Perinatal social work and the high risk obstetrics patient

Even under the most favorable conditions, pregnancy and childbirth may tax the family's ability to cope. If there are problems with the pregnancy, these coping capacities may be further stressed. This article examines the common high risk obstetrical problems, frequently seen emotional reactions to the treatment of those problems, and social work assessment and intervention with families.     

A high risk recognition program for adolescents in conflict with the law.

Describes a high risk recognition program aimed at reducing recidivism among the heterogeneous young offender population. The program, which is based on cognitive-behavioral relapse prevention programs for adult sexual offenders, was developed for use within an inpatient treatment program for 14–18 yr olds sentenced to secure custody for a variety of crimes. Young offenders identify risk factors or warning signs for various forms of offending behavior based on their analysis of past criminal acts. They then generate strategies for coping with future recurrence of these risk factors. The authors consider the utility and applicability of such an intervention and make recommendations for researching the efficacy of the technique. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The identification of high risk knee bleeds in adolescents with severe haemophilia A

One hundred and thirty-seven knee bleeds treated with an initial dose of 11-16 units of factor VIII/kg have been reviewed in an attempt to find the predictive factors for bleeds requiring retransfusion. Thirty-two bleeds (23.4%) were retransfused within 48 hours because of extension of bleeding or poor progress. Fifty-nine per cent of bleeds which were retransfused presented with pain and 72% were tender at presentation. These figures contrasted with those for bleeds which were not retransfused of 30% and 45%. The difference in each case is significant. Forty-seven per cent of retransfused bleeds presented with less than 50% of normal movement against 12% who were not retransfused. This difference was also highly significant. It is suggested that knee bleeds presenting with pain, tenderness and/or more than 50% restriction of movement should be considered for higher initial doses of factor VIII.     

Genetic counseling for families at high cancer risk

About 5-10% of the most common cancers, such as breast, colon and melanoma, result from mutations in inherited predisposition genes. Recently some of these genes have been mapped or even cloned. These advances in cancer genetics have made more precise genetic counseling possible for cancer patients and their families. In our clinic for specific genetic counseling 180 families with a history of cancer were seen during a 10-month period. In counseling sessions, the family history was confirmed and interpreted, personal risk was estimated and the availability of molecular genetic testing was presented. Blood samples for DNA testing were drawn from those with certain criteria who wished to be tested. Instructions for early detection were also given, depending on the personal risk of cancer as compared to that of the general population.     

The individual at high risk for endometrial carcinoma

The relative frequency of gonorrhea and nongonococcal urethritis was studied among all active duty US Navy and Marine Corps personnel. Between 1966 and 1974, the incidence of the two diseases increased in parallel fashion, reaching 80.2 cases of gonorrhea and 61.8 cases of nongonococcal urethritis per 1000 average strength in 1974. The 56,457 cases of gonorrhea and 43,538 cases of nongonococcal urethritis reported in 1974 were unevenly distributed geographically. In the United States that year, nongonococcal urethritis was the more commonly reported condition, with 32.9 cases per 1000 average strength per year compared to 28.6 for gonorrhea; and, for the last four years, the ratio of the two was 1.05 cases of nongonococcal urethritis for each case of gonorrhea. These findings imply that nongonococcal urethritis is a significantly greater problem than has been generally recognized.     

Workplace homicide: industries and occupations at high risk

The individual activities for adenosine kinase, deoxyadenosine kinase, adenosine deaminase, deoxyguanosine kinase, and purine nucleoside phosphorylase were determined during days 7 to 13 of mouse embryonic development. Adenosine deaminase increased 74-fold between days 7 and 9; deoxyadenosine kinase increased 5.4-fold during the same interval. Adenosine kinase, deoxyguanosine kinase, and purine nucleoside phosphorylase exhibited less than 2-fold changes in activity between days 7 and 13. Using Michaelis constants for each enzyme and the maximal velocities determined from enzyme assay, the relative routes of adenosine and deoxyadenosine metabolism via phosphorylation or deamination were modeled as a function of nucleoside concentration for days 7 through 13. For days 7 and 8, phosphorylation of adenosine is the principle route of metabolism at physiological concentrations. A switch occurred at day 9 and following where deamination is at least 5-fold greater than phosphorylation at all substrate concentrations. Deoxyadenosine phosphorylation was at most 10% of deamination at day 7 and then declined to less than 1% for days 9 to 13. Phosphorolysis was the principle route of deoxyguanosine metabolism through the 7 to 13 day period. Thus catabolism rather than phosphorylation was the principle pathway for purine deoxynucleoside metabolism during this period.     

