Medical risk classification of dental patients in The Netherlands

This study centers on the general health of dental patients, evaluated on the basis of the physical status classification system of the American Society of Anesthesiologists (ASA). A total of 4,087 patients completed a risk-related, patient-administered questionnaire. On the basis of their medical data, a computerized ASA classification was determined for each patient: 63.3 percent were in ASA class I, 25.7 percent in class II, 8.9 percent in class III, and 2.1 percent in class IV. After verification and/or consultation with the physician, the dentist also determined the ASA class, and this was compared with the computerized outcome. The agreement expressed as a kappa value was 0.64; the computer result generally placed the patient in a higher category of medical risk. The computer-determined ASA classes differed among the various dental practices (chi 2 = 262.9; df = 138; P < .01). It is possible to estimate the risk class of dental patients on the basis of standardized medical information only; however, the definitive ASA class can only be determined after verification of the patient's reply or, in some cases, after consultation with a physician.     

Infective endocarditis prophylaxis in children

There has been no significant decrease in the incidence of infective endocarditis. Contributing factors include increased survival of susceptible patients, increased number of 'at risk' procedures and poor compliance with existing recommendations. This review highlights the scientific basis for prophylaxis, identifies patients and procedures at risk, and tabulates a simple protocol.     

Growth in literacy and cognition in bilingual children at risk or not at risk for reading disabilities.

This study investigated growth in reading, vocabulary, and memory in children (ages 5 to 10) learning English as a second language identified at risk for reading disabilities (RD). A growth curve analysis showed that RD children were significantly below children not at risk in English and Spanish reading, Spanish short-term memory (STM), Spanish comprehension, and English and Spanish working memory (WM). RD children were also inferior on growth measures of English and Spanish WM and Spanish STM. Growth on measures of Spanish vocabulary, reading, STM, and WM accounted for 12% of the variance in predicting growth in English reading. However, only Spanish measures of WM growth contributed unique variance. The results show that growth in WM in the primary language predicts growth in second-language reading. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preschool children at risk for repeat injuries

BACKGROUND: Nitric oxide (NO) is cytostatic for proliferating cells, inhibits microbial growth, and down-regulates the synthesis of specific proteins. Studies were undertaken to determine the mechanism by which NO inhibits total protein synthesis and whether the inhibition correlates with established cytostatic activities of NO. MATERIALS AND METHODS: In in vitro experiments, various cell types were exposed to NO using either donors or expression of inducible NO synthase (iNOS). The capacity of NO to suppress total protein synthesis, measured by incorporation of 35S-methionine into protein, was correlated with the capacity of NO to suppress cell proliferation, viral replication, or iNOS expression. Phosphorylation of eIF-2 alpha was examined as a possible mechanism for the suppressed protein synthesis by NO. RESULTS: Both NO donors and expression of the iNOS suppressed total protein synthesis in L929 cells and A2008 human ovarian tumor cells in parallel with decreased cell proliferation. Suppressed protein synthesis was also shown to correlate with decreased vaccinia virus proliferation in murine peritoneal macrophages in an iNOS-dependent manner. Furthermore, iNOS expression in pancreatic islets or RAW264.7 cells almost completely inhibited total protein synthesis, suggesting that nonspecific inhibition of protein synthesis may be the mechanism by which NO inhibited the synthesis of specific proteins such as insulin or iNOS itself. This possibility was confirmed in RAW264.7 cells where the inhibition of total protein synthesis correlated with the decreased iNOS protein. The decrease in protein levels occurred without changes in iNOS mRNA levels, implicating an inhibition of translation. Mechanistic studies revealed that iNOS expression in RAW264.7 cells resulted in the phosphorylation of eIF-2 alpha and inhibition of the 80S ribosomal complex formation. CONCLUSIONS: These results suggest that NO suppresses protein synthesis by stimulating the phosphorylation of eIF-2 alpha. Furthermore, our observations indicate that nonspecific inhibition of protein synthesis may be a generalized response of cells exposed to high levels of NO and that inhibition of protein synthesis may contribute to many of the described cytostatic actions of NO.     

