Effects of grade retention on academic performance and behavioral development

This study examined the controversial practice of grade retention and children's academic and behavioral adjustment using data from the Quebec Longitudinal Study of Kindergarten Children. We employed an autoregressive modeling technique to detect the impact of being held back during primary school on subsequent academic performance and behavioral development until age 12 years. The results indicate both a short- and long-term negative influence on academic performance for boys and girls. Children's anxious, inattentive, and disruptive behaviors persisted and, in some cases, worsened after grade retention. These prospective associations were long lasting and more pronounced when grade retention occurred early in primary school. Boys were more vulnerable to the negative influence of grade retention on academic performance and classroom disruptiveness. Disruptive behavior in girls was comparatively less associated with long-term consequences than boys. Nevertheless, girls experienced both short- and long-term academic performance problems in the aftermath of grade retention. Children's prosocial behavior appeared unaffected by grade retention. These results are independent of what would have been expected by the natural course of academic and behavioral development.

Prevalence of psychiatric diagnoses and the role of perceived impairment: findings from an adolescent community sample

The present study examined psychiatric functioning in a community sample of adolescents aged 14 to 17 years (average age of 15 years). We administered the Diagnostic Interview Schedule for Children-2.25 (DISC-2.25) to 1,201 adolescents and their mothers to obtain prevalence estimates of DSM-III-R disorders and the amount of perceived impairment associated with these disorders. While adolescent females reported a significantly higher prevalence of psychiatric disorders than males (15.5% vs. 8.5%), mothers indicated no sex difference. Compared with adolescent males, females had significantly higher rates of internalizing, anxiety. and depressive disorders. In contrast, the prevalence of externalizing disorders was significantly higher among adolescent males. The inclusion of an impairment criterion had a significant impact in reducing the prevalence rates of overall psychiatric disorders. This reduction occurred mainly through impairment's effects on internalizing disorders, specifically anxiety-based disorders (i.e., simple and social phobia). Given the limited research on the effect of impairment on the prevalence of adolescent psychiatric disorders, future work in this area seems warranted.

Reappearance of human diphyllobothriasis in a limited area of Lake Como, Italy

BACKGROUND

Very few sporadic cases of autochthonous diphyllobothriasis have been reported in Italy during the past 20 years, probably due to the drastic decrease or disappearance of some fish species, mainly Perca fluviatilis L., known as the intermediate host of the infective larval stage of this tapeworm. However, increasing consumption of raw or undercooked fish during the last years as influenced by Oriental cuisine, played an important role in a number of new single cases of the infection or microepidemics.

PATIENTS

We describe six cases which were diagnosed within a period of 4 months, which all originated from the area of Lake Como (Lombardy region). All subjects had previously eaten raw perch fillets. Four individuals complained of gastrointestinal signs and symptoms, whereas two were asymptomatic.

DISCUSSION

Parasitological diagnosis was achieved in four cases by recovery of typical operculated eggs in stool specimens; in two others by morphological features of proglottids recovered from feces. Treatment with niclosamide, as a single oral dose, cured the infection in all subjects. This is the first report of this infection in Italy in the last 10 years.

Extended-spectrum TEM- and SHV-type beta-lactamase-producing Klebsiella pneumoniae strains causing outbreaks in intensive care units in Italy

The aim of the present study was to investigate the production of extended-spectrum beta-lactamases (ESbetaLs) and the epidemiological correlations in a total of 107 Klebsiella pneumoniae strains resistant to third- and fourth-generation cephalosporins. The strains were collected from patients in four intensive care units (3 neonatal and 1 general) in three hospitals in Italy between March 1996 and July 1997. All strains were found to produce ESbetaLs. Phenotypic (antibiotyping and ESbetaL patterns) and genotypic (plasmid profile and pulsed-field gel electrophoresis) analyses showed that a single strain had been responsible for each outbreak in each of the four intensive care units. Isoelectric focusing, activity on substrates and gene sequencing showed that the strains produced SHV-5, SHV-2a, SHV-12 and TEM-52 beta-lactamases. This is not only the first time that ESbetaL-producing Klebsiella pneumoniae strains have been reported as causing epidemics in Italian hospitals, it is also, to the best of our knowledge, the first time that an outbreak caused by a TEM-52 ESbetaL-producing Klebsiella pneumoniae strain has been reported. The data presented here illustrate the complexity of determining the epidemiological pattern of ESbetaL producers in large hospitals that do not have an ESbetaL-monitoring program.

Ivermectin alone or in combination with benzyl benzoate in the treatment of human immunodeficiency virus-associated scabies

In order to establish a safe and reliable treatment for human immunodeficiency virus (HIV)-associated scabies, we have treated 60 episodes of scabies in this setting, occurring in 39 patients, with one of the following regimens: (i) topical treatment with benzyl benzoate solution; (ii) single-dose oral treatment with ivermectin alone; and (iii) combination therapy with benzyl benzoate solution and oral ivermectin, employing the same regimens as single-agent therapy. Patients were stratified according to the severity score of the disease and the outcome (eradication, relapse, failure). We found that both benzyl benzoate and ivermectin alone were quite effective in mild to moderate scabies, but they were both associated with an unacceptable rate of relapse and failure in severe or crusted scabies. In contrast, combined treatment produced an optimal rate of success, without significant treatment-related side-effects. Therefore, we consider that combination treatment with benzyl benzoate solution and oral ivermectin is preferable to single-agent therapy in crusted scabies occurring in HIV/acquired immune deficiency syndrome patients.

