Biochemical risk factors for cardiovascular disease in an aged male population: emerging vascular pathogens

The progressive increase of deaths and morbidity from cardiovascular disease (CVD) in most developed societies has led to the formulation of preventive strategies and application of several diagnostic guidelines. However, there is emerging evidence that most panels and algorithms are inadequate and require urgent revision and updating. Therefore, the aim of this study was the evaluation of a wide cardiovascular risk profile in elderly male patients with acute myocardial infarction (AMI) or peripheral occlusive disease (POD). The risk profile was assessed by measuring conventional serum lipid and lipoprotein levels and emerging parameters: lipoprotein(a) (Lp[a]), homocysteine (Hcy), and C-reactive protein (CRP). The concentration of triglycerides, Lp(a), Hcy and the total cholesterol/high-density lipoprotein (TC/HDL) ratio were significantly higher in both classes of patients than in a population of matched healthy controls and, similarly, patients with CVD displayed lower plasma values of HDL. No significant differences were observed for TC, low-density lipoprotein (LDL), and CRP. Patients with POD exhibited a marked atherogenic profile, as attested by substantially increased values of Hcy, Lp(a), triglycerides, and TC/HDL ratio. The frequency distributions of Lp(a) and Hcy concentrations were markedly shifted toward upper values in both classes of patients than in controls. In multivariate regression analysis, Lp(a) and Hcy were the best predictors for AMI, whereas Lp(a), Hcy, and the TC/HDL ratio were the best predictors for POD. Taken together, these data suggest that Lp(a) and Hcy excesses might exert a central role in the development of atherosclerotic disease in elderly male patients. Thereby, the inclusion of those tests, along with the TC/HDL ratio and other more conventional analyses in panels for the evaluation of the cardiovascular risk might be profitable in terms of effectual prevention.

Redundancy gain in the stop-signal paradigm: implications for the locus of coactivation in simple reaction time

The authors carried out 2 experiments designed to cast light on the locus of redundancy gain in simple visual reaction time by using a stop-signal paradigm. In Experiment 1, the authors found that single visual stimuli were more easily inhibited than double visual stimuli by an acoustic stop signal. This result is in keeping with the idea that redundancy gain occurs prior to the ballistic stage of the stop-signal task. In Experiment 2, the authors found that the response to an acoustic go signal was more easily inhibited by a double than by a single visual stop signal. This result provides conclusive evidence for a redundancy gain in the stop process--in a process that does not involve a motor response but rather its inhibition.

Vascular adhesion molecule-1 and markers of platelet function before and after a treatment with iloprost or a supervised physical exercise program in patients with peripheral arterial disease

Platelet function and levels of vascular adhesion molecule-1 (VCAM-1) were investigated in 24 patients with peripheral arterial disease at Fontaine stage II undergoing a 2 weeks treatment with iloprost (0.5-2 ng/kg/h i.v. infused, 6 h/day) or a 2 weeks supervised physical training, randomly assigned. Patients were studied before (T0) and after (T14) treatments and 10 days later (T24). The adhesion of washed platelets to fibrinogen coated microwells was reduced after treatment both with iloprost (1.9+/-0.4 vs 6.8+/-0.7%; T24 vs T0; M+/-SEM; p<0.05) and physical exercise (3.0+/-1.0 vs 6.7+/-0.7; p<0.05) while adhesion to human plasma coated microwells was reduced only after treatment with iloprost (1.9+/-0.8 vs 5.8+/-0.9; p<0.05). The expression of fibrinogen receptor (glycoprotein IIb/IIIa) on platelets, measured by flow-cytometry was also reduced after iloprost treatment (17.1+/-1.5 vs 31.8+/-4.8 AU; p<0.05) and physical exercise (14.6+/-1.5 vs 34.0+/-3.3; p<0.05). Theurinaryexcretion of platelet thromboxane A2 metabolite 2,3-dinor-thromboxane B2 decreased only in patients treated with iloprost (154.7+/-97.9 vs 256.2+/-106.4 pg mg creatinine(-1); p<0.05). Similarly plasma VCAM-1 was lower in patients who were treated with iloprost (827.7+/-77.4 vs 999.0+/-83.8 ng ml(-1); p<0.05). In conclusion, both iloprost and physical exercise seem to act on reversible phenomena such as the expression of adhesion molecules or ex vivo adhesion, whereas only iloprost reduces thromboxane A2 biosynthesis in vivo. This anti-platelet activity seems to be extended in time and to be associated with an improvement in vascular function.

Longitudinal predictors of behavioural adjustment in pre-adolescent children

OBJECTIVES

Longitudinal data from infancy onwards, from the Australian Temperament Project, a prospective study of the temperament and development of a large and representative sample of Victorian children, were examined to identify predictors of psychological disorder at 11-12 years of age.

METHOD

Those children scoring in the at-risk range for psychological disorder according to parents, teachers and self-reports using the Child Behaviour Questionnaire were selected at 11-12 years of age for in-depth assessment and comparison with a group of children with no history of adjustment problems. Analyses of group differences using longitudinal data gathered from infancy to 12 years focused on parent and teacher reports on child temperament and behaviour, and various facets of home and school adjustment.

RESULTS

The strongest predictors of adjustment at 12 years were previous behaviour problems, along with some specific temperament factors involving self-regulation capacities and mother's overall rating of child difficulty. Results based on parallel teacher data including peer adjustment, and social and academic competence measures were consistent with parent data.

