosome were found to score consistently below controls on Verbal IQ and subtests comprising the Verbal Comprehension factor but they did not differ on Performance IQ, which was in the normal range. At all ages, they showed poorer reading and arithmetic achievement; relative risk for reading and arithmetic impairment was 2.6 and 2.6 in males and 1.1 and 1.7 in females. Males with an extra X chromosome were more likely to receive special education than females, who more often failed a grade. Academic achievement was not affected in aneuploid children with higher levels of intelligence. Overall, these results suggest milder impairment than previously reported, particularly among trisomy X females.

Concurrent activities and instructed human fixed-interval performance

Two experiments explored the effects of two types of concurrent activity on human fixed-interval performance. Eight adult subjects were given access to either reading material or a working television set across three fixed-interval values (60 s, 300 s, and 600 s). During Experiment 1, 2 subjects produced "scalloped" patterns and reported no verbal regulation (e.g., counting) in the presence of the reading material, but shifted to low-rate patterns and reported verbal regulation when the reading material was withdrawn. The 2 other subjects in Experiment 1 produced consistent low-rate performances and reported verbal regulation during access to reading material. However, when these subjects were given access to a working television set, they produced scalloped patterns and reported no verbal regulation. During Experiment 2, 4 experimentally naive subjects showed consistent scalloped patterning and no verbal regulation across fixed-interval values when they were allowed to watch television. When access to the television was denied, subjects reliably reported verbal regulation, and low-rate patterns emerged. These behavioral effects focus our attention on the contingencies that control human performance on fixed-interval schedules.

Total quality management: a matter of quality polarity analysis and management

Alvin Zander claims that group members are often more concerned with personal needs and rights than those of the organization. People tend to have their attention on only half (the upside of their preferred pole and the downside of the other) of the whole "picture" of a polarity. By making a complete, accurate diagram of the entire polarity and continually updating and using it, people can promote collaboration and effectiveness despite the automatic tendency for people to be both blind to the entire situation and individualistically undermining successful management of the polarity over time. In other words, most efforts to produce noteworthy and lasting results in successful implementation of total quality management most likely will be limited--or result in failure--due to the fact that nursing managers, staff, and administrators view autocratic management and employee empowerment as separate choices to be made and are unclear that their day-to-day action impacts both direction and empowerment continually. Polarity analysis and management tend to integrate what appear to be personal and individual needs with those of others in a collaborative partnership. When addressing any polarity, it is important to acknowledge that people at all levels of the organization potentially are paradoxically the greatest resources and the biggest barriers to unprecedented breakthrough results. Overzealous action to reduce autocratic leadership will subsequently affect empowerment negatively and thus ultimately erode direction. Likewise overzealous action to increase empowerment will promote a lack of focus and finally erode organization and compliance. As any group of people begins to experience the recurrence of the ups and downs of both poles, there is increased frustration, resignation, and sense of ineffectiveness.

Anaesthesia for congenital hypertrophic pyloric stenosis. A review of 350 patients

The anaesthetic management of 350 consecutive patients with congenital hypertrophic pyloric stenosis over an 8-year period is reviewed. The anaesthetic technique is discussed and the complications encountered reviewed. The morbidity rate was 15.9%. The anaesthetic related morbidity rate was 3.7%. One patient in the series died (0.27%) 8 weeks after pyloromyotomy, as a result of an underlying myopathy.

Effects of fixed-time shocks and brief stimuli on food-maintained behavior of rats

When a fixed-time schedule of shocks was presented to rats lever pressing for food on a random-interval schedule, a pattern of behavior developed with a high rate of pressing after shock declining to near zero before the next shock was delivered. Once this pattern had stabilized, one-quarter of the shocks were replaced with brief auditory stimuli (tones) in a random sequence. Tone maintained behavior similar to shock, although tone was never paired with shock. Both tone and shocks elicited responding when presented at various times as probe stimuli, and responding was usually totally suppressed if neither stimulus occurred at the beginning of the fixed-time interval. When other stimuli were paired with tone and shock, only those paired with tone gained discriminative control and elicited responding. These findings suggest that stimuli that signal a shock-free, or safe, period will maintain the pattern of behavior generated by shock on a fixed-time schedule. There is a parallel between this phenomenon and the control of behavior on second-order schedules of positive reinforcement with nonpaired brief stimuli.