2',3'-cyclic nucleotide 3'-phosphodiesterase: a novel candidate autoantigen in demyelinating diseases

Autoaggressive T-cells specific for myelin proteins like proteolipid protein (PLP) and myelin basic protein (MBP) are thought to play a major role in the pathogenesis of demyelinating diseases of the central nervous system (CNS). 2',3'-cyclic nucleotide 3'-phosphodiesterase (CNPase) is the third most abundant myelin protein in the CNS. Due to lack of supply with enough CNPase of sufficient purity its immunologic properties have not been studied yet. We subcloned a human CNPase cDNA and expressed human recombinant CNPase (rh-CNPase) in E. coli. Purification of the protein was achieved by Ni(2+)-chelating chromatography. Furthermore we describe for the first time several rh-CNPase specific T-cell lines from a multiple sclerosis patient and a healthy control.

Developmental outcome of very low birth weight infants at four years of age as a function of biological risk and psychosocial risk

The continuing contribution of early biological and psychosocial risk factors to developmental outcome of 55 very low birth weight infants (< or = 1500 g) was assessed at 4 years of age. Biological risk, assessed by the Neurobiologic Risk Score, accounted for significant portions of the variance in the perceptual-performance (17%) and motor (35%) dimensions of the McCarthy Scales of Children's Abilities. Psychosocial risk, reflected in maternal appraisals of daily stress during the newborn period, did not account for a significant portion of variance in any of the McCarthy Scales. Maternal education level, however, another measure of psychosocial risk, accounted for significant portions of variance (from 6% to 34%) on each of the McCarthy Scales. Movement from low neurobiologic risk status to poor outcome status at 4 years of age was associated with a number of psychosocial variables, including maternal education and early levels of maternal daily stress. The findings are discussed in terms of early markers for very low birth weight infants who require careful follow-up and of potential intervention targets to promote developmental outcome.

Developmental loss of hypoxic chemosensitivity in rat adrenomedullary chromaffin cells

1. We investigated whether adrenomedullary chromaffin cells (AMCs) derived from neonatal (postnatal day (P) 1-P2) and juvenile (P13-P20) rats, and maintained in short-term culture (1-3 days), express O2-chemoreceptive properties. 2. In whole-cell recordings, the majority (approximately 70%; n = 47) of neonatal AMCs were sensitive to hypoxia. Under voltage clamp, acute hypoxia (PO2 approximately 40 mmHg) suppressed voltage-dependent K+ current by 25.1 +/- 3.4% (mean +/- S.E.M.; n = 22); under current clamp, acute hypoxia caused a membrane depolarization of 14.1 +/- 1.3 mV (n = 13) from a resting potential of -54.8 +/- 2.8 mV (n = 13), and this was often sufficient to trigger action potentials. 3. Exposure of neonatal AMC cultures to a moderate (PO2 approximately 75 mmHg) or severe (PO2 approximately 35 mmHg) hypoxia for 1 h caused a dose-dependent stimulation (approximately 3 or 6 times normoxia, respectively) of catecholamine (CA) release, mainly adrenaline, determined by HPLC. This induced CA release was abolished by the L-type calcium channel blocker, nifedipine (10 microM). 4. In contrast to the above results in neonates, hypoxia had no significant effects on voltage-dependent K+ current, membrane potential, or CA release in juvenile AMCs. 5. We conclude that rat adrenal chromaffin cells possess a developmentally regulated O2-sensing mechanism, similar to carotid body type I cells.

Analysis of polymorphisms of the 2',3'-cyclic nucleotide-3'-phosphodiesterase gene in patients with multiple sclerosis

Susceptibility to multiple sclerosis (MS) is widely held to have a genetic component. Possible candidate genes conferring this susceptibility include those coding for proteins specific to central nervous system (CNS) myelin. 2',3'-cyclic nucleotide-3'-phosphodiesterase (CNPase) is an enzyme found at high concentrations in CNS myelin, however its function is unknown. The amino acid sequence of CNPase shows a C-terminal motif characteristic of proteins involved in signal transduction pathways, suggesting a key role in myelin function. We have analysed the entire expressed sequence of the human CNPase gene in patients with multiple sclerosis and in healthy controls using single strand conformation polymorphism (SSCP) analysis. Nine previously undescribed mutations were detected, most of these occurred with equal frequency in both groups. However, a T-->C transition at nucleotide position 4306 in the region of the gene coding for the 3' untranslated region of the mature mRNA was found in a homozygous form in two out of 54 patients but in none of 100 controls. While the significance of this is unclear, it would appear unlikely that mutations in the expressed regions of the human CPNase gene contribute to genetic susceptibility to MS in the majority of sufferers.