CONCLUSIONS

Our research confirms the persistence of early appearing behaviour problems in a community sample and the longitudinal influence of temperament factors in childhood. The study supports the need for a focus on early intervention and prevention strategies in the child mental health field.

Association of a polymorphism of the dopamine transporter gene with externalizing behavior problems and associated temperament traits: a longitudinal study from infancy to the mid-teens

There have been reports that a variable number of tandem repeats (VNTR) polymorphism situated in the 3' untranslated region of the dopamine transporter gene is associated with attention-deficit hyperactivity disorder. On the basis of these findings, we predicted an association of this polymorphism with hyperactivity, other externalizing behavior problems, and related temperament traits in a general population sample. The association was investigated using children participating in a longitudinal study of childhood temperament and development. DNA was taken from 660 children who had been assessed for temperament from 4-8 months to 15-16 years, and for behavior problems from 3-4 to 15-16 years. No significant associations were found at any age. There are a number of methodological differences from earlier studies that might explain the lack of associations with hyperactivity. It is also possible that the earlier findings are not replicable.

Poisoning with the recreational drug paramethoxyamphetamine ("death")

OBJECTIVE

To describe the clinical features of paramethoxyamphetamine (PMA; "death") poisoning and to compare these with those of people with self-reported "ecstasy" poisoning.

DESIGN

Retrospective casenote review.

PARTICIPANTS AND SETTING

22 patients who presented to the Emergency Department of the Royal Adelaide Hospital (RAH), a major metropolitan teaching hospital, between 1 January 1996 and 31 December 1998 with PMA poisoning identified through urine drug screens; and 61 patients with self-reported ecstasy poisoning between 1 September 1997 and 31 December 1998 found through the hospital databases.

RESULTS

Patients with PMA poisoning presented with tachycardia (64%), hyperthermia (temperature > 37.5 degrees C; 36%), coma (41%), seizures (32%), arrhythmias (23%), and QRS intervals > or = 100 ms (50%) with greater frequency and often greater severity than those with self-reported ecstasy poisoning. Two patients with PMA poisoning presented with severe hypoglycaemia (blood glucose level, < 1.5 mmol/L) accompanied by hyperkalaemia (K+ concentration, > 7.5 mmol/L).

CONCLUSIONS

At our hospital, PMA poisonings accounted for most of the severe reactions among people who believed they had taken ecstasy. Hypoglycaemia and hyperkalaemia may be specific to PMA poisoning. PMA toxicity should be suspected with severe or atypical reactions to "ecstasy", and confirmed by chromatographic urine drug screens.

Atomic dynamics in single and multi-photon double ionization: An experimental comparison

We have used a multi-particle imaging technique (COLTRIMS) to observe the double ionization of rare gas atoms by multi-photon absorption of 800 nm (1.5 eV) femto-second laser pulses and by single photon absorption (synchrotron radiation). Both processes are mediated by electron correlation. We discuss similarities and differences in the three-body final state momentum distributions.

MRI studies of the neurotoxic effects of l -2-chloropropionic acid on rat brain

L-2-Chloropropionic acid (L-CPA) is selectively toxic to rat cerebellar granule cells; necrosis is first observed about 36 hours after administration of L-CPA (750 mg/kg p.o.) becoming more marked by 48 h. Parallel to the onset of cell death an increase in cerebellar water content and sodium concentration has been reported suggesting an oedematous reaction. In this study T(2)-weighted (T(2)WI) and diffusion weighted (DWI) imaging were used to detect the development of neuronal damage in the cerebellum of rats as a result of exposure to L-CPA. T(2)WI and DWI were not able to detect cerebellar abnormalities at 37 h post-dosing except for a slight swelling of the cerebellum. However, at 48 h post-dosing when cerebellar swelling and granule cell necrosis were marked, T(2)WI and DWI hyperintensities were observed in the cerebellum. Therefore, under the conditions of this study, MRI was not able to detect abnormalities in the cerebellum prior to the onset of the clinical signs of neurotoxicity or at the time of early histological changes. T(2)WI also suggested a marked increase in the amount of fluid in the ventricular system of rats 37 and 48 h after dosing; fluid accumulation was observed in all animals studied whether or not necrosis was detected. The occurrence of T(2)WI hyperintensity in the forebrain lead us to discover a new lesion in the habenular nucleus.

Do executive function deficits differentiate between adolescents with ADHD and oppositional defiant/conduct disorder? A neuropsychological study using the Six Elements Test and Hayling Sentence Completion Test

Two neuropsychological measures of executive functions--Six Elements Tests (SET) and Hayling Sentence Completion Test (HSCT)--were administered to 110 adolescents, aged 12-15 years. Participants comprised four groups: Attention Deficit Hyperactivity Disorder (ADHD) only (n = 35). ADHD and Oppositional Defiant Disorder/Conduct Disorder (ODD/CD) (n = 38), ODD/CD only (n = 11), and a normal community control group (n = 26). Results indicated that adolescents with ADHD performed significantly worse on both the SET and HSCT than those without ADHD, whether or not they also had ODD/CD. The adolescents with ADHD and with comorbid ADHD and ODD/CD were significantly more impaired in their ability to generate strategies and to monitor their ongoing behavior compared with age-matched controls and adolescents with ODD/CD only. It is argued that among adolescents with clinically significant levels of externalizing behavior problems, executive function deficits are specific to those with ADHD. The findings support the sensitivity of these two relatively new tests of executive functions and their ecological validity in tapping into everyday situations, which are potentially problematic for individuals with ADHD.

Association of a functional polymorphism of the serotonin transporter gene with anxiety-related temperament and behavior problems in children: a longitudinal study from infancy to the mid-teens

A polymorphism in the promoter region of the serotonin transporter gene (5-HTTLPR) has been associated with anxiety-related personality traits in adults. Initial studies showed that the short allele was associated with higher neuroticism, anxiety and harm avoidance. However, most attempts to replicate these findings have been negative. Because the association of candidate polymorphisms with behavioral traits may vary with stage of development, we investigated the association using participants in a longitudinal study of childhood temperament. DNA was available for 660 children who had been assessed for temperament from 4-8 months to 15-16 years, and for behaviour problems from 3-4 years to 15-16 years. No significant associations were found at most ages. However, at ages 13-14 years and 15-16 years, the long/long genotype was associated with higher anxiety. These findings do not support an association of the short allele with anxiety-related traits in early life.

Does shy-inhibited temperament in childhood lead to anxiety problems in adolescence?

OBJECTIVE

To assess the relationships between shy-inhibited temperament in childhood and anxiety problems in early adolescence using a prospective, longitudinal data set from a large community sample.

METHOD

Relationships between shyness ratings on age-appropriate temperament scales and anxiety problems were analyzed, looking both forward and backward in time from infancy to adolescence.

RESULTS

Forty-two percent of children rated as shy on 6 or more occasions over 8 surveys in childhood had anxiety problems in adolescence, compared with 11% who were never shy. Persistence of shyness and its presence in middle childhood increased risk for anxiety. A highly reactive temperament added to shyness did not increase the risk for anxiety. Few children with an anxiety diagnosis in early adolescence had a history of shyness.

CONCLUSIONS

Prediction from childhood shyness to adolescent anxiety disorder is modest but clinically meaningful in a community sample. However, most shy children did not develop an anxiety disorder and most adolescents with anxiety disorders had not been especially shy.

Activity of cardiopulmonary baroreceptors, peripheral resistance and cutaneous microcirculation in patients with peripheral obstructive arterial disease

OBJECTIVES

To assess the effects of cardiopulmonary baroreceptors on the haemodynamics of the humeral and common carotid arteries in patients suffering from peripheral artery disease (PAD) and to discover whether the stimulation of these receptors modifies the cutaneous microcirculation in the forearm.

DESIGN

We studied a group of patients suffering from peripheral artery disease and two groups as controls.

SETTING

Patients were examined at the ambulatory for Vascular Research, Division of Vascular Medicine and Rehabilitation, University of Verona.

PATIENTS

We studied 15 patients with peripheral artery disease of the lower limbs at Fontaine stage II (group C), 10 free of arterial pathologies (group B) and 10 young people (group A).

MAIN OUTCOME MEASURES

We subjected the patients to passive elevation of the legs and the trunk in a horizontal position with pressure monitoring and measurement of the calibre and flow in the brachial and common carotid arteries using a colourDoppler ultrasound. We also studied the cutaneous microcirculation with laserDoppler flowmetry.

RESULTS

During the test, arterial pressure and cardiac frequency remained constant in group A, systolic pressure values showed a slight, but statistically significant increase in group B, whilst the increase in systolic pressure values at this stage was marked in group C. Diastolic pressure values and cardiac frequency remained unchanged in all groups. The calibre of the humeral artery increased in the control groups. Carotid resistance was unchanged in the three groups. Humeral resistance during the test decreased in the two control groups whilst it increased in group C. The number of perfusion units felt in the control groups; no variations in group C.

CONCLUSIONS

Our study demonstrates, in patients with peripheral artery disease, a reduction in the activity of the cardiopulmonary baroreceptors with an increase in the humeral resistance during the test and impairment of the mechanisms of cutaneous microcirculatory vasoregulation in the forearm.

A longitudinal study of the role of childhood temperament in the later development of eating concerns

OBJECTIVE

This study examined the relationship between childhood temperament and the later development of eating and body concerns in early adolescent children.

METHOD

The Australian Temperament Project has followed a cohort of children from birth, assessing temperament factors such as Negative Emotionality, Persistence, Approach/Withdrawal, and Activity. Using a longitudinal design, the study reports on the relationship between temperament measured from infancy onward and eating and body concerns at 12-13 years of age. Participants (597 girls, 631 boys) completed the Eating Disorders Inventory subscales Drive For Thinness, Body Dissatisfaction, and Bulimia, and an estimate of their current size. Parents described their child's temperament and body size.

RESULTS

High Negative Emotionality and low Persistence were the factors most associated with risk status over time, particularly in girls.

DISCUSSION

While it is unlikely that temperamental characteristics per se lead to disordered eating, it is argued that in combination with other risk factors, certain temperamental characteristics may increase vulnerability.

Prevalence and characteristics of escape rhythms after radiofrequency ablation of the atrioventricular junction: results from the registry for AV junction ablation and pacing in atrial fibrillation. Ablate and Pace Trial Investigators

BACKGROUND

Radiofrequency ablation of the atrioventricular junction is a well-established procedure for the management of atrial fibrillation refractory to medical therapy. However, there are few data available on the prevalence and characteristics of the escape rhythms that are present after the procedure.