Self-perceptions of social relationships in hearing-impaired adolescents.

A social activity scale was administered to 220 mainstreamed hearing-impaired adolescents. In general, students reported participating in school activities more frequently with hearing-impaired than with hearing peers, but this was qualified by the extent that the students were mainstreamed. Ratings of participation with hearing-impaired peers decreased for the students who were mainstreamed for more classes. Students indicated that they were more emotionally secure with hearing-impaired peers, and there was no increase in emotional security with hearing peers with more mainstreaming. Responses of students who were mainstreamed for more classes suggested that they realized they had less interaction with hearing-impaired peers even though this was the group with whom they were most comfortable. Although these students were surrounded with hearing peers, this contact did not appear to promote identification and relational bonds.with them. When there is opportunity for participation, the quality of the relationships is not necessarily positive. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Relationship among social and intrapersonal risk, alcohol expectancies, and alcohol usage among early adolescents

We evaluated 3 patients with biopsy-proven hypertrophic cranial pachymeningitis apparently unrelated to any systemic disease. Each patient had chronic headache, cranial neuropathy, an elevated ESR, and a mild CSF pleocytosis. Neuro-ophthalmic findings included bilateral sixth nerve palsies in two patients and the third had bilateral optic neuropathies. MR imaging revealed thickened dura that enhanced with Gd-DTPA administration. Histologic examination showed thickened, fibrotic dura with a sterile, chronic, nongranulomatous inflammation. The response to treatment was variable with corticosteroids, immunosuppressive drugs, or radiation. The distinctive MR appearance should help physicians recognize this rarely reported disease.     

Effects of coping skills training on adolescents at risk for substance use.

279 high-risk secondary school students completed one of the following treatment conditions: (1) coping skills school intervention, (2) coping skills school plus parent intervention, or (3) comparison control. Ss in the coping skills conditions improved on a measure of coping skills acquisition, whereas those in the control group did not. All Ss improved on a variety of personality and school behavior variables. There were some modest increases in self-report of substance use; however, these were smaller than would be expected in a high-risk population over the study period. The findings suggest that preventive intervention with high-risk youth has some positive effect on risk factors, although the differential efficacy of coping skills training with high-risk youth was not supported. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anger and cardiovascular risk in adolescents.

Examined the relationship between anger and elevations in cardiovascular risk among 213 13–18 yr old adolescents. Ss were assessed on an anger index and also on certain physical (e.g., blood pressure, cholesterol) and psychological (e.g., anxiety, life dissatisfaction) variables associated with increased risk of cardiovascular diseases. The anger index was factor analyzed, producing a terminal solution of 2 factors: Frequent Anger Directed Outward and Anger-Producing Situations. Regression analyses showed that the factor scores were predictive of the physical and psychological measures of cardiovascular risk, and that the factor scores were differentially related to these indices. Findings are supportive of systematic study both of the multidimensional nature of anger and of the associations of the dimensions of anger with indices of cardiovascular risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Investigation of immune response in rubber workers at high risk for cancer

The study was concerned with immune response in the workers engaged in rubber manufacture which is a cancer hazard. A group of healthy donors were in control. The study group was divided into those free from carcinogen-protein adducts (CPA) and those who revealed them and, therefore, are considered at high risk for cancer. CPAs containing benzidine, 2-naphtylamine or 3-oxyanthranyl acid were assayed in blood serum. B- and T-immunity inhibition was shown to be present in both study sub-groups. A significant difference in immune response indices was established between the CPA-free and CPA-containing groups of the rubber workers. The latter group had relatively higher levels of IgA, IgM and globulins of immunocomplexes, and revealed inhibition of formation of antibody-forming cells to ovine erythrocytes following injection of CPA-containing blood serum into mice as well as relatively higher suppression of T-cell immunity in the workers at high risk.     

Registered criminality in families with children at high risk for schizophrenia.