Kindergarten performance of children born at risk.

Conducted a longitudinal study of 20 children born with medical complications and 15 normal children to assess the effects of home environment on development in high-risk Ss. Ss were studied from birth to completion of kindergarten. Pre- and postkindergarten Ss completed the Wechsler Preschool and Primary Scale of Intelligence (WPPSI), the Peabody Individual Achievement Test, 2 vocabulary and 2 syntax batteries, and an adaptive behavior scale. Data indicate that high-risk Ss exhibited early deficiencies in social, emotional, and cognitive functioning that decreased during kindergarten. It is suggested that adequate home environment may minimize impairment for high-risk Ss. (French abstract) (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Social cognition and adjustment in children at risk for psychopathology.

This study tested two models of how social cognition affects the link between child adjustment and two family risk factors, maltreatment and parental psychopathology. The mediation model proposed that social cognition mediates the link between the risk factors and maladjustment. The compensation model proposed that social cognition compensates for the risk factors. Social cognitive measures were social problem-solving competency and hostile attributional and response biases. In 83 Ss (7 to 14 years of age), maltreatment, but not parental psychopathology, predicted aggression and peer rejection. The adjustment of Ss with a disturbed parent depended on maltreatment status. Risk status did not predict social cognition, so the mediation model was not supported. Consistent with the compensation model, Ss with high social cognitive skills were better adjusted regardless of risk status. Implications for high-risk research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Peer relations and later personal adjustment: Are low-accepted children at risk?

In this review, we examine the oft-made claim that peer-relationship difficulties in childhood predict serious adjustment problems in later life. The article begins with a framework for conceptualizing and assessing children's peer difficulties and with a discussion of conceptual and methodological issues in longitudinal risk research. Following this, three indexes of problematic peer relationships (acceptance, aggressiveness, and shyness/withdrawal) are evaluated as predictors of three later outcomes (dropping out of school, criminality, and psychopathology). The relation between peer difficulties and later maladjustment is examined in terms of both the consistency and strength of prediction. A review and analysis of the literature indicate general support for the hypothesis that children with poor peer adjustment are at risk for later life difficulties. Support is clearest for the outcomes of dropping out and criminality. It is also clearest for low acceptance and aggressiveness as predictors, whereas a link between shyness/withdrawal and later maladjustment has not yet been adequately tested. The article concludes with a critical discussion of the implicit models that have guided past research in this area and a set of recommendations for the next generation of research on the risk hypothesis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Growth in working memory and mathematical problem solving in children at risk and not at risk for serious math difficulties.

The influence of cognitive growth in working memory (WM) on mathematical problem solution accuracy was examined in elementary school children (N = 353) at risk and not at risk for serious math problem solving difficulties. A battery of tests was administered that assessed problem solving, achievement, and cognitive processing (WM, inhibition, naming speed, phonological coding) in children in 1st, 2nd, and 3rd grade across 3 testing waves. The results were that (a) children identified as at risk for serious math problem solving difficulties in Wave 1 showed less growth rate and lower levels of performance on cognitive measures than did children not at risk; (b) fluid intelligence and 2 components of WM (central executive, visual-spatial sketchpad) in Wave 1 (Year 1) predicted Wave 3 word problem solving solution accuracy; and (c) growth in the central executive and phonological storage component of WM was related to growth in solution accuracy. The results support the notion that growth in WM is an important predictor of children's problem solving beyond the contribution of reading, calculation skills, and individual differences in phonological processing, inhibition, and processing speed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Systemic antibiotic prophylaxis after gastrointestinal hemorrhage in cirrhotic patients with a high risk of infection