METHODS

The Ablate and Pace Trial was a prospective, multicenter registry of atrioventricular junction ablation and pacing in atrial fibrillation. Ablation of the atrioventricular junction was accomplished with radiofrequency energy with standard techniques. Before discharge from the hospital, patients underwent a systematic analysis of the rate and morphologic features of the escape rhythm, if any, that was present when the pacing rate was gradually decreased.

RESULTS

There were 156 patients from 16 centers who underwent attempted radiofrequency ablation of the atrioventricular junction. The procedure was successful in 155 (99%) of 156 patients. An escape rhythm was present in 104 patients (67%) after radiofrequency ablation. The escape rate ranged from 11 to 65 beats/min (mean 39 +/- 10 beats/min). Only 49 patients (31%) had an escape rate >/=40 beats/min. Of the 104 patients with an escape rhythm, 53 patients (51%) had a QRS that was unchanged from baseline. There was no correlation between the number of radiofrequency applications and the presence of an escape rhythm.

CONCLUSION

The majority of patients who undergo radiofrequency catheter ablation of the atrioventricular junction are pacemaker dependent after the procedure, as defined by lack of an escape rhythm or the presence of an escape rhythm that is <40 beats/min.

Psychological disorders and their correlates in an Australian community sample of preadolescent children

The nature and correlates of psychological disorders of preadolescent children from the longitudinal Australian Temperament Project (ATP) are reported. Almost half of the children identified via checklists completed by mothers, teachers, and the children themselves as being in the at-risk range for disorder received a DSM-III-R diagnosis. Nine per cent of comparison, or low-risk, children also received a diagnosis. Internalising disorders were the most common, and 44% of cases had multiple problems. Children rated as problematic by all three informants or by child plus teacher were the most likely to receive a diagnosis. The at-risk group had more difficult temperament, poorer family and peer relationships, lower levels of social skills, and were of lower SES than the comparison group. There were minimal differences on these variables between at-risk children who did, or did not, receive a DSM-III-R diagnosis. It is argued that especially for boys, checklists from multiple informants are effective tools for identifying clinically significant disorders.

[Endothelial function and the microcirculation in diabetes mellitus]

The role of endothelial dysfunction in the pathogenesis of diabetic microangiopathy is reviewed. Reversible alterations in microcirculation, consisting of increased capillary pressure, blood flow and endothelial permeability, can be detected at an early stage in diabetes mellitus. Irreversible structural modifications of the vascular wall, such as thickening of the basal membrane due to the extracellular accumulation of proteins, take place at later stages. Atherosclerosis further affects microcirculation in diabetes mellitus by decreasing autoregulatory capacity and blood flow reserve. Endothelial dysfunction has been observed to precede the onset of microvascular lesions, as demonstrated by reduction in the vasodilatory response to vasoactive agents and by alterations in the antithrombotic properties of the endothelium. Experimental data available so far suggest that endothelial dysfunction may be directly related to hyperglycemia. Abnormalities in lipoprotein metabolism, generation of glycation end products, and increased oxidative stress may also be responsible for the endothelial dysfunction in diabetes mellitus. Insulin resistance appears to be related to endothelial dysfunction in non-insulin-dependent diabetes mellitus through a reduction in the biological activity of endothelial-derived nitric oxide.

Relationships between learning difficulties and psychological problems in preadolescent children from a longitudinal sample

OBJECTIVES

To examine the relationships between learning difficulties and behavior problems in preadolescent children both concurrently and longitudinally, using data from the Australian Temperament Project, and to examine associations between DSM-diagnosed disorders and types of learning difficulties.

METHOD

Clinical and comparison groups of 11- to 12-year-old children were assessed on behavioral and learning indices and completed a structured diagnostic interview. Longitudinal data were available from earlier surveys of the development of these children.

RESULTS

Children in the clinical group were disadvantaged on all learning and behavioral indices, and their problems in many cases had been evident from 7 to 8 years of age. There were specific associations between types of learning difficulties and both internalizing and externalizing disorders. Numeracy difficulties were strongly associated with DSM diagnoses for both boys and girls, and externalizing problems tended to co-occur with a combination of learning problems.

CONCLUSIONS

Behavioral maladjustment in many domains is strongly associated with learning difficulties even after intelligence and socioeconomic factors are controlled. The odds ratios for persistence of difficulties throughout elementary school are extremely high for children with clinical problems.

The role of the family for behavioral outcome in children and adolescents following traumatic brain injury

This study assessed the behavioral outcome of 51 children with traumatic brain injury (TBI) up to 2 years following injury. Children with severe injuries, but not those with mild or moderate injuries, were reported by parents to have a greater incidence of behavior problems following TBI. Regression analyses indicated that the presence of a partner for the primary caregiver of the child and the acute emotional reaction of the parent to the injury were both predictive of child behavioral outcome, although not by 2-year follow-up. These findings suggest that parental coping resources may impact on the development of child behavioral sequelae following TBI, emphasizing the role of the family in the child's response and the importance of supportive intervention.

The role of the family for behavioral outcome in children and adolescents following traumatic brain injury

This study assessed the behavioral outcome of 51 children with traumatic brain injury (TBI) up to 2 years following injury. Children with severe injuries, but not those with mild or moderate injuries, were reported by parents to have a greater incidence of behavior problems following TBI. Regression analyses indicated that the presence of a partner for the primary caregiver of the child and the acute emotional reaction of the parent to the injury were both predictive of child behavioral outcome, although not by 2-year follow-up. These findings suggest that parental coping resources may impact on the development of child behavioral sequelae following TBI, emphasizing the role of the family in the child's response and the importance of supportive intervention.