Describes a project in which 207 Danish children (mean age 15.1 yrs in 1962) with schizophrenic mothers have been periodically assessed and followed since 1962. 104 children matched in age, whose parents and grandparents had never been psychiatrically hospitalized, served as controls. The number of registered criminal offenses in the Ss, their schizophrenic mothers, and their fathers was found to be higher than for controls. Implications for high-risk research and hypotheses on the relation of schizophrenia and criminality are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vitamin A levels at birth of high risk preterm infants

Inclusion body myositis is an increasingly recognised form of inflammatory myopathy with characteristic clinical and histopathological features which has seldom been reported in the United Kingdom. This paper presents the clinicopathological features of a series of patients diagnosed in Nottingham from 1986 to 1990. During this period, 1319 muscle biopsy samples were processed by this laboratory and rimmed vacuoles were seen in 17 patients. Eleven patients had definite or probable inclusion body myositis according to published criteria. The mean age of the group was 69.4 years with a male to female ratio of 8:3. Typical clinical features were a slowly progressive painless, proximal lower limb weakness, with muscle wasting and early loss of reflexes. The median duration of illness from first symptom to presentation was five years (range 2-18 years). Falls were a prominent symptom in six patients and distal weakness occurred in nine patients. Creatine kinase was increased in 10 patients but only one had a level > 1000 IU/l; the erythrocyte sedimentation rate was normal in five patients. Treatment with steroids or cytotoxic drugs, or both, did not prevent disease progression. It is confirmed that inclusion body myositis is a distinct cause of inflammatory myopathy which is probably underdiagnosed in the United Kingdom. Clinically, it should be suspected in older patients presenting with muscle weakness of insidious onset. Pathologically, a careful search should be made for rimmed vacuoles and inflammation; ultrastructurally, the presence of inclusions will confirm the diagnosis.     

Movement abnormalities and the progression of prodromal symptomatology in adolescents at risk for psychotic disorders.

The link between movement abnormalities and psychotic disorders is presumed to reflect common neural mechanisms that influence both motor functions and vulnerability to psychosis. The prodromal period leading to psychotic disorders represents both a viable point for intervention and a developmental period that, if studied, could shed light on etiology; however, no published studies have examined the temporal progression of this link. A group with high levels of prodromal symptomatology (i.e., adolescents with schizotypal personality disorder [SPD]; n = 42) and both psychiatric controls (with other personality disorders or conduct disorder [OD]; n = 30) and nonpsychiatric controls ([NC]; n = 49) were recruited. Videotapes of structured psychiatric interviews were coded for movement abnormalities by raters blind to participants' diagnostic status, and follow-up assessments were conducted 1 year later. Controlling for psychotropic medications, the authors found that adolescents with SPD exhibited significantly more motor abnormalities in the face and upper body than did OD and NC controls. At baseline, movement abnormalities were positively correlated with the severity of positive, negative, and total prodromal symptoms. Within the SPD group, baseline movement abnormalities predicted symptom severity 1 year later. Movement abnormalities represent an early risk indicator that may be predictive of later symptom severity and potentially of psychosis onset. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Protective and risk factors in health-enhancing behavior among adolescents in china and the United States: Does social context matter?

An explanatory model of adolescent health-enhancing behavior based on protective and risk factors at the individual level and in 4 social contexts was used in a study of school-based samples from the People's Republic of China (n = 1,739) and the United States (n = 1,596). A substantial account of variation in health-enhancing behavior--and of its developmental change over time--was provided by the model for boys and girls, and for the 3 grade cohorts, in both samples. In both samples, social context protective and risk factors accounted for more unique variance than did individual-level protective and risk factors, and context protection moderated both contextual and individual-level risk. Models protection and controls protection were of particular importance in the explanatory account. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A test of the social development model during the transition to junior high with Mexican American adolescents.

Mexican American adolescents have higher rates of externalizing problems than their peers from other ethnic and racial groups. To begin the process of understanding factors related to externalizing problems in this population, this study used the social development model (SDM) and prospective data across the transition to junior high school from 750 diverse Mexican American families. In addition, the authors examined whether familism values provided a protective effect for relations within the model. Results showed that the SDM worked well for this sample. As expected, association with deviant peers was the primary predictor of externalizing behaviors. There was support for a protective effect in that adolescents with higher familism values had slower rates of increase in association with deviant peers from 5th to 7th grades than those with lower familism values. Future research needs to determine whether additional culturally appropriate modifications of the SDM would increase its usefulness for Mexican American adolescents. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Identifying children at high risk for the development of essential hypertension