Locus heterogeneity in progressive familial intrahepatic cholestasis

Progressive familial intrahepatic cholestasis (PFIC or Byler disease) is a rare autosomal recessive form of severe and fatal cholestatic liver disease. A locus for PFIC has recently been mapped to chromosome 18q21-q22 in the original Byler pedigree. This region harbours the locus for a related phenotype, benign recurrent intrahepatic cholestasis (BRIC), suggesting that these traits are allelic. Linkage analysis was undertaken in five consanguineous PFIC pedigrees from Saudi Arabia using marker loci (D18S69, D18S41, D18S64, D18S38, D18S42, D18S55, D18S68, and D18S61) which span the Byler disease/BRIC region on 18q21-q22. In this family set the disease locus was excluded from this region, showing that locus heterogeneity exists for the PFIC phenotype.

Cognitive functioning and brain magnetic resonance imaging in children with sickle Cell disease. Neuropsychology Committee of the Cooperative Study of Sickle Cell Disease

OBJECTIVE

Brain magnetic resonance imaging (MRI) and neuropsychological evaluations were conducted to determine whether neuroradiographic evidence of infarct in children with sickle cell disease between ages 6 and 12 years would result in impairment in cognitive and academic functioning.

METHOD AND DESIGN

Children enrolled in the Cooperative Study of Sickle Cell Disease were evaluated with brain MRI and neuropsychological evaluation. Completed studies were obtained for 194 children, 135 with HbSS. MRIs were categorized according to the presence of T2-weighted, high-intensity images suggestive of infarct and were further categorized on the basis of a clinical history of cerebrovascular accident (CVA). An abnormal MRI but no clinical history of CVA was classified as a silent infarct. Neuropsychological evaluations included assessment of both global intellectual functioning and specific academic and neuropsychological functions.

RESULTS

Central nervous system (CNS) abnormalities were identified on MRI in 17.9% of the children (22.2% of children homozygous for HbS), and a clinical history of CVA (N = 9, 4.6%) was identified in only children with HbSS disease. Subsequent analyses examined only children with HbSS. Children with a history of CVA performed significantly poorer than children with silent infarcts or no MRI abnormality on most neuropsychological evaluation measures. Children with silent infarcts on MRI performed significantly poorer than children with no MRI abnormality on tests of arithmetic, vocabulary, and visual motor speed and coordination.

CONCLUSIONS

These results substantiate the importance of careful evaluation, educational planning, and medical intervention for CNS-related complications in children with sickle cell disease.

A novel splice-site mutation in the gamma subunit of the epithelial sodium channel gene in three pseudohypoaldosteronism type 1 families

Pseudohypoaldosteronism type 1 (PHA1, OMIM 264350) is an uncommon inherited disorder characterized by salt-wasting and end-organ unresponsiveness to mineralocorticoids. A complete genome search using homozygosity mapping in eleven consanguineous families with PHA1 provided conclusive evidence of linkage with heterogeneity. The disease locus mapped to chromosome 16p12.2-13.11 in six families and to 12p13.1-pter in the other five families. These two chromosomal regions harbour the genes encoding the three subunits of the human amiloride sensitive epithelial sodium channel (hENaC): SCNN1B and SCNN1G on 16p and SCNN1A on 12p. Our linkage results have been further supported by the recent report of mutations in the alpha and beta subunit genes in PHA1 patients. We now report the identification of a 3' splice site mutation in SCNN1G (318-1 G-->A) in three families showing linkage to 16p. Abnormal splicing results with the production of two messenger RNAs, one arising from activation of an adjacent cryptic splice site and the other from skipping of the downstream exon. The two corresponding mutant gamma hENaC subunits are predicted to have three highly conserved amino acids in the extracellular domain replaced by a novel amino acid (KYS106-108-->N) and truncation from 649 to 134 amino acids respectively. These three families all originate from the Indian sub-continent and the probands have severe generalized PHA. They share a common haplotype which suggests the presence of a founder mutation in this sub-population.