Delayed language onset as a predictor of clinical symptoms in pervasive developmental disorders

DSM-IV states that Asperger Disorder may be distinguished from Autistic Disorder by a lack of a delay in early language development. The aim of this study was to establish whether the presence or absence of early language delay would predict autistic symptomatology in children diagnosed with a PDD/autism spectrum disorder. Forty-six language-delayed and 62 normal language onset individuals (M age 11 years) were compared on ICD-10 research criteria and DSM-IV criteria, receptive language, and developmental history variables. Retrospective data were also obtained to determine whether language onset predicted autism symptomatology when young (< 6 years). We found that early language delay predicts more autistic symptomatology when young, but not at an older age. Early language delay is also associated with developmental motor milestone delays and lower receptive language abilities. The results question the use of early language delay as a valid discriminating variable between PDD subgroups.

Are there subgroups within the autistic spectrum? A cluster analysis of a group of children with autistic spectrum disorders

Comprehensive data on the developmental history and current behaviours of a large sample of high-functioning individuals with diagnoses of autism, Asperger's syndrome, or other related disorder were collected via parent interviews. This provided the basis for a taxonomic analysis to search for subgroups. Most participants also completed theory of mind tasks. Three clusters or subgroups were obtained; these differed on theory of mind performance and on verbal abilities. Although subgroups were identified which bore some relationship to clinical differentiation of autistic, Asperger syndrome, and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) cases, the nature of the differences between them appeared strongly related to ability variables. Examination of the kinds of behaviours that differentiated the groups suggested that a spectrum of autistic disorders on which children differ primarily in term of degrees of social and cognitive impairments could explain the findings.

Preschool behaviour problems in a multicultural Australian urban area

OBJECTIVE

This paper reports on a survey of behaviour problems in a sample of 4-year-old preschoolers from the western suburbs of metropolitan Melbourne. This region consists of a diverse multicultural population and families from lower socio-economic status (SES) backgrounds.

METHODOLOGY

Nineteen preschools participated in the study and information was obtained for 743 preschool children (Refer to MS) age=4.7 years). Parents were asked to complete the Preschool Behaviour Questionnaire (PBQ) and additional questions referring to demographic and family information. Teachers were also asked to complete the PBQ on each of the children. Three factors were extracted from the PBQ (anxious-fearful, hostile-aggressive, hyperactive), and also a combined externalising behaviours factor.

RESULTS AND CONCLUSIONS

Findings indicated lower levels of behaviour problems in this sample compared to that of other Australian studies. Boys showed higher rates of externalising behaviour problems than girls. The relationships between behaviour problems and language difficulties, ethnicity, and socio-economic status are discussed.

Clinical and circulatory effects of Iloprost either administered for 1 week or 4 weeks in patients with peripheral obstructive arterial disease at Leriche-Fontaine stage III

BACKGROUND

Iloprost therapy for severe peripheral obstructive arterial disease (POAD) has demonstrated to be effective in reducing the need for amputation. However the feasibility of a 28-day infusion regimen in less severe stages of the disease is poor due to the length in hospital stay. A randomized, controlled, parallel-group pilot study was carried out with the aim to evaluate clinical and circulatory effects of Iloprost, a stable prostacyclin analogue, administered with two different infusion schedules to patients with POAD at Leriche Fontaine stage III.

METHODS

Twenty patients 16 males and 4 females, mean age 66 +/- 6 years) with objective signs of POAD, rest pain for at least two weeks and posterior tibial artery pressure > 50 mmHg, were randomized to either Iloprost i.v. infusion up to 2 ng/Kg/min for 6/h/day for 28 days (Group A) or to Iloprost i.v. infusion up to 1.5 ng/Kg/min for 16/h/day for 7 days (Group B). At baseline (before starting first infusion) after 7 days (for group B only, end of therapy) and after 28 days (end of therapy for Group A, end of study for Group B) the following parameters were evaluated: walking distance, rest pain and analgesic consumption, plethysmographyc parameters (first flow, peak flow and peak flow time) and laser Doppler parameters (rest flow, post ischemic flow).

RESULTS

After 28 days, both Iloprost infusion schedules increased walking capacity (maximum walking distance/pain free walking distance +119/+84% +199/+85% respectively, for Group A and B respectively) reduced ischemic pain (-45% and -48% respectively for Group A and B) and analgesic consumption and improved plethysmographyc and laser Doppler parameters. Tolerability seemed to be better in Group B, suggesting that the lower dose and the shorter duration of the therapy period might result in reduced incidence of headache thus, in principle, increasing patient acceptability.

CONCLUSIONS

The results of this pilot study, if confirmed by larger trials, could have important positive implications in terms of costs, patient comfort and management.

Predictors and indicators of academic outcome in children 2 years following traumatic brain injury

Within the context of a longitudinal study investigating outcome for children following traumatic brain injury, this paper reports on the utility of neuropsychological testing in predicting academic outcome in children 2 years following traumatic brain injury (TBI). Twenty-nine school-age children who were admitted to hospital after TBI were assessed with a battery of neuropsychological and academic measures at 3 and 24 months postinjury. The neuropsychological battery included measures of memory, learning, and speed of information processing. Academic outcome was assessed in terms of post-TBI change in school placement. According to logistic regression analysis, change in placement from regular to special education at 2 years post-TBI was predicted by injury severity and by neuropsychological performance at 3 months post-TBI. Findings suggest that neuropsychological testing is useful in identifying children with special educational needs subsequent to TBI.

"Growing pains": clinical and behavioral correlates in a community sample

Parents of 183 children identified them as having "pain in arms, legs, or joints during the previous 12 months." This group was compared with a group of children without pains selected randomly from the rest of a 1605-member community-based cohort in a study of chronic illness. The pains were most likely to be deep seated, to involve predominantly the lower limbs, and to be described in vague, nonspecific terms. These children were significantly more likely to have recurrent abdominal pain, a negative mood, and behavior problems, and to be aggressive, anxious, and hyperactive. There were no differences between the groups on any teacher ratings of behavior, temperament, social skills, or academic achievement. We conclude that children with "growing pains" are rated by their parents, but not their teachers, as having different temperamental and behavioral profiles than controls. These data suggest a psychosocial contribution to growing pains akin to that seen with other pain syndromes.

Depression and suicide in young children

Despite the dramatic increase of depression and suicidal behavior in children, research within this field is limited. Suicide is the 10th leading cause of death in children aged 1 through 14 years. For each child who completes the act of suicide, there are at least 50 more who attempt it. It is difficult to collect statistics on suicide in children owing to the lack of standard criteria for determining suicide in this age group and the myths that surround childhood suicide deaths. Children of all ages, including infants, can experience depression, but it will be manifested differently across each age group, especially from the infant to the school-aged child. Factors that identify children at risk for suicide include family history, loss of a loved one before the age of 12, violence, decreased family ties, and increased family pressures. Prevention strategies need to be accessible to the child both at home and in school. A variety of community-based suicide prevention programs are available for children and adults to assist children in overcoming suicidal feelings.

Input and response determinants of visual extinction: a case study

We have studied a patient, CZ, with contralateral visual extinction due to a large ischaemic frontal-parietal-temporal lesion in the right hemisphere. We found that manipulation of intensity of the visual stimulus had little effect while an increase in eccentricity substantially increased extinction rate. An important factor was represented by the hemifield of stimulus presentation: when double stimuli were presented to the contralesional (left) hemifield, the leftmost stimulus was consistently extinguished while when stimuli were presented to the ipsilesional (right) hemifield, extinction was absent. Such effect was specific to hemifield rather than to head- and trunk-defined hemispace. Manipulation of response-related variables affected extinction to a large extent: In particular, the use of nonverbal responses diminished extinction considerably. This suggests that an important component of extinction may be represented by an impaired access of visual information to the left hemisphere. Finally, the RT results confirmed previous evidence of an ipsilesional attentional bias favouring the rightmost stimuli both in the contralesional and in the ipsilesional hemifield.

Comparison of clinical symptoms in autism and Asperger's disorder

OBJECTIVE

To determine what clinical symptoms clinicians have been using to distinguish between Asperger's disorder (AsD) and autistic disorder (AD).

METHOD

Parents of children and adolescents with high-functioning AD (n = 48) and AsD (n = 69) were given a structured interview based on DSM-III-R and ICD-10 diagnostic criteria. Information regarding early and current symptom presentation and family, developmental, and verbal mental age information were collected. Logistic regression analyses were conducted to determine which variables best predicted clinician's diagnosis.

RESULTS

A number of clinical variables predicted diagnosis. Delayed language onset was the only variable of the family and developmental variables that predicted diagnosis. The AsD group was also significantly higher than the AD group in verbal mental age.

CONCLUSION

Clinicians appear to be diagnosing AsD and AD on the basis of published research and case study accounts. The findings question whether DSM-IV and ICD-10 criteria adequately describe the AsD individual, particularly in the communication domain.

Reading disabilities with and without behaviour problems at 7-8 years: prediction from longitudinal data from infancy to 6 years

Seven-year-old children with reading disabilities (RD-only), behaviour problems (BP-only), both conditions (RD-BP) and neither condition (Comparison) were compared on indices including temperament and behaviour, gathered in five periods between infancy and 6 years of age. The RD-BP group differed clearly from the RD-only group from infancy onwards. This comorbid group was similar to the BP-only group, while the RD-only group was similar to the Comparison group, until school age. The gender composition of the two RD groups differed, and the RD-BP boys showed the most problematic characteristics. The findings indicate different developmental pathways for "pure' RD children and those with comorbid BPs.

Connections between reading disability and behavior problems: testing temporal and causal hypotheses

In this study of children's reading and behavior problem status from Grade 2 to Grade 4 of elementary school, we tested hypotheses concerned with the temporal and causal connections between these two closely associated disorders. Children with both, either, or neither kinds of problems were followed up over 2 years. While reading disability remained stable over time, there was greater variability in behavior problem status. Our data did not support the claim that reading problems lead to the development of behavior problems. Children who were comorbid had the worst outcome at follow-up, suggesting that behavior problems may exacerbate reading delay. Reading-disabled children were lower (albeit in the normal range) on intelligence, but when IQ was controlled, large group differences on reading and spelling were still evident. Attention deficit hyperactivity disorder (ADHD) type behavior problems significantly differentiated children with comorbid problems from children with behavior problems alone. Sex differences were noted in the association, with two-thirds of reading-disabled boys also having behavior problems and two-thirds of reading-disabled girls having no behavior problems, suggesting that pathways to reading disability may be gender specific.

