What is Prevalence of Autism Spectrum Disorders in Republic of Georgia?

Introduction

Despite the fact that 95% of all <5 years of age children with developmental disabilities including Autism Spectrum Disorders (ASD) live in low- and middle-income countries (LAMI), to date there is an information gap in LAMI studies including Republic of Georgia.

Objectives

To estimate the prevalence and describe the clinical characteristics of ASDs among the third-grade school students using a total population approach.

Methods

The target population (N=27,336) included all 3rd grade students of schools of five main cities of Georgia. The study was conducted in four steps: phase I screening, sampling of screen positive students, phase II confirmative diagnostic assessment, and best-estimate diagnosis. Parents and teachers completed two screening questionnaires in phase I: 27-item Autism Spectrum Screening Questionnaire (ASSQ) and 25-item Strengths and Difficulties Questionnaire (SDQ). In phase II, screen-positive children were evaluated using standardized diagnostic assessments.

Results

Overall, 16,654 students (82%) were assessed by either parent and/or teacher. Students whose ASSQ and/or SDQ scores were in the top 10th percentile were considered as screened positive for diagnostic assessment (N=1976). Of 300 students completed diagnostic assessment 53 were diagnosed ASD. Crude prevalence of ASDs was estimated to be 4.5%. 75% of cases of ASD were first diagnosed. Efforts are currently underway to compute adjusted prevalence, which will be available for the Conference presentation.

Conclusions

The prevalence data of ASD is important to assess the burden of the disorder and facilitate better understanding of specifics of the disorder in different part of the world.

Disclosure

No significant relationships.

Defining in Detail and Evaluating Reliability of DSM-5 Criteria for Autism Spectrum Disorder (ASD) Among Children

This paper describes a process to define a comprehensive list of exemplars for seven core Diagnostic and Statistical Manual (DSM) diagnostic criteria for autism spectrum disorder (ASD), and report on interrater reliability in applying these exemplars to determine ASD case classification. Clinicians completed an iterative process to map specific exemplars from the CDC Autism and Developmental Disabilities Monitoring (ADDM) Network criteria for ASD surveillance, DSM-5 text, and diagnostic assessments to each of the core DSM-5 ASD criteria. Clinicians applied the diagnostic exemplars to child behavioral descriptions in existing evaluation records to establish initial reliability standards and then for blinded clinician review in one site (phase 1) and for two ADDM Network surveillance years (phase 2). Interrater reliability for each of the DSM-5 diagnostic categories and overall ASD classification was high (defined as very good .60-.79 to excellent ≥ .80 Kappa values) across sex, race/ethnicity, and cognitive levels for both phases. Classification of DSM-5 ASD by mapping specific exemplars from evaluation records by a diverse group of clinician raters is feasible and reliable. This framework provides confidence in the consistency of prevalence classifications of ASD and may be further applied to improve consistency of ASD diagnoses in clinical settings.

Clinical decision-making augmented by simulation training: neural correlates demonstrated by functional imaging: a pilot study

BACKGROUND

Investigation of the neuroanatomical basis of clinical decision-making, and whether this differs when students are trained via online training or simulation training, could provide valuable insight into the means by which simulation training might be beneficial.

METHODS

The aim of this pilot prospective parallel group cohort study was to investigate the neural correlates of clinical decision-making, and to determine if simulation as opposed to online training influences these neural correlates. Twelve third-year medical students were randomized into two groups and received simulation-based or online-based training on anaphylaxis. This was followed by functional magnetic resonance imaging scanning to detect brain activation patterns while answering multiple choice questions (MCQs) related to anaphylaxis, and unrelated non-clinical (control) questions. Performance in the MCQs, salivary cortisol levels, heart rate, and arterial pressure were also measured.

RESULTS

Comparing neural responses to clinical and non-clinical questions (in all participants), significant areas of activation were seen in the ventral anterior cingulate cortex and medial prefrontal cortex. These areas were activated in the online group when answering action-based questions related to their training, but not in the simulation group. The simulation group tended to react more quickly and accurately to clinical MCQs than the online group, but statistical significance was not reached.

CONCLUSIONS

The activation areas seen could indicate increased stress when answering clinical questions compared with general non-clinical questions, and in the online group when answering action-based clinical questions. These findings suggest simulation training attenuates neural responses related to stress when making clinical decisions.

