Developmental lead exposure and adult criminal behavior: A 30-year prospective birth cohort study

Using a variety of research designs and measures of lead absorption, numerous studies link childhood lead exposure to a range of cognitive and behavioral deficits, including low IQ, impulsivity, juvenile delinquency, and criminal behavior in adolescence and early adulthood. In this study, we tested the association between multiple measures of blood lead concentration assessed in childhood with criminal behavior in adulthood and across the life-course. Prospective data from the Cincinnati Lead Study (CLS) included blood lead measures quarterly across the first 78 months of life and the number of times a person was arrested across the life-course (from age 18 to 33 years) and in later adulthood (age 27 to 33 years). Childhood blood lead concentration prospectively predicted variation in adult arrests and arrests over the life-course, indicating lead absorption is implicated in the etiology of crime-especially in geographic areas where environmental sources of lead are more prevalent and concentrated. Efforts to decrease lead exposure in both developed and developing countries should be part of a comprehensive strategy to reduce social dislocation and crime.

Autonomic Findings in Takotsubo Cardiomyopathy

Takotsubo cardiomyopathy (TC) often occurs after emotional or physical stress. Norepinephrine levels are unusually high in the acute phase, suggesting a hyperadrenergic mechanism. Comparatively little is known about parasympathetic function in patients with TC. We sought to characterize autonomic function at rest and in response to physical and emotional stimuli in 10 women with a confirmed history of TC and 10 age-matched healthy women. Sympathetic and parasympathetic activity was assessed at rest and during baroreflex stimulation (Valsalva maneuver and tilt testing), cognitive stimulation (Stroop test), and emotional stimulation (event recall, patients). Ambulatory blood pressure monitoring and measurement of brachial artery flow-mediated vasodilation were also performed. TC women (tested an average of 37 months after the event) had excessive pressor responses to cognitive stress (Stroop test: p <0.001 vs baseline and p = 0.03 vs controls) and emotional arousal (recall of TC event: p = 0.03 vs baseline). Pressor responses to hemodynamic stimuli were also amplified (Valsalva overshoot: p <0.05) and prolonged (duration: p <0.01) in the TC women compared with controls. Plasma catecholamine levels did not differ between TC women and controls. Indexes of parasympathetic (vagal) modulation of heart rate induced by respiration and cardiovagal baroreflex gain were significantly decreased in the TC women versus controls. In conclusion, even long after the initial episode, women with previous episode of TC have excessive sympathetic responsiveness and reduced parasympathetic modulation of heart rate. Impaired baroreflex control may therefore play a role in TC.

Prevalence of unrecognized diabetes, prediabetes and metabolic syndrome in patients undergoing elective percutaneous coronary intervention

BACKGROUND

Diabetes mellitus (DM) and metabolic syndrome are important targets for secondary prevention in cardiovascular disease. However, the prevalence in patients undergoing elective percutaneous coronary intervention is not well defined. We aimed to analyse the prevalence and characteristics of patients undergoing percutaneous coronary intervention with previously unrecognized prediabetes, diabetes and metabolic syndrome.

METHODS

Data were collected from 740 patients undergoing elective percutaneous coronary intervention between November 2010 and March 2013 at a tertiary referral center. Prevalence of DM and prediabetes was evaluated using Haemoglobin A1c (A1c ≥ 6.5% for DM, A1c 5.7-6.4% for prediabetes). A modified definition was used for metabolic syndrome [three or more of the following criteria: body mass index ≥30 kg/m2; triglycerides ≥ 150 mg/dL; high density lipoprotein <40 mg/dL in men and <50 mg/dL in women; systolic blood pressure ≥ 130 mmHg and/or diastolic ≥ 85 mmHg; and A1c ≥ 5.7% or on therapy].

RESULTS

Mean age was 67 years, median body mass index was 28.2 kg/m(2) and 39% had known DM. Of those without known DM, 8.3% and 58.5% met A1c criteria for DM and for prediabetes at time of percutaneous coronary intervention. Overall, 54.9% met criteria for metabolic syndrome (69.2% of patients with DM and 45.8% of patients without DM).