In cirrhotic patients with gastrointestinal hemorrhage, bacterial infections are frequent and play a significant role in mortality. We have previously found that patients with a Child-Pugh's class C or a rebleeding are a subgroup of cirrhotic patients with a high risk of infection. The aims of the study were (1) to validate these indicators and (2) to assess the effectiveness of a systemic antibiotic treatment in preventing bacterial infections in bleeding cirrhotics with a high risk of infection. One hundred and nineteen bleeding cirrhotic patients were divided into 3 groups. Patients with a Child-Pugh's class A-B and no rebleeding (i.e., with a low risk of infection) constituted group 1 (n = 55). Patients with a high risk of infection were randomly allocated to serve as controls (group 2, n = 34) or to receive the ciprofloxacin and a combination of amoxicillin and clavulanic acid for 3 days after hemorrhage (group 3, n = 30). This antibiotic prophylaxis was administered first intravenously and then orally when the bleeding was controlled. The study period was defined as 10 days after hemorrhage. Incidence of bacterial infections was significantly higher in patients from group 2 than in patients from group 1 (52.9% vs. 18.2%; P < .001). Moreover, infections were more severe in group 2: a sepsis syndrome or a septic shock developed in 66.7% of infected patients from this group, but in only 20% of infected patients from group 1. Incidence of bacterial infections was much lower in patients from group 3 than in those from group 2 (13.3% vs. 52.9%; P < .001). Eight patients from group 2 (23.5%) and 4 patients from group 3 (13.3%) died during the first four weeks (P-not significant). Septic shock was the cause of death in 3 patients from group 2 and in only 1 patient from group 3. The cost of antibiotic therapy, including antibiotic prophylaxis in group 3, was $208 +/- $63 per patient in group 2 and $167 +/- $42 per patient in group 3 (P < .05). We conclude that (1) patients with a Child-Pugh's class C and/or a rebleeding are a subgroup of cirrhotic patients with a high risk of infection after gastrointestinal hemorrhage and that (2) in these patients, a prophylactic treatment with systemic antibiotics is very effective in preventing bacterial infections.     

Dilemmas of child care in the United States: Employed mothers and children at risk.

Describes the lack of US policies and the research on child care needs, both for employed parents and for their children. Unlike all other industrialized nations, the US has not developed coherent policies on the twin initiations of parental leaves and quality child care. Although neither Canada nor the US have achieved the level of support for employed families that are common in Europe, the deficiencies of US policies are especially glaring. Given the high rates of maternal employment in both countries, the major issues are how to provide a comprehensive system of high quality child care for infants and young children and how to fund necessary services. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How to take a weapons history: interviewing children at risk for violence at school

BACKGROUND: Malignant melanoma is the most common metastatic tumor of the gastrointestinal tract and can present with abdominal pain, small bowel obstruction, or occult gastrointestinal bleeding. Diagnosing abdominal pain due to metastatic melanoma is best accomplished by intraluminal studies and computed tomography. Surgical resection of the tumor burden limited to the gastrointestinal tract has been shown to extend periods of palliation in this poor long-term survival group. OBJECTIVES: We will review a case of abdominal pain in a melanoma patient and review the literature.     

Prospective study of risk factors in natural rubber latex hypersensitivity

Five hundred sixty-nine subjects routinely underwent skin prick tests for latent sensitization to latex. The study of risk factors included skin tests to inhalant allergens, to diagnose atopy, and a questionnaire aimed at revealing frequent exposure to latex such as the wearing of gloves, multiple surgical procedures, or urinary catheterization. The subjects were categorized into five groups: group I, subjects with no risk factor (n = 272); group II, nonatopic subjects exposed to latex (n = 73); group III, atopic subjects not exposed (n = 180); group IV, exposed atopic subjects (n = 44); and group V, subjects with a history of intraoperative anaphylactic shock caused by latex (n = 13). Twenty-five subjects had spina bifida and were in either group II (14 subjects) or group IV (11 subjects). The questionnaire identified a probable allergy to latex in 18 subjects: 16 cases were confirmed by skin test, but responses were not informative in 23 patients who were sensitive to latex. Positive prick tests to latex were obtained in 0.37% of group I, 6.85% of group II, 9.44% of group III, and 36.36% of group IV. Of the children with spina bifida, 32% had positive skin test results. As risk factors, atopy and exposure were synergistic. We recommend predictive prick tests not only in children with spina bifida but also in any atopic subject or in any patient with a history of frequent exposure to latex. Latex could be considered a habitual allergen. The use of latex urinary catheters should be avoided in patients who are catheterized on a daily basis.     