Hindered proton collectivity in 16(28)S12: possible magic number at Z=16

The reduced transition probability B(E2;0(gs)(+)→2(1)(+)) for (28)S was obtained experimentally using Coulomb excitation at 53 MeV/nucleon. The resultant B(E2) value 181(31) e(2)fm(4) is smaller than the expectation based on empirical B(E2) systematics. The double ratio |M(n)/M(p)|/(N/Z) of the 0(gs)(+)→2(1)(+) transition in (28)S was determined to be 1.9(2) by evaluating the M(n) value from the known B(E2) value of the mirror nucleus (28)Mg, showing the hindrance of proton collectivity relative to that of neutrons. These results indicate the emergence of the magic number Z=16 in the |T(z)|=2 nucleus (28)S.

Warm autoadsorption with enzyme-treated red blood cells

Patients demonstrating warm autoantibody specificity present serologic challenges for laboratory staff performing antibody identification in the blood bank. Autoantibody can be removed from plasma or serum by adsorption onto autologous red blood cells (RBCs) provided the patient has not been transfused in the previous 3 months. The adsorption process can be enhanced by enzyme pretreatment of autologous RBCs.

An adjunctive Management of Depression Program for difficult-to-treat depressed patients and their families

BACKGROUND

The goal of this open-label feasibility trial was to test a short-term, adjunctive intervention, the Management of Depression (MoD) Program, to determine if patients with difficult-to-treat forms of depression and their family members could learn to cope more effectively with their illness.

METHODS

Nineteen patients meeting The Diagnostic and Statistical Manual IV criteria for major depressive disorder, dysthymia, or chronic/recurrent depression and their family members participated in an open-label study testing the efficacy of the MoD Program. The intervention consisted of nine sessions over 16 weeks, followed by an 8-month maintenance phase. Outcome measures focused on quality of life, psychological and family functioning, and level of depression.

RESULTS

Fourteen patients and their family members improved significantly in psychosocial and family functioning, and depression severity (all P-values <.05) by the end of the 16-week intervention. There was also significant improvement in quality of life, psychosocial and family functioning, and depression scores (all P-values<.05) for the 10 patients who completed the maintenance phase.

CONCLUSION

The MoD Program is a useful adjunctive intervention that helped patients and their family members deal more effectively with their persisting depression. The disease management approach improved the patient's perceived quality of life and functioning, reduced depressive symptoms, and improved perception of their family's functioning.

Development of large deformation in 62Cr

The structure of neutron-rich isotopes 60Cr and 62Cr was studied via proton inelastic scattering in inverse kinematics. The deformation lengths (delta) for 60Cr and 62Cr were extracted as 1.12(16) and 1.36(14) fm, respectively, providing evidence for enhanced collectivity in these nuclei. An excited state at 1180(10) keV in 62Cr was identified for the first time. We adopted 4;{+} as its spin and parity, leading to the rapid increase of the Ex(4;{+})/E_{x}(2;{+}) ratio, which indicates the development of large deformation in 62Cr near N=40. Importance of the admixture of the gd-shell component above N=40 is also discussed by comparing with a modern shell model calculation.

Spectroscopic study of neutron shell closures via nucleon transfer in the near-dripline nucleus 23O

Neutron single particle energies have been measured in 23O using the 22O(d,p)23O*-->22O+n process. The energies of the resonant states have been deduced to be 4.00(2) MeV and 5.30(4) MeV. The first excited state can be assigned to the nu d3/2 single particle state from a comparison with shell model calculations. The measured 4.0 MeV energy difference between the nu s1/2 and nu d3/2 states gives the size of the N=16 shell gap which is in agreement with the recent USD05 ("universal" sd from 2005) shell model calculation, and is large enough to explain the unbound nature of the oxygen isotopes heavier than A=24. The resonance detected at 5.3 MeV can be assigned to a state out of the sd shell model space. Its energy corresponds to a approximately 1.3 MeV sized N=20 shell gap, therefore, the N=20 shell closure disappears at Z=8 in agreement with Monte Carlo shell model calculations using SDPF-M interaction.

High-efficiency vacuum cleaners increase personal mite allergen exposure, but only slightly

BACKGROUND

High-efficiency particulate-arrest-filter vacuum cleaners are recommended to allergy sufferers although their use increases personal cat allergen exposure. We aimed to measure personal mite allergen exposure during vacuum cleaning by nasal air sampling and to compare exposures while vacuuming and emptying the vacuum cleaner bag.

METHODS

Five brand new high-efficiency vacuum cleaners were selected. An old, previously used vacuum cleaner with its original microfilter in situ was used as a control. Nasal air samples were taken prior to and during vacuum cleaning in 10 homes. Samples were processed by HALOgen assay. Personal mite and cat allergen exposure was measured as the dust compartments were emptied.

RESULTS

There was an increase in personal mite allergen exposure with vacuum cleaning, which approached significance (P = 0.058). There was no difference between the high-efficiency vacuum cleaners and the control vacuum cleaner (P = 0.141). When the dust compartments were emptied, personal mite and cat allergen exposure increased (P < 0.02). CONCLUSIONS. The increase in personal mite allergen exposure while vacuum cleaning in an area with mild to moderate mite allergen exposure is small. High-efficiency vacuum cleaners confer no benefit and cannot currently be recommended to allergy sufferers as a means of reducing personal mite allergen exposure.

An interspecific comparison of foraging range and nest density of four bumblebee (Bombus) species

Bumblebees are major pollinators of crops and wildflowers in northern temperate regions. Knowledge of their ecology is vital for the design of effective management and conservation strategies but key aspects remain poorly understood. Here we employed microsatellite markers to estimate and compare foraging range and nest density among four UK species: Bombus terrestris, Bombus pascuorum, Bombus lapidarius, and Bombus pratorum. Workers were sampled along a 1.5-km linear transect across arable farmland. Eight or nine polymorphic microsatellite markers were then used to identify putative sisters. In accordance with previous studies, minimum estimated maximum foraging range was greatest for B. terrestris (758 m) and least for B. pascuorum (449 m). The estimate for B. lapidarius was similar to B. pascuorum (450 m), while that of B. pratorum was intermediate (674 m). Since the area of forage available to bees increases as the square of foraging range, these differences correspond to a threefold variation in the area used by bumblebee nests of different species. Possible explanations for these differences are discussed. Estimates for nest density at the times of sampling were 29, 68, 117, and 26/km2 for B. terrestris, B. pascuorum, B. lapidarius and B. pratorum, respectively. These data suggest that even among the most common British bumblebee species, significant differences in fundamental aspects of their ecology exist, a finding that should be reflected in management and conservation strategies.

Air filtration units in homes with cats: can they reduce personal exposure to cat allergen?

BACKGROUND

Domestic air filtration units have previously been shown to cause a dramatic fall in airborne pet allergen levels in homes with pets. Clinical trials of air filtration units, however, have failed to reveal a significant beneficial effect. Personal pet allergen exposure during air filtration unit use has never been measured.

OBJECTIVE

To determine the effect of air filtration on inhaled cat allergen exposure in homes with cats.

METHODS

Nasal air samplers were worn to measure personal cat allergen exposure. The study was carried out in five homes with cats on 4 separate days examining four experimental conditions (cat absent or present, air filtration off or on). The two operators collected four baseline samples and two 15-min samples/h over three consecutive hours. Cat allergen-bearing particles were detected by immunoblotting and allergen concentrations measured by amplified enzyme-linked immunosorbent assay (ELISA).

RESULTS

There was a significant reduction in the quantity of the inhaled Fel d 1 when the air cleaner was used with the cat in the room. Fel d 1 halo counts (detransformed means) were 29.3 at baseline, 11.8 after 1 h, 10.0 after 2 h and 14.1 after 3 h, with no change on control days (P = 1.00). With the cat elsewhere in the house, a marginal, but statistically significant reduction was observed only after 3 h with the use of air cleaner (Fel d 1 halo count: baseline 12.4; 3 h 5.5; P = 0.01).

CONCLUSIONS

The use of air filtration units appears to result in a much smaller reduction of inhaled cat allergen exposure than suggested by previous studies using standard air samplers. Cat removal remains the best advice to cat-allergic patients who experience symptoms upon exposure.

21Na(p,gamma)22Mg reaction and oxygen-neon novae

The 21Na(p,gamma)22Mg reaction is expected to play an important role in the nucleosynthesis of 22Na in oxygen-neon novae. The decay of 22Na leads to the emission of a characteristic 1.275 MeV gamma-ray line. This report provides the first direct measurement of the rate of this reaction using a radioactive 21Na beam, and discusses its astrophysical implications. The energy of the important state was measured to be E(c.m.)=205.7+/-0.5 keV with a resonance strength omegagamma=1.03+/-0.16(stat)+/-0.14(sys) meV.

Precise half-life measurement for the superallowed 0(+)-->0(+) beta emitter (74)Rb: first results from the new radioactive beam facility (ISAC) at TRIUMF

Presently, the world data for superallowed beta decay leads to a result in disagreement (at the 98% confidence level) with the predictions of the minimal standard model for the unitarity of the Cabibbo-Kobayashi-Maskawa matrix. Precise data for the superallowed 0(+)-->0(+) beta decay of (74)Rb would provide a critical test of the nucleus-dependent isospin symmetry-breaking corrections that must be calculated for these superallowed Fermi beta decays. The present work reports the first precise measurement of the half-life for (74)Rb ( t(1/2) = 64.761+/-0.031 ms). The data were obtained at the radioactive beam facility (ISAC) at TRIUMF using a beam of approximately 4000 (74)Rb ions s(-1).

Self-help group attendance and participation among cocaine dependent patients

The authors examined frequency and patterns of self-help group attendance and active participation over a 6-month period among 411 patients receiving treatment in the NIDA Collaborative Cocaine Treatment Study. Nearly two-thirds of patients attended at least one self-help group, and nearly all of these actively participated. Alcoholics Anonymous and Narcotics Anonymous meetings were attended most frequently. Statistical analyses included chi square, one-way analyses of variance, and cluster techniques. While patterns of attendance were relatively consistent over time, findings suggest that a treatment emphasizing the importance of self-help groups is likely to encourage more self-help group attendance and participation over time.

Pathological effects of extensive radiofrequency energy applications in the pulmonary veins in dogs

INTRODUCTION

The long-term complications of catheter ablation within the pulmonary veins are unknown. The development of pulmonary vein stenosis has recently been described after catheter ablation to treat either chronic or paroxysmal atrial fibrillation. The purpose of this study was to examine the pathological and hemodynamic effects of radiofrequency (RF) energy application within the pulmonary veins.

METHODS AND RESULTS

Right heart and transseptal catheterization were performed in 9 anesthetized mongrel dogs. The pulmonary vein ostia were cannulated and pulmonary venous pressure was measured before RF energy application in up to 4 separate pulmonary veins. Animals were euthanized at intervals of 2 to 4 weeks (n=3), 6 to 8 weeks (n=3), or 10 to 14 weeks (n=3) after ablation. Repeat catheterization before euthanasia demonstrated statistically significant differences in pulmonary capillary wedge pressure, cardiac output, pulmonary vascular resistance, and systemic vascular resistance (P<0.05) compared with the baseline. Luminal narrowing was observed in 22 of 33 pulmonary veins to which RF energy was applied. Of these, 7 were totally occluded, 7 had severe stenosis, and 8 were only minimally narrowed. Histological examination revealed intimal proliferation with organizing thrombus, necrotic myocardium in various stages of collagen replacement, endovascular contraction, and a proliferation of elastic lamina.

CONCLUSIONS

Applications of RF current within the pulmonary veins may result in pulmonary vein narrowing or complete occlusion. These observations should be considered in treatment of arrhythmias originating within the pulmonary veins.

Disfiguring burn scars and adolescent self-esteem

Although children with burn scars are reported to have positive self-concepts, social and sexual maturation can be expected to stimulate anxiety, depression and diminished self-esteem in adolescents with disfiguring scars. This study examines complex self-regard of adolescents with burn scars. The following were hypothesized: (1) adolescents with disfiguring burn scars would view themselves as less competent than unburned normative samples; (2) subjects' perceived competence would be incongruent with the importance ascribed to the domains of physical appearance and athletic competence and (3) depression/anxiety would correlate negatively with perceived competence. Subjects were 14 adolescents: 6 male and 8 female, 13-20 years old, at least 2 years post-burn injury (TBSA = 39% +/- 23%). All had scars in at least 2 of the following areas: head/face, neck, chest, hands, genitals. Each subject was administered the Harter Self Perception Profile, a standardized measure of self-competence and value in 8 domains plus a general competence measure. The subjects were also assessed for anxiety/depression by the Child Behavioral Checklist. Overall, adolescents in this sample exhibited a similar or higher degree of self-worth as compared to their peers. However, the athletic competence and physical appearance sub-domains of self-worth for the burn survivors were significantly lower as compared to the normative group. Half of the participants rated the importance of physical appearance to be higher than their level of personal competence in this area, making for distressing emotions. Mood was similar to the normative group and mood correlated significantly with self-worth.