Psychological adjustment of adults with sickle cell anemia: stability over 20 months, correlates, and predictors

The stability of psychological adjustment was assessed across three time points spanning a 20-month period with 59 African-American adults with sickle cell anemia. Stable good adjustment was associated with lower levels of daily and illness-related stress, palliative methods of coping with stress, and pain coping strategies characterized by negative thinking/passive adherence. With baseline levels of illness and demographic parameters controlled, baseline levels of daily and illness-related stress made significant independent contributions to adjustment at 20 months follow-up. The findings are discussed in relation to the potential utility of improving methods of coping with stress and pain to enhance the adjustment of patients with sickle cell anemia.

Behavioral characteristics of very-low-birth-weight infants of varying biologic risk at 6, 15, and 24 months of age

OBJECTIVE

To explore the relationship between developmental outcome and behavior of very-low-birth-weight (VLBW) infants (< or = 1500 g) at high and low biologic risk.

DESIGN

Descriptive, ex post facto.

SETTING

Clinic for follow-up of infants at high risk.

PARTICIPANTS

A convenience sample of 102 VLBW infants, free of major congenital anomalies, who completed 6-, 15-, and 24-month developmental testing and who were part of a larger study of 274 VLBW infants.

MAIN OUTCOME MEASURE

Bayley Scales of Infant Development.

RESULTS

Infants at high biologic risk, versus infants at low biologic risk, were less attentive and active through age 15 months and were less adept in gross and fine motor skills through age 24 months (p < or = 0.05-0.001). Infants with continuous delay were less attentive than infants with no delay or late delay through age 24 months, less active through age 15 months (p < or = 0.001-0.001), and less skilled in motor behaviors through age 24 months (p < or = 0.05-0.001).

CONCLUSION

Infants at high biologic risk and infants with developmental delays are less attentive, less active, and less skilled in motor tasks during the first 15-24 months of life, suggesting an association between biologic risk and behavior and developmental delay and behavior.

Localisation of pseudohypoaldosteronism genes to chromosome 16p12.2-13.11 and 12p13.1-pter by homozygosity mapping

Pseudohypoaldosteronism type 1 (PHA1, OMIM 264350) is a rare Mendelian disorder characterised by end-organ unresponsiveness to mineralocorticoids. Most steroid hormone insensitivity syndromes arise from mutations in the corresponding receptor, but available genetic evidence is against involvement of the mineralocorticoid receptor gene, MLR, in PHA1. A complete genome scan for PHA1 genes was undertaken using homozygosity mapping in 11 consanguineous families. Conclusive evidence of linkage with heterogeneity was obtained with a maximum two-locus admixture lod score of 9.9. The disease locus mapped to chromosome 16p12.2-13.11 in six families and to 12p13.1-pter in the other five families. The two chromosomal regions harbour genes for subunits of the amiloride-sensitive epithelial sodium channel: SCNN1B and SCNN1G on 16p and SCNN1A on 12p. Liddle's syndrome of hypertension and pseudoaldosteronism has been shown to arise from mutations in SCNN1B and SCNN1G. These results strongly suggest that PHA1 and Liddle's syndrome are allelic variants caused by mutations in genes encoding subunits of this sodium channel. These genes are of broad biological interest both in relation to sodium and water homeostasis in mammals and by virtue of their homology to the mec genes of Caenorhabditis elegans involved in mechanosensitivity and neuronal degeneration.

Identification of evolutionary conserved regulatory sequences in the 5' untranscribed region of the neural-specific ubiquitin C-terminal hydrolase (PGP9.5) gene

The structure at the 5' end of the gene encoding neural-specific protein gene product 9.5 (PGP9.5) has been compared between two evolutionary distant species: the human and Monodelphis domestica. In contrast to the highly conserved coding sequences of the gene, only a 48% identity was found across a 1-kb stretch of 5' untranslated and untranscribed DNA. Promoter function studies performed on the human sequence identified a 233-bp CpG-rich minimal promoter. Truncation mutagenesis revealed the presence of essential positive cis-acting regulatory sequences within the region -182 to -123 relative to the transcription initiation site. Sequence alignment analysis of the human and Monodelphis promoter sequences showed 76% identity in this 59-bp region of the gene. A perfectly conserved 12-bp sequence (PSN) located within this region acts as a non-cell-specific activator of transcription in a heterologous reporter gene (pBLCAT2). PGP9.5 gene expression can be readily detected in human neuroblastoma cell lines but is absent in nonneuronal cell lines such as HeLa. Studies on the cell type specificity of the human PGP9.5 promoter demonstrated that in contrast to the endogenous gene, the promoter is active in HeLa cells. However, the promoter displays higher levels of activity in human neuroblastoma cell lines. A conserved 16-bp sequence located at -356 (motif 5) was able to reduce the activity of a heterologous minimal promoter specifically in HeLa cells. In conclusion, we have shown that expression of the PGP9.5 gene is regulated by evolutionary conserved positive and negative cis-acting sequences located in the untranscribed region of the gene.