Telephonic nursing: empowering patients at risk for preterm birth

Telephonic nursing is an innovative approach to providing prevention-focused care to patients at risk for preterm birth. Telephonic nursing includes case management and direct care services. A focus on health promotion supports client empowerment in self-care and decision making during the high-risk pregnancy.     

Behavioral and electrographic measures of attention in children at risk for schizophrenia.

A previous study by H. Grunebaum et al (see record 1975-00816-001) found that 5-yr-old children of schizophrenic mothers were impaired on visual attention tasks as compared with controls. No difference was observed in 6-yr-olds, however. This study reexamined the attentive behavior of 12 of these children 3 yrs later. In addition, evoked potentials to various visual stimuli were obtained. Group differences could no longer be found in visual attentive behavior; however, the risk group had evoked potentials of significantly higher amplitude and, under certain conditions, of longer latency than the controls. These findings suggest a maturational lag in visual stimulus processing in these children at risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maternal communication: Predictors of outcome at follow-up in a sample of children at high and low risk for depression.

Separate lines of investigation have shown the increased risk of dysfunction for children of depressed women and impaired interaction between depressed mothers and their children. The link between the two was examined in 57 children at high and low risk for depression. Children of unipolar depressed, bipolar depressed, chronically medically ill, and normal, mothers were evaluated at a 6-mo follow-up. Hierarchical regression analyses suggested a relation between maternal interaction behavior on 2 dimensions, task focus and affective quality, and children's subsequent depression and school behavior; academic performance was related only to affective quality of interaction. Chronic stress was predictive of more negative, critical maternal behavior, whereas depressed mood was associated with less task involvement. Maternal interactions are viewed as a marker of a complex, mutual process involving interpersonal relationships in an adverse environmental context. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Work in progress. Intraoperative neurosurgical ultrasound: localization of brain tumors in infants and children

Intraoperative real-time ultrasonic sector scanning was performed through the unincised dura mater or the intact brain surface of eight patients (aged six months to 13 years), each of whom had a previously documented mass lesion (four supratentorial, three infratentorial, one intraventricular). In each case, there was a clear definition of the location, configuration, and tissue consistency of the mass. With the exception of a choroid plexus papilloma, all lesions demonstrated both solid and fluid components. The location of a subcortical parietal lobe mass (ependymoma) was apparent only by prior sonography. All neoplastic tissue of one cerebellar astrocytoma that was identified at gross examination was removed, but additional intraoperative scanning following removal of the neoplasm suggested the presence of residual abnormal tissue. This was confirmed during further exploration, and additional gross tumor tissue was excised.     

At risk for language disorders? Correlates and course of language disorders in preschool children born at risk

The language abilities of 324 children of an at-risk population were investigated at age 2 and 4.5 y. Modified research criteria of the ICD-10 for specific developmental disorders of speech and language were applied. Frequencies between 4% and 7%, depending on age and type of disorder, were diagnosed among children whose performance on the language measure was only 1 instead of ICD-10's 2 SD below group mean, but the discrepancy measure of 1 SD between non-verbal language score and language measure was retained. Psychosocial aspects of a child's environment proved to be better predictors of later language disorders than obstetric complications. Stability of specific language disorders was on the whole fairly low, but children who perform below age level on language measures remained at risk. Gender differences are almost compensated by the age 4.5 y.     

Verbal associative disturbances in children at high risk for schizophrenia.

Analyzed single-word and continuous association test behaviors of children at high (207 Ss) and low (104 Ss) risk for schizophrenia. A comparison was also made between test scores of those high-risk Ss who later became schizophrenic and scores of others who did not. Although high-risk Ss exhibited more deviant associations than low-risk Ss, premorbid associative disturbance did not characterize those who later became schizophrenic. These findings are not supportive of learning theories of associative disturbance. When combined with recent evidence showing that degree of associative disturbance at initial breakdown is not predictive of chronicity or outcome, these findings call for a reevaluation of the central character of associative disturbance in schizophrenia. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)