Implicit redundant-targets effect in visual extinction

Patients with left visual extinction as a result of unilateral right hemisphere damage were tested on a redundant-targets effect paradigm (RTE). LED-generated brief flashes were lateralized either to the left or to the right visual hemifield or presented bilaterally. Subjects were asked to press a key as fast as possible following either unilateral or bilateral stimuli and immediately afterwards to report on the number of stimuli presented. As previously found in normal subjects, bilateral stimuli were responded to faster than unilateral ones, and this was evidence of a RTE. The main thrust of this study was that extinction patients showed a RTE not only for correctly perceived bilateral stimuli but also in trials in which they extinguished the stimulus on the field contralateral to the lesion. This result is compatible with a preserved processing of the extinguished input at least up to the stage at which it may interact with the input from the normal side to yield a speeded motor response. Interestingly, the implicit redundancy gain of extinction patients was found to fit a coactivation (i.e. neural) rather than a probabilistic model.

Lipoprotein(a) and general risk factors in patients with angiographically assessed peripheral arterial disease

High lipoprotein(a) [Lp(a)] has been observed in patients with ischemic heart disease and cerebrovascular disease. Lp(a) is actually thought to be an independent risk factor for coronary disease. We therefore carried out a case-control study, evaluating plasma Lp(a) in 61 patients with angiographically documented peripheral arterial disease (PAD) and in 61 age- and sex-matched patients with no cardiovascular disease. General risk factors for vascular disease were also taken into account. Lp(a) was significantly higher in patients than controls (257.0 +/- 34.8 vs 146.5 +/- 23.5 mg/l p < 0.05), as were cigarette smoking, diabetes, cholesterolemia, fibrinogenemia and the waist-to-hip circumference ratio. Stepwise logistic regression analysis showed that, in addition to cigarette smoking, diabetes, cholesterol and fibrinogen, Lp(a) is a significant independent risk indicator for PAD. This result suggests that high plasma Lp(a) is associated with enhanced risk of PAD and must therefore be evaluated alongside traditional risk factors.

Neuropsychological deficit and academic performance in children and adolescents following traumatic brain injury

Evaluated the utility of neuropsychological testing in predicting academic outcome in children 1 year following traumatic brain injury (TBI). Fifty-one school age children who were admitted to hospital after TBI were assessed with a battery of neuropsychological measures at 3 months postinjury. Academic achievement was assessed at 3 and 12 months postinjury. The neuropsychological battery included intelligence testing and measures of memory, learning, and speed of information processing. Academic outcome was assessed in terms of post-TBI changes in reading, spelling, and arithmetic; changes in teacher ratings of school performance; and change in school placement. According to logistic regression analysis, change in placement from regular to special education at 1-year post-TBI was predicted by injury severity and by neuropsychological performance at 3 months post-TBI. Findings suggest that neuropsychological testing is useful in identifying children with special educational needs subsequent to TBI.

Visual attention orienting in liver cirrhosis without overt hepatic encephalopathy

The attention system in patients with liver cirrhosis has not yet been fully investigated. We therefore studied visual attention orienting in cirrhotic patients without overt hepatic encephalopathy. Seventy cirrhotic patients without overt hepatic encephalopathy (aged 57 +/- 10 yr., mean +/- s.d.) and 55 controls (aged 49 +/- 12 yr.) were enrolled. Visual attention orienting was evaluated by a computerized neuropsychological test. The Reitan A test, commonly used to detect subclinical hepatic encephalopathy, was used to evaluate mental performance. Psychometric test scores were reduced in cirrhotics compared to controls (attention test: neutral condition = 495 +/- 149 vs. 401 +/- 98 msec; valid condition = 434 +/- 110 vs. 398 +/- 84 msec; invalid condition = 485 +/- 146 vs. 392 +/- 110 msec; p < 0.001; Reitan A test = 52 +/- 20 vs. 35 +/- 11 sec., p < 0.001). The attention effect of the cue was found both in controls and cirrhotics; however, it was significantly higher in cirrhotics than in controls (61 +/- 111 vs. 33 +/- 41 msec; p < 0.002). The attention effect was directly correlated with Reitan A test (r = 0.23, p = 0.05) in cirrhotics. In conclusion, in cirrhotic patients without overt hepatic encephalopathy, visual attention orienting was present and focusing to an indexed location had a higher effect on reaction time compared to controls, possibly because of reduced basal arousal.

Micro- and macrocirculatory, and biohumoral changes after a month of physical exercise in patients with intermittent claudication

We studied 15 subjects with intermittent claudication, classed as stage II according to Leriche-Fontaine. The patients were subjected to laser Doppler flowmetry, strain gauge plethysmography, Doppler velocimetry, and blood sampling, in basal conditions and after one month of physical training. Symptom-free walking distance at the end of the training period showed a significant increase, while there was no major change in maximal walking distance or the Windsor index. Laser Doppler flowmetry showed no significant change in cutaneous blood flow at rest, after the month of physical training. On the other hand, strain gauge plethysmography showed a significant decrease in rest flow at the end of the training period, while peak flow of postischemic hyperemia did not change appreciably. Biohumoral evaluations showed a significant decrease of white blood cell count, triglycerides and uric acid. Platelet count, prothrombin time, aPTT and plasminogen were unchanged. On the other hand, we recorded a small, but significant, rise of fibrinogen. Our study confirmed the importance of scheduled physical activity in the patient with intermittent claudication, showing that clinical improvement is not accompanied by an increase in the circulatory reserve. The unchanged levels of plasminogen suggest that the fibrinolytic activity does not vary significantly after a course of physical exercise.

The development of patterns of stable, transient, and school-age onset aggressive behavior in young children

OBJECTIVE

To examine the development of patterns of aggressive behavior in children from the age of 2 to 8 years.

METHOD

Children with early histories of aggressive behavior were selected from a community sample of 2,400 infants participating in a longitudinal study. The sample was divided into four groups: children with stable aggressive behavior, those with transient aggression, those with aggression only after age 5 years (late onset), and a comparison group of nonaggressive children.

RESULTS

Children with stable aggressive behavior were characterized by a difficult temperament, hostile sibling interactions, maternal perception of the child as difficult, and harsher child-rearing practices. Children whose early aggression decreased over time and those who became aggressive only after entering school could not be reliably classified with the selected family variables. Teacher ratings of temperament factors of task orientation and reactivity and ability ratings correctly classified 74% of children whose aggression began at school-age.

CONCLUSIONS

Children with persistent aggressive behavior differed from those who improved, predominantly in terms of symptom severity. Problems with aggression can be identified early in development, and a significant proportion of aggressive children are at risk for continuing social and scholastic difficulties. Knowledge of associated factors may play an important role in prevention.

Comparison of Asperger syndrome and high-functioning autistic children on a test of motor impairment

Compared the motor impairment levels of Asperger syndrome and high functioning autistic children using a standardized test, the Test of Motor Impairment-Henderson Revision. The two groups did not differ on either total or subscale impairment scores. Intelligence level was negatively correlated with motor impairment although the relationship was mostly accounted for by the Asperger children. There was considerable variability within both clinical groups but 50% of Asperger children and 67% of autistic children showed a clinically significant level of motor impairment. Results offer no support for clumsiness as a diagnostically differentiating feature of these disorders.

Temperament and stress resilience in school-age children: a within-families study

OBJECTIVE

Stress resilience was assessed in 81 school-age children, from within 32 families acknowledging severe psychosocial stress. Resilient and nonresilient children, identified via competence and behavior disorder measures from school and home, were compared.

METHOD

Parents and teachers completed questionnaires and rating scales, and children were observed and assessed at home on attributes of temperament, self-esteem, ability, gender, and mother-child warmth.

RESULTS

Individual differences in child and family attributes that were predictive of competent child functioning varied according to the outcome measure used. Teachers' ratings of positive temperament (low emotional reactivity, high social engagement) best discriminated children showing resilience on all indicators, i.e., behavioral and social competence both at home and at school, with maternal warmth and the number of adverse life events the child had recently experienced also contributing. Level of maternal stress and individual differences in child intelligence were related to academic adjustment, but the child's age, sex, ability, and self-concept were not significant discriminators of behavioral adjustment.

CONCLUSIONS

The findings emphasize the salience of a positive temperament as a resilience factor as well as the need to consider different estimates and contexts in assessing resilience for children growing up in stressful situations.

Can autistic children distinguish lies from jokes? A second look at second-order belief attribution

Previous studies show that autistic children fail tests of second-order belief attribution. They also fail tests of lying and deception. The present study used Leekam's (1988) joke-lie distinction task to test (a) understanding of second-order mental states (intention and belief) and (b) the ability to judge these acts as lies or jokes. Seventeen normal and 16 autistic children took part. Eight of the autistic children had previously passed a test of first-order false belief. Results showed that six autistic subjects (37.5%), all of whom are false belief "passers", gave consistently correct answers to second-order mental state questions. Neither normal nor autistic children found second-order intention easier than second-order belief. However, normal children found the ability to judge another person's mental state easier than labelling whether the person was lying or joking, supporting previous evidence. In contrast, there was no difference in these two judgements for autistic children. Overall these results qualify previous evidence by showing that autistic children can use second-order reasoning and can distinguish lies from jokes. Observational data on these children, however, suggest that their competence on the comprehension of these hypothetical situations was not matched by an ability to use lying and joking in real life. Methodological, language and diagnostic factors are discussed as providing possible explanations for the results.

Precursors of hyperactivity and aggression

OBJECTIVE

This study investigated the early characteristics of children who at 8 years old were hyperactive, aggressive, or both, to clarify the etiology of these disorders.

METHOD

Prospective data from infancy to 8 years on children who were hyperactive (N = 65), aggressive (N = 57), or both (N = 60) at 8 years were compared with those on a normal comparison group (N = 70). Variables included ratings of temperament, behavior, school performance, and socioeconomic and life stress indices.

RESULTS

The two aggressive groups, particularly the hyperactive-aggressive group, were more difficult in temperament and behavior from infancy and had less optimal environments. In contrast, the "pure" hyperactive group showed more problems than did the comparison group only from 3 to 4 years on. All three clinical groups had poorer academic performance than did the controls.

CONCLUSIONS

The findings are consistent with a transactional model of development in which aggression (with or without hyperactivity) emerges when difficultness in infancy interacts with a stressed environment. Hyperactivity, when unassociated with aggression, may emerge later from poor self-regulation when faced with societal, especially school, demands. The pattern of group differences found suggest that risk indicators for specific patterns of later maladjustment may be identifiable for early intervention.