BACKGROUND AND OBJECTIVES: Because blood pressure (BP) tracks from childhood to adulthood, some have recommended screening to identify children at high risk for the development of essential hypertension as adults. Others, however, have argued against this strategy because they believe that correlations between childhood and adulthood BP levels are too low. To address these issues, we considered prediction of adult BP from childhood levels. DESIGN: Cohort study with follow-up of participants from childhood to early adulthood. SETTING AND PARTICIPANTS: We ascertained BP in 337 schoolchildren from East Boston, Mass., and reexamined 317 (94%) of them 8 to 12 years later, at ages 18 to 26 years. MEASUREMENTS AND DATA ANALYSIS: On each of several visits, 1 week apart (four for children, three for adults), we obtained three BP readings with a random-zero sphygmomanometer. To calculate correlation coefficients (tracking correlations) between childhood and adult BP, we assumed a multivariate normal distribution and used an iterative maximal likelihood approach in a longitudinal model. We then used these correlations in expressions for sensitivity and specificity of childhood BP as a screening test and for positive predictive value for adult BP above specified cutoff points. RESULTS: During the 8- to 12-year interval, tracking correlations, corrected for within-person variability and adjusted for age, sex, smoking, and medication and alcohol use, were 0.55 for systolic BP and 0.44 for diastolic BP. The corresponding positive predictive values indicated that, for example, the probability that a 20-year-old man's true systolic BP will be > 139 mm Hg (> 90th percentile) was 0.44, given that his observed average systolic BP at age 10 years was > 95th percentile (> 117 mm Hg). The sensitivity of a 10-year old boy's systolic BP > 95th percentile to detect systolic BP > 139 mm Hg 10 years later was 0.17. The specificity of his BP < 95th percentile at age 10 years to detect systolic BP < 139 mm Hg at age 20 years was 0.97. For diastolic BP, predictive values and sensitivities were somewhat lower. CONCLUSIONS: After correction for within-person variability, tracking correlations from childhood to early adulthood are higher than previously reported. However, the resulting sensitivities and predictive values for childhood BP as a screening test for adult BP are of only modest magnitude. These data call into question the usefulness of routine BP measurement to identify children at high risk for the development of essential hypertension.     

Profile of nutritional risk in pregnant adolescents]

A sample of 215 adolescents (16.9 +/- 0.7 y; 13-18 y) from a low socioeconomic level of Valencia, Venezuela, at their first trimester of pregnancy were studied in order to identify nutritional risk. Socioeconomic, anthropometrical, hematological and dietary characteristic were assessed. Pregestational weight, actual weight, height, arm circumference (AC), triceps skin fold (TS), fat and muscle area (FA/MA) and pregestational body mass index (PBMI) were determined. Hemoglobin (Hb) and ferritin were measured by colorimetric and ELISA methods. Two 24 hour recalls were obtained. According to age, two groups were created. Pregnant adolescents were grouped by age: Group 1, 13 to 15 years old and Group 2, 16 to 18 years old. Nutritional risk was defined as: Gynecological age lower than 4 years since menarche. PBMI < 19.8 kg/m2, height below 10th Percentile of reference, Hb below 11 g/dL and ferritin < 12 micrograms/L. Almost all the adolescents (96.3%) were in poverty. 83.3% were single, 83.3% were at elementary school before pregnancy but 84.1% were attending house chores at the time of exam. There were significant differences (p < 0.001) for gynecological age and menarche age, but not for anthropometrical, hematological and dietary variables when Group 1 was compared to group 2. 35.3% of the adolescents had a gynecological age lower than 4 years, 23.3% were below 10th percentile for height, 36.3% had a PBMI lower than 19.8 kg/m2, 26.5% were below 10th percentile for arm circumference, anemia was present in 13.7% and low levels of ferritin in 18.4% of the adolescents. Calorie intake was below recommendation in 87.3% and adequacy for vitamin A and C, calcium and zinc were below 2/3 of recommendation in 36.3%. 25.9%, 88.7% and 73.5% of the adolescents respectively. Studied adolescents had a high prevalence of risk factors for nutritional deficiencies (short age, poverty, low weight, anemia and deficient intake). Early assessment of this conditions allows to identify the risk, to establish interventions and to monitor pregnancy evolution.