Suture placement for hemostasis during laparoscopy using the Stamey needle

Bleeding at cannula insertion sites during laparoscopic procedures often is difficult to manage. The few published techniques for controlling abdominal wall bleeding include suturing under direct observation, electrocoagulation, and placement of a Foley catheter. These methods may provide less than adequate hemostasis, however. We developed a technique of direct suture placement under laparoscopic guidance using an absorbable monofilament suture and the Stamey needle as a ligature carrier.

Single strand conformation analysis of two genes contained within the first intron of the neurofibromatosis type I gene in patients with multiple sclerosis

Single strand conformation analysis has become the most widely used technique to screen large numbers of DNA samples for unknown mutations which may contribute to genetic susceptibility to disease. The method relies on the electrophoretic migration of a single strand of nucleic acid in a polyacrylamide gel being dependent on its conformation which is in turn dependent on its sequence. We have examined two closely related genes present in the first intron of the neurofibromatosis type I gene--the oligodendrocyte myelin glycoprotein (OMGP) gene and the ecotropic viral integration 2A (EVI2A) gene--in 36 patients with multiple sclerosis (MS) and 36 healthy controls. A single mutation was found in the OMGP gene which resulted in an amino-acid change of glycine to aspartic acid. This occurred in identical proportions (16.6%) in MS patients and controls. Two rare mutations were found in the EVI2A gene, one resulting in an arginine substituting for a glutamine (one control and one patient), the other in the replacement of a glycine with serine (one control only). A third common polymorphism was seen in 5'-untranslated region of the EVI2A gene, with 65% of patients and controls showing a T-->C transition in either a heterozygous or a homozygous form. This makes it unlikely that either of these genes is involved in genetic susceptibility to MS, but regions of these genes outside of the exonic sequences have not been examined.

PGP9.5, a ubiquitin C-terminal hydrolase; pattern of mRNA and protein expression during neural development in the mouse

PGP9.5 is a neurone and neuro-endocrine specific ubiquitin carboxyl terminal hydrolase estimated to form 1-2% of total brain protein. We have examined the temporal and spatial distribution of PGP9.5 mRNA and protein in the developing mouse embryo. These studies show that PGP9.5 is present at high levels in all differentiated neurones throughout the central and peripheral nervous systems at all stages of development. The mRNA is detected in the neural tube 1 day prior to the protein and before neuronal differentiation is underway. Both mRNA and protein are present during the initial appearance of motor and sensory neurones, prior to their peak production. PGP9.5 immunoreactivity was detected using microwave pretreatment of sections in order to unmask epitopes. In general unmasking led to an overall enhancement of immunoreactivity although in some sites, for example the dorsal root and cranial nerve ganglia and the bundle of His, there was evidence for anatomical variation in the distribution of masked versus unmasked protein. The very early expression of PGP9.5 suggests that there is a role for ubiquitin hydrolases in the differentiation of neurone precursors as well as in the differentiated neurone.

Screening for child-reported behavioral and emotional problems in primary care pediatrics

In light of the findings that mother-completed checklists do not adequately reflect children's perceptions of their own adjustment, two child-completed questionnaires were assessed as screening measures for behavioral or emotional problems with 50 children seen for well-child examinations. Case criterion was child-reported DSM-III symptoms through a clinical interview. Support was provided for the Revised Children's Manifest Anxiety Scale but not the Children's Depression Inventory as a child-reported screening measure. Moreover, the findings indicated that both mother-completed and child-completed measures are needed to screen adequately for behavioral or emotional problems of children seen in a primary care pediatric clinic.