The strategic power of saying no

Susan Bishop started Bishop Partners with the aim of making it the best boutique executive-search firm in the business. Specializing in television, radio, and publishing industries, her plan was to beat out her larger, established competitors through superb execution. Great service would lead to happy clients, which would lead to more business, which would keep clients happy, which would lead to even more business. A virtuous circle, right? Wrong. Before long, she and her staff grew weary of jumping through every hoop their clients could think of--trying to find candidates for lower-level positions in remote locations at below-market rates, for instance. But what could they do? How could they afford to disappoint any customer when they didn't have that many to begin with? In this vivid first-person account, Bishop describes how she and her staff came to an answer that was highly counterintuitive: stop trying to make everyone happy. Focus instead on making the right customers happy. Raise their prices. Limit their searches to high level positions in their field of expertise. Stick to companies big enough to give them repeat business. As hard as it was to define the right clients, it was even harder to say no to the wrong clients. One member of the staff had to turn down work worth $120,000; Bishop herself had to turn down $250,000 from her largest client, Coca-Cola. But in the end, those clients came back with higher-quality work, and her company was on its way from chaotic little start-up to successful, professional enterprise. Bishop tells the classic entrepreneur's story, one with important lessons about strategy making, courage, and discipline for all businesspeople.

High-resolution mapping and histologic examination of long radiofrequency lesions in canine atria

INTRODUCTION

Catheter ablation may prevent conduction of multiple atrial wavefronts and/or reduce the critical mass of atrial myocardium required to sustain fibrillation. The purpose of this study was to examine the effect of radiofrequency (RF) energy application on conduction in canine atria by performing high-density epicardial mapping and careful histologic examination of the ablation zone.

METHODS AND RESULTS

RF energy was applied to the right atrial endocardium in nine anesthetized mongrel dogs in an attempt to create a line of conduction block spanning the vertical length of a 504-channel epicardial mapping plaque. The mean length and width of the histologically determined ablation zone was 34 +/- 4 and 7.3 +/- 2.6 mm, respectively. No thrombus was present. Conduction block that spanned the mapping plaque in 6 of 9 animals was matched histologically by continuous transmural necrosis in five. In one, only a portion of the ablation zone was transmural; the remainder was wide but nontransmural. In 2 of 3 animals with conduction, a narrow region was present where continuous transmural necrosis was absent. In the other animal, conduction was present despite continuous transmural necrosis.

CONCLUSION

Conduction block usually occurred when continuous transmural necrosis was present, and conduction usually persisted when continuous transmural necrosis was absent. However, important exceptions were observed, including block when the ablation zone was wide but nontransmural, and conduction despite a thin line of continuous transmural necrosis.

Beta-adrenergic receptor blockade arrests myocyte damage and preserves cardiac function in the transgenic G(salpha) mouse

Transgenic (TG) mice with cardiac G(salpha) overexpression exhibit enhanced inotropic and chronotropic responses to sympathetic stimulation, but develop cardiomyopathy with age. We tested the hypothesis that cardiomyopathy in TG mice with G(salpha) overexpression could be averted with chronic beta-adrenergic receptor (beta-AR) blockade. TG mice and age-matched wild-type littermates were treated with the beta-AR blocker propranolol for 6-7 months, starting at a time when the cardiomyopathy was developing but was not yet severe enough to induce significant cardiac depression (9.5 months of age), and ending at a time when cardiac depression and cardiomyopathy would have been clearly manifest (16 months of age). Propranolol treatment, which can induce cardiac depression in the normal heart, actually prevented cardiac dilation and the depressed left ventricular function characteristic of older TG mice, and abolished premature mortality. Propranolol also prevented the increase in myocyte cross-sectional area and myocardial fibrosis. Myocyte apoptosis, already apparent in 9-month-old TG mice, was actually eliminated by chronic propranolol. This study indicates that chronic sympathetic stimulation over an extended period is deleterious and results in cardiomyopathy. Conversely, beta-AR blockade is salutary in this situation and can prevent the development of cardiomyopathy.

Effects of metallic ion toxicity on human gingival fibroblasts morphology

Alloys used as implant materials release metal ions to surrounding tissues. Cytotoxic substances attack at the molecular level, and these effects are reflected in the structure of the cells and organelles. The objective of this study was to evaluate the cellular morphology and ultrastructural changes of cultured human gingival fibroblasts to salt solutions of ions (beryllium (Be+2), chromium (Cr+6 and Cr+3), nickel (Ni+2), molybdenum (Mo+6)) which may be released from nickel-chromium dental alloys. The concentrations chosen were based on previously conducted cell culture studies. Fibroblasts were exposed to the different ion concentrations for 24 or 72 h. Cellular morphology and ultrastructural features were examined using scanning electron microscopy and transmission electron microscopy. Ultrastructural alterations observed included irregular shaped nuclei for cells exposed to hexavalent chromium and nickel, pseudopodia for cells exposed to beryllium and molybdenum, and lipid droplet formation in cells exposed to nickel.

A randomized controlled trial of a smoking cessation intervention during pregnancy

This study was a randomized controlled trial of a smoking cessation intervention for pregnant smokers. Women who reported smoking at their first antenatal visit and satisfied the inclusion criteria were asked to participate in the trial. Analysis was restricted to 393 evaluable women in the control group (received usual antenatal care) and 339 women to the study group (received usual antenatal care plus the intervention). The primary hypotheses were that the intervention would result in a higher proportion of quitters and that the mean birth-weight of babies born to women receiving the intervention would be greater than that of babies born to women in the control group. The outcome measures were smoking status based on self-report combined with a urinary cotinine level of <115 ng/mL, and birth-weight. There was no significant difference in quit rate between women receiving the intervention and women in the control group (11.9% versus 9.8% p=0.41). Babies born to women receiving the intervention were on average 84 g heavier than babies born to controls (p=0.04). The factors that contribute to the lack of a significant increase in smoking cessation in the intervention group and the possible explanation for the changes in birth-weight are discussed.

Cocaine-induced mood disorder: prevalence rates and psychiatric symptoms in an outpatient cocaine-dependent sample

This paper attempts to examine and compare prevalence rates and symptom patterns of DSM substance-induced and other mood disorders. 243 cocaine-dependent outpatients with cocaine-induced mood disorder (CIMD), other mood disorders, or no mood disorder were compared on measures of psychiatric symptoms. The prevalence rate for CIMD was 12% at baseline. Introduction of the DSM-IV diagnosis of CIMD did not substantially affect rates of the other depressive disorders. Patients with CIMD had symptom severity levels between those of patients with and without a mood disorder. These findings suggest some validity for the new DSM-IV diagnosis of CIMD, but also suggest that it requires further specification and replication.

Psychosocial treatments for cocaine dependence: National Institute on Drug Abuse Collaborative Cocaine Treatment Study

BACKGROUND

This was a multicenter investigation examining the efficacy of 4 psychosocial treatments for cocaine-dependent patients.

METHODS

Four hundred eighty-seven patients were randomly assigned to 1 of 4 manual-guided treatments: individual drug counseling plus group drug counseling (GDC), cognitive therapy plus GDC, supportive-expressive therapy plus GDC, or GDC alone. Treatment was intensive, including 36 possible individual sessions and 24 group sessions for 6 months. Patients were assessed monthly during active treatment and at 9 and 12 months after baseline. Primary outcome measures were the Addiction Severity Index-Drug Use Composite score and the number of days of cocaine use in the past month.

RESULTS

Compared with the 2 psychotherapies and with GDC alone, individual drug counseling plus GDC showed the greatest improvement on the Addiction Severity Index-Drug Use Composite score. Individual group counseling plus GDC was also superior to the 2 psychotherapies on the number of days of cocaine use in the past month. Hypotheses regarding the superiority of psychotherapy to GDC for patients with greater psychiatric severity and the superiority of cognitive therapy plus GDC compared with supportive-expressive therapy plus GDC for patients with antisocial personality traits or external coping style were not confirmed.

CONCLUSION

Compared with professional psychotherapy, a manual-guided combination of intensive individual drug counseling and GDC has promise for the treatment of cocaine dependence.

"A survey of antenatal clinic staff: some perceived barriers to the promotion of smoking cessation in pregnancy"

Antenatal clinic staff were surveyed for their attitudes to smoking in pregnancy in 1993 and again in 1996 to monitor the effect of a randomised controlled trial of a smoking intervention conducted in the clinic over the period. Descriptive analysis showed that staff believe smoking in pregnancy is an important health risk for both mother and baby, quitting smoking is difficult, counselling is only moderately successful, they lack the skill to counsel smokers and there is little time to do so. The lack of structural support within clinic administration, the lack of a comprehensive hospital policy on smoking and unclear public health messages, were also identified as barriers to reducing the prevalence of smoking.

Oral contraceptives and the risk of hereditary ovarian cancer. Hereditary Ovarian Cancer Clinical Study Group

BACKGROUND

Women with mutations in either the BRCA1 or the BRCA2 gene have a high lifetime risk of ovarian cancer. Oral contraceptives protect against ovarian cancer in general, but it is not known whether they also protect against hereditary forms of ovarian cancer.

METHODS

We enrolled 207 women with hereditary ovarian cancer and 161 of their sisters as controls in a case-control study. All the patients carried a pathogenic mutation in either BRCA1 (179 women) or BRCA2 (28 women). The control women were enrolled regardless of whether or not they had either mutation. Lifetime histories of oral-contraceptive use were obtained by interview or by written questionnaire and were compared between patients and control women, after adjustment for year of birth and parity.

RESULTS

The adjusted odds ratio for ovarian cancer associated with any past use of oral contraceptives was 0.5 (95 percent confidence interval, 0.3 to 0.8). The risk decreased with increasing duration of use (P for trend, <0.001); use for six or more years was associated with a 60 percent reduction in risk. Oral-contraceptive use protected against ovarian cancer both for carriers of the BRCA1 mutation (odds ratio, 0.5; 95 percent confidence interval, 0.3 to 0.9) and for carriers of the BRCA2 mutation (odds ratio, 0.4; 95 percent confidence interval, 0.2 to 1.1).

CONCLUSIONS

Oral-contraceptive use may reduce the risk of ovarian cancer in women with pathogenic mutations in the BRCA1 or BRCA2 gene.

The National Institute on Drug Abuse Collaborative Cocaine Treatment Study. Rationale and methods

The National Institute on Drug Abuse Collaborative Cocaine Treatment Study is a large, multisite psychotherapy clinical trial for outpatients who meet the DSM-IV criteria for cocaine dependence. For 480 randomized patients, the outcomes of 4 treatments are compared for an 18-month period. All treatments include group drug counseling. One treatment also adds cognitive therapy, one adds supportive-expressive psychodynamic therapy, and one adds individual drug counseling; one consists of group drug counseling alone. In addition, 2 specific interaction hypotheses, one involving psychiatric severity and the other involving degree of antisocial personality characteristics, are being tested. This article describes the main aims of the project, the background and rationale for the study design, the rationale for the choice of treatments and patient population, and a brief description of the research plan.

Self-help activities in cocaine dependent patients entering treatment: results from NIDA collaborative cocaine treatment study

Although little is known about self-help attendance among cocaine dependent patients, clinicians frequently recommend this treatment. Cocaine dependent patients (519) entering a psychotherapy study were therefore surveyed regarding their recent self-help group attendance and participation. During the previous week, 34% had attended a self-help group. Of self-help attenders who actively participated 55% initiated abstinence within the next month, compared with 40% of non-attenders and 38% of non-participating attenders (P < 0.01). These findings support the potential short-term positive prognostic significance of self-help attendance and participation in cocaine dependent patients.

Introduction of solid foods to African American and Anglo American low-birth-weight and full-term infants

A secondary data analysis of 7,174 infants explores the use of cereal, fruits and vegetables, and meats with African-American and Anglo-American very-low-birth-weight (VLBW), low-birth-weight (LBW) and term infants over the first five months after discharge. The first solid foods offered were cereal for African-American infants and fruits and vegetables for Anglo infants. There are statistically significant differences in the number of feedings offered by the two ethnic groups. During the last two-to-three months, African-American term and LBW infants received all solid foods more frequently than Anglo infants. Neither ethnic group followed current feeding practice recommendations on when to introduce solid food.