CONCLUSION

Among patients undergoing elective percutaneous coronary intervention, a substantial number were identified with a new DM, prediabetes, and/or metabolic syndrome. Routine screening for an abnormal glucometabolic state at the time of revascularization may be useful for identifying patients who may benefit from additional targeting of modifiable risk factors.

Suboptimal risk factor control in patients undergoing elective coronary or peripheral percutaneous intervention

BACKGROUND

The American Heart Association recommends targeting 7 cardiovascular (CV) health metrics to reduce morbidity and mortality. Control of these targets in patients undergoing CV intervention is uncertain.

METHODS

We prospectively studied patients undergoing elective percutaneous coronary or peripheral intervention from November 2010 to May 2012. We recorded data on patient demographics, clinical characteristics, and social history. Risk factor control was categorized as ideal, intermediate, or poor according to the 7 American Heart Association-defined CV health metrics (smoking status, body mass index, physical activity, diet, cholesterol, blood pressure, and metabolic control). Linear regression model was used to evaluate the association between baseline characteristics and poor CV health.

RESULTS

Among 830 consecutive patients enrolled, mean age is 67.3 ± 10.8 years, 74.2% are male, and 62.1% are white. The adequacy of achievement of ideal CV health is suboptimal in our cohort; the mean number of ideal CV metrics is 2.15 ± 1.06. Less than 1 in 10 (9.7%) met ≥4 ideal CV health metrics. After multivariate analysis, male sex (P = .04), nonwhite race (P = .01), prior coronary artery disease (P < .01), prior peripheral arterial disease (P < .01), and history of depression (P = .01) were significantly associated with poor CV health.

CONCLUSIONS

Among patients referred for elective CV intervention, achievement of ideal CV health is poor. Elective interventions represent an opportunity to identify and target CV health for risk factor control and secondary prevention.

The validity and utility of patients' daily ratings of mood and impairment in clinical trials of bipolar disorder

OBJECTIVE

Traditional cross-sectional clinician-rated measures have limited use in clinical trials of bipolar disorder. We examine the validity and usefulness of patients' daily ratings of mood and functional impairment during a treatment trial.

METHOD

Ten subjects with bipolar II disorder completed daily ratings of depression severity, depression, hypomania and functional impairment over a 9-month trial. Ratings were correlated with clinician-rated measures at nine time points to determine validity. Mood ratings were contrasted with cross-sectional data for one subject to determine usefulness of such fine-grained data.

RESULTS

Moderate to large correlations were found between patients' and clinicians' ratings of mood and impairment for most of the nine time points. The utility of the patients' ratings relative to clinician-rated cross-sectional measures was also illustrated.

CONCLUSION

Results support the validity and usefulness of patients' daily mood ratings.

Consonant production patterns of young severely language-delayed children with autism

While much attention has been given to documenting the language skills of verbal children with autism, the basic speech sound development patterns of severely language-impaired children with autism are unknown. Previous research has shown that certain consonants are generally produced earlier in development than other consonants, both in typically developing children and in children with language-learning impairments. While several large studies indicate that children with autism who have strong verbal skills have intact phonological development, there is some evidence that children with autism who are more severely language impaired may have abnormal phonological production. This study documents the speech sound development of non-verbal and minimally verbal children with autism. Prompts were administered for each individual speech sound while spontaneous and imitated sounds were recorded and scored. Results indicate that children with autism show the same general speech sound production patterns as typically developing and language-learning impaired children.

LEARNING OUTCOMES

Individuals who read this manuscript will obtain information regarding: (1) normal phonological development, (2) a comparison of speech sound production of a group of 14 children with a diagnosis of autism spectrum disorder with the production of a group of 10 typically developing children, and (3) comparisons of imitated and spontaneous sound production of the children diagnosed with autism spectrum disorder.

Evolution of the uses of ICD-9-CM coding: Medicare risk adjustment methodology for managed care plans

The health information management (HIM) profession is expanding to new sites and perspectives. The implementation of Medicare managed care has brought changes not only by emphasis on management of the individual's medical care and the cost of that care, but also by creating new uses for coded data. This article examines the evolution of risk adjustment methods in Medicare Managed Care. The current choice for risk adjustment is the Principal Inpatient Diagnostic Cost Groups (PIP-DCG). This article explains the health plan's submission of encounter data and how HIM can play a valuable role in data capture and improvement in data quality and reimbursement.