Influence of acidosis, hypoxemia, and hypotension on neurodevelopmental outcome in very low birth weight infants

OBJECTIVE

We previously demonstrated that acidosis (pH < 7.15) predicts poor motor outcome in very low birth weight (VLBW) infants. The present study was undertaken to examine the association between acidosis and developmental outcome in more detail and to better understand the interrelationship of acidosis with related factors such as hypoxemia and hypotension.

METHODS

The nursery records of 191 infants enrolled in our VLBW follow-up study were reviewed to identify the type of acidosis (metabolic or respiratory) present, measure the duration of single and cumulative episodes, and examine the interaction of acidosis with hypoxemia and hypotension. The Bayley Scales of Infant Development and a detailed neurologic examination were performed at 6 (n = 158) and 24 (n = 106) months corrected age.

RESULTS

At 6 months, both respiratory and metabolic acidosis as well as the total duration and longest single episode of acidosis were significantly correlated with cognitive, motor, and neurologic outcome (P < .0001). By 24 months, only the association of the metabolic component of acidosis with all three outcome measures remained significant. Duration of hypotension independently correlated with outcome at both testing periods (P < .002) but isolated hypoxemia did not. The metabolic component of acidosis and isolated hypotension contributed significantly to the variance in all three outcome measures (P < .05). Duration of hypoxemia, but not hypotension, contributed significantly (53%) to the variance in the metabolic component of acidosis.

CONCLUSION

We conclude that it is the metabolic component of acidosis that is important in predicting poor developmental outcome in VLBW infants. The detrimental effect of hypoxemia appears to be closely related to the occurrence of metabolic acidosis while hypotension has an independent effect on outcome.

Multiple sclerosis in island populations: prevalence in the Bailiwicks of Guernsey and Jersey

The aim of this study was to establish for the first time the prevalence of multiple sclerosis in the Bailiwicks of Guernsey and Jersey, as representing the most southerly part of the British Isles. All patients with multiple sclerosis in the Channel Islands resident on prevalence day were identified by contacting all medical practices, Multiple Sclerosis, and Action Research for Multiple Sclerosis societies by letter and visits. The crude overall prevalence rates were 113/100,000 (95% confidence interval (95% CI) 90.3-135.7) and 86.7/100,000 (95% CI 63.3-110.0) for the Bailiwicks of Jersey and Guernsey respectively. When standardised to the age and sex structure of a previously reported Northern Ireland population the standardised prevalence ratios were 120.2/100,000 (95% CI 96.0-144.3) for Jersey and 95.6/100,000 (95% CI 69.9-121.3) for the Bailiwick of Guernsey. When compared with recent studies in the northern United Kingdom the prevalence rates for multiple sclerosis in the Channel Islands lend some support to the proposed latitudinal gradient in the British Isles although the standardised prevalence ratio in the Bailiwick of Jersey is similar to those found in recent studies of southern Britain. The standardised prevalence rates of probable and definite multiple sclerosis for the male populations were 37.3/100,000 (95% CI 17.9-56.7) for the Bailiwick of Guernsey and 45.5/100,000 (95% CI 26.3-64.7) for the Bailiwick of Jersey whereas the standardised prevalence rates for the female populations were 97.5/100,000 (95% CI 73.9-143.5) and 139.5/100,000 (95% CI 112.6-181.2) respectively. Thus there is a striking and unexplained 43% higher prevalence of probable and definite multiple sclerosis in the female population of Jersey compared with that of the Bailiwick of Guernsey. This seems to be due to an unusually low prevalence of the disease among the female population of the Bailiwick of Guernsey compared with that of the United Kingdom mainland.

An enzyme-linked immunosorbent assay for complement regulatory proteins and membrane-bound immunoglobulins on intact red blood cells

We have developed an ELISA technique to examine RBC-bound molecules in autoimmune disorders. In particular, the technique has enabled us to investigate the role of some complement regulatory proteins in immune complex transport and to suggest that decay accelerating factor (DAF) may be involved in this process. In both autoimmune haemolytic anaemia (AHA) and systemic lupus erythematosus (SLE) a sub-set of individuals was identified, on the basis of patterns of complement receptor 1 (CR1) expression on RBC. In these patients, CR1 identified using the monoclonal antibody E11 was low or absent whereas CR1 identified using a DAKO monoclonal antibody (C3RTo5) was present at normal levels.

Psychological adjustment of children with sickle cell disease: stability and change over a 10-month period

Rates of poor psychological adjustment of children with sickle cell disease remained relatively constant over initial and follow-up assessment points. However, there was relatively little stability in the classification of the adjustment of individuals, low congruence in specific behavior problem patterns and diagnoses in accordance with the Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; American Psychiatric Association, 1980), and less stability in child adjustment by child report than by mother report. With initial levels of adjustment controlled, children's strategies for coping with pain accounted for a significant increment in child-reported symptoms (19%) and mother-reported internalizing behavior problems (8%) at follow-up beyond the contribution of illness and demographic parameters and follow-up interval. The findings suggest that children's coping strategies are a salient intervention target for enhancing adjustment.

National survey of state trauma registries--1992

Registries, such as those for oncology, have demonstrated usefulness in collating information. Trauma care can be improved through the accumulation of local, regional, and state trauma statistics. The efforts to develop a National Trauma Registry in the United States are still in their infancy. A four-page survey questionnaire was returned by each of the 50 State Emergency Medical Services (EMS) Directors, as well as the EMS Directors of the District of Columbia and five American possessions, to evaluate the status of state trauma registries in the United States. In 1992, 24 (48%) states had a registry. Development costs average $101,107 and annual maintenance costs averaged $72,105. An average of 1.7 full-time equivalents (FTE) was necessary to maintain the registry. Fourteen (58%) states have effected legislation through the registry. Trauma prevention has been promoted in nine (38%) states and a decrease in mortality recognized through the registry in five (21%) states. Trauma registries are labor intensive and expensive but are effective in decreasing morbidity and mortality. The need for a National Trauma Registry incorporating and comparing data from health care facilities around the United States and its possessions has the potential of improving trauma health care.

Psychological adjustment of children with sickle cell disease: stability and change over a 10-month period

Rates of poor psychological adjustment of children with sickle cell disease remained relatively constant over initial and follow-up assessment points. However, there was relatively little stability in the classification of the adjustment of individuals, low congruence in specific behavior problem patterns and diagnoses in accordance with the Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; American Psychiatric Association, 1980), and less stability in child adjustment by child report than by mother report. With initial levels of adjustment controlled, children's strategies for coping with pain accounted for a significant increment in child-reported symptoms (19%) and mother-reported internalizing behavior problems (8%) at follow-up beyond the contribution of illness and demographic parameters and follow-up interval. The findings suggest that children's coping strategies are a salient intervention target for enhancing adjustment.

Resident research in obstetrics and gynecology

Mandatory research in an obstetrics-and-gynecology residency can be an effective tool for teaching physicians the skills needed for them to become intelligent readers of the medical literature. We present our 15-year experience with a resident research program. We discovered that in addition to achieving the primary goal in resident education, structured resident research has many other benefits.

Developmental outcome of very low birth weight infants as a function of biological risk and psychosocial risk

The relative contribution of biological and psychosocial risk factors to developmental outcome of 102 very low birth weight infants (< 1500 g) was delineated through 24 months corrected age. Biological risk, assessed by the Neurobiologic Risk Score (NBRS), accounted for significant amounts of variance in Bayley Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) at the 6-, 15-, and 24-month assessment points. Psychosocial risk, reflected in maternal appraisals of daily stress, accounted for a significant increment in cognitive outcome (MDI), over and above that accounted for by the NBRS, at each assessment point. Cognitive functioning at each assessment point differed as a function of biological risk and psychosocial risk status. The findings are discussed in terms of maternal stress as a marker of, and salient intervention target for, caregiving environments that can maximize or minimize the effects of biological vulnerability.

Change over a 12-month period in the psychological adjustment of children and adolescents with cystic fibrosis

Found that group rates of mother-reported and child-reported adjustment problems remained relatively constant over initial and 12-month follow-up assessment points. However, there was less stability in the classification of the adjustment of individuals, in specific behavior problem patterns and diagnoses, and in child-reported adjustment than in mother-reported adjustment. With initial level of child adjustment controlled, children's perceptions of self-worth accounted for a significant increment in child-reported symptoms and mother-reported adjustment at follow-up. Maternal distress also accounted for a significant increment in child-reported symptoms. These findings add support for the role of maternal adjustment and child self-worth in the adjustment of children with cystic fibrosis.