Subcutaneous apomorphine in Parkinson's disease: response to chronic administration for up to five years

Subcutaneous apomorphine, administered by continuous waking-day infusion with boluses, or by repeated intermittent injection, was given to 71 parkinsonian patients with severe refractory levodopa related on-off fluctuations for 1-5 years. A mean reduction in daily off period time of approximately 50% was maintained, and the incidence of neuropsychiatric toxicity remained low on long-term follow-up. No clinically significant tolerance or loss of therapeutic effect was seen, although increasingly severe on-phase dyskinesias and postural instability marred the long-term therapeutic response in many patients. Despite these drawbacks, apomorphine, when combined with the peripheral dopamine receptor agonist domperidone, represents a significant therapeutic advance in the management of late-stage Parkinson's disease and should certainly be considered before experimental implantation procedures.

Cardiovascular reflexes in Parkinson's disease: effect of domperidone and apomorphine

Cardiovascular reflexes were evaluated in 18 patients with idiopathic Parkinson's disease who had a Hoehn & Yahr score of III-IV. The effect of apomorphine and domperidone on blood pressure, heart rate, R-R interval variation, and the Valsalva ratio were studied. Autonomic dysfunction was not found in the patients and there were no differences between subgroups of patients on different treatments. Apomorphine altered cardiovascular reflexes to a greater degree in patients who received the drug for the first time than in chronically treated patients. The changes were antagonized by domperidone, a peripheral dopamine receptor antagonist. Apomorphine treated patients who were receiving long-term domperidone had similar abnormalities of cardiovascular reflexes to those who had been able to withdraw it.

Peristomal pyoderma gangrenosum

A patient with Crohn's disease and peristomal pyoderma gangrenosum is described. This patient is unique because she had a rapid response to intralesionally injected steroids. This treatment is ideal for peristomal pyoderma gangrenosum because it is administered intermittently when the ostomy appliance is changed and it does not interfere with adhesion of the device. All 11 cases of peristomal pyoderma gangrenosum described in the literature are reviewed.

The motor response to repeated apomorphine administration in Parkinson's disease

Seven patients with Parkinson's disease and levodopa-induced motor fluctuations were studied with repeated injections of apomorphine over a 10-h period to explore possible changes in the latency, duration, and quality of motor response with recurrent dopaminergic stimulation. Doses were given when the motor effects induced by the previous dose had just worn off. No significant change in the motor response to repeated boluses of subcutaneous apomorphine was found. Our results do not support the suggestion that rapid changes in receptor sensitivity during repeated intermittent dopaminergic stimulation are a major factor in the pathogenesis of parkinsonian motor fluctuations.

Concentrations of immunoactive inhibin in serum during human pregnancy: evidence for an ovarian contribution

Immunoactive inhibin (ir-inhibin) concentrations in maternal serum during normal human pregnancy have been established in two separate studies employing cross-sectional and longitudinal sampling regimes. Ir-inhibin concentrations rose from the mid-luteal phase (geometric mean + 95% confidence intervals 1.490 (1.086-2.028) U mL-1) to peak at week 11 of gestation (3.77 (3.26-4.35) U mL-1), declined to a plateau from 14 to 25 weeks with means ranging from 1.8 to 2.3 U mL-1, and subsequently rose slowly to a peak of 6.53 U mL-1 at 41 weeks. In the longitudinal study, similar results were obtained and no differences were found in maternal inhibin levels in women carrying male or female fetuses. Paired cord blood and maternal samples showed no significant difference in ir-inhibin concentrations irrespective of the sex of the fetus. However, in all such pregnancies amniotic fluid ir-inhibin levels were 2-3 fold greater than maternal or fetal levels raising the possibility that the amnion may secrete inhibin. In 12 women without functional ovaries in whom a singleton pregnancy was achieved by donation of oocytes and in vitro fertilization, the ir-inhibin levels showed a similar pattern in the first trimester of pregnancy but the concentrations achieved were markedly lower (peak 1.1 U mL-1 at 9 weeks). In five women from the group in whom samples were available late in gestation, three showed greater than normal levels and two had subnormal levels.(ABSTRACT TRUNCATED AT 250 WORDS)