Molecular profile of Epstein-Barr virus infection in HHV-8-positive primary effusion lymphoma

Primary effusion lymphoma (PEL) selectively involves the serous body cavities, occurs predominantly in immunodeficient patients and is infected consistently by human herpesvirus type-8. PEL is also frequently infected by Epstein-Barr virus (EBV). The precise pathogenetic role of EBV coinfection in PEL is not fully understood. The lymphoma fails to express the EBV transforming proteins EBNA-2 and LMP-1, whereas it expresses EBNA-1 (latency I phenotype). Some studies have hypothesized that other EBV-positive lymphomas expressing the latency I phenotype may associate with specific molecular variants of EBNA-1, although this issue has not been addressed in PEL. On this basis, this study is aimed at a detailed molecular characterization of EBV in PEL. Fifteen EBV positive PEL (12 AIDS-related, one post-transplant, two arising in immunocompetent hosts) were subjected to molecular characterization of the viral genes EBNA-1 and LMP-1, as well as definition of EBV type-1/type-2. The EBNA-1 gene displayed a high degree of heterogeneity in different cases of PEL, with seven distinct recognizable variants and subvariants. A wild-type LMP-1 gene was detected in 10/15 cases, whereas in 5/15 cases the LMP-1 gene harbored a deletion spanning codons 346-355. EBV type-1 occurred in 11/15 PEL whereas EBV type-2 occurred in 4/15 cases. Despite a high degree of genetic variability of the virus in different PEL cases, each single PEL harbored only one EBV variant, consistent with monoclonality of infection and suggesting that infection preceded clonal expansion. Overall, our results indicate that: (1) individual PEL cases consistently harbor a single EBV strain; (2) EBNA-1 displays a high degree of heterogeneity in different PEL cases; (3) no specific EBV genotype preferentially associates with PEL.

Effects of poverty on academic failure and delinquency in boys: a change and process model approach

Using data from the Montreal Longitudinal-Experimental Study, we examined the impact of poverty (and its correlate, family configuration status) on academic placement and self-reported delinquency in boys at age 16. We then investigated whether the relation between family economic hardship and antisocial behaviour is direct or indirect by considering the value of parenting practices and academic failure as process variables in the model. Data included official records, and parent, teacher, and self-reports. The temporal intensity of poverty was classified into five categories: never-poor; always-poor; poor-earlier; poor-later; and transitory-poverty. Family configuration status was classified by both temporal characteristics and number of marital transitions: intact-family; short-term-single; long-term-single; short-term-remarried; long-term-remarried; and multiple-marital-transitions. Results revealed that when maternal education and early childhood behaviour were controlled, poverty had an effect on both academic failure and extreme delinquency. This effect was independent of family configuration status. Although they both significantly predicted extreme delinquency on their own, academic failure and parental supervision did not mediate the relationship between poverty and delinquency. Divorce increased the risk of theft and fighting at age 16, regardless of financial hardship. Parental supervision only helped explain the effects of divorce on boys' fighting.

Comparative activity of piperacillin/tazobactam against clinical isolates of extended-spectrum beta-lactamase-producing Enterobacteriaceae

beta-Lactam resistance on the part of the Enterobacteriaceae causes serious therapeutic problems in our institutions due to their production of extended-spectrum beta-lactamases (ESbetaLs). We studied the in vitro activity of beta-lactam/beta-lactamase inhibitor combinations and third-generation cephalosporins and monobactams against 71 clinically relevant Enterobacteriaceae which produced TEM- and SHV-derivative ESbetaLs. Of the single drugs and combinations tested, piperacillin/tazobactam proved to be the most effective. Piperacillin/tazobactam was highly active against Proteus mirabilis, with minimum inhibitory concentrations (MICs) ranging from 0.125 to 16 microg/ml; Escherichia coli (MICs from 2 to 16 microg/ml) and Serratia marcescens (MICs from 4 to 8 microg/ml), while its activity against Klebsiella pneumoniae ESbetaL producers turned out to be closely related to the type and the amount of enzyme produced, the MIC ranging from 1 to 128 microg/ml. The antibacterial activity of piperacillin/tazobactam was stronger than that of ticarcillin/clavulanate, ceftriaxone, cefotaxime, ceftazidime and aztreonam, and the combination shared favorable in vitro activity properties against the ESbetaL producers with imipenem which, however, should be kept as reserve product.

Repeated epidemics caused by extended-spectrum beta-lactamase-producing Serratia marcescens strains

An outbreak of Serratia marcescens involving 42 patients admitted to the general intensive care unit of the Hospital of Varese, Italy, occurred from March 1994 to August 1995. The causative strains were resistant to oxyimino-cephalosporins and monobactams due to their production of an extended-spectrum beta-lactamase. Another outbreak caused by Serratia marcescens strains had occurred in the same unit a few months earlier, from February to October 1993, with the strains involved producing a novel TEM-derived extended-spectrum beta-lactamase. In order to verify whether there were any relationships between isolates from the two epidemics, the strains and their enzymes were characterized. Biochemical data and gene amplification experiments showed that the isolates of the second outbreak harbored a non-conjugative plasmid of approximately 48 kb, codifying for the production of an SHV-derived extended-spectrum beta-lactamase with pI 8.2. Restriction fragment length polymorphism analysis of total genomic DNA by pulsed-field gel electrophoresis of Serratia marcescens isolates unambiguously identified two different bacterial clones responsible for the two epidemics. Epidemiological and microbiological investigations demonstrated the long persistence of Serratia marcescens strains and their circulation in other hospital wards, thus suggesting their possible role as a long-term reservoir for further epidemic spread.

[Emergency coronary surgery after failed angioplasty: 11 years of experience (1987-1997)]

METHODS

From January 1987 to December 1997, thirty patients underwent emergent or urgent coronary artery bypass grafting after failed elective percutaneous transluminal coronary angioplasty. Dissection/occlusion of the target artery was the commonest complication, but we also had two cases of stent dislocation and one case of coronary artery wall perforation. Two-thirds of the patients experienced extreme preoperatory hemodynamic instability (i.e., cardiac arrest or cardiogenic shock) and half had to be intubated in the Catheterization Laboratory. An average of 1.73 grafts/patient was performed. Complete coronary revascularization was achieved in 93% of the cases; the internal mammary artery could be employed in one-third only.

RESULTS

In-hospital mortality was 10%, and perioperatory myocardial infarction or persistent ischemia could be detected in half of the patients. The need for aortic counterpulsation, and the use of inotropic and antiarrhythmic drugs were higher than average in this group of patients; while intensive care unit and hospital stay were longer. Patients with deteriorated preoperative hemodynamics fared significantly worse. Late results were encouraging: seventy-five per cent of all patients (and 84% of hospital survivors) were still alive an average of 52 months after surgery. Two-thirds of all patients (and 72% of hospital survivors) were alive and angina-free.

CONCLUSIONS

Even in the current era, revascularization surgery after failed coronary angioplasty still carries an increased risk for postoperative complications and death, especially for patients with deteriorated preoperative hemodynamic conditions. On the other hand, postoperative middle- and long-term results are encouraging, as hospital survivors were similar to elective bypass patients regarding survival and freedom from return of angina.

The impact of family transition on the development of delinquency in adolescent boys: a 9-year longitudinal study

The purpose of this study was to examine prospectively the impact of family transition on deviant development in a sample of 427 French-Canadian boys participating in a longitudinal study from kindergarten onwards. During the course of the study some boys experienced family transition. We grouped the boys by developmental period and number of marital transitions they experienced: divorced between ages 6 and 11; divorced between ages 12 to 15; remarried between ages 6 and 11; and remarried between ages 12 and 15. From ages 11 to 15 we assessed boys' delinquency and their family processes (parental supervision, punishment, and communication) annually. The results suggest that boys who experienced remarriage between ages 12 and 15 are at greater risk for delinquency. In particular, they showed evidence of comparatively more theft and fighting at earlier ages than their peers from families that had remained intact. At similar points in development, they perceived less expressive parent-child relationships. Finally, these boys also perceived less monitoring by their parents, both overall and at different points in adolescence.

Characterization of a new TEM-derived beta-lactamase produced in a Serratia marcescens strain

A natural TEM variant beta-lactamase was isolated from an epidemic strain of Serratia marcescens. Nucleotide gene sequencing revealed multiple point mutations located in the 42-to-44 tripeptide and positions 145 to 146, 178, and 238. In addition, a glutamic acid 212 deletion was also found. The purified enzyme was studied from a kinetic point of view, revealing the highest catalytic efficiency (k[cat]/Km) values for ceftazidime and aztreonam compared with the TEM-1 prototype enzyme. The in vitro resistance correlated with kinetic parameters, and the enzyme also mediated resistance to some penicillins and an ampicillin-clavulanic acid combination. The mutational and kinetic changes are discussed in relation to the three-dimensional crystallographic structure of the wild-type TEM-1 enzyme.

Behavioural development in children of divorce and remarriage

We employed an autoregressive modelling technique with data from the Québec Longitudinal Study to prospectively examine the developmental impact of family transition on behaviour while controlling for predivorce and preremarriage effects. Teachers rated children's anxious, hyperactive, physically aggressive, oppositional, and prosocial behaviour every 2 years from kindergarten through to the end of elementary school. Once individual and parental characteristics and antecedent family events were controlled, children who experienced parental divorce before age 6 exhibited comparatively more behavioural disturbance than their peers whose parents divorced later. With the exception of a protective effect on hyperactive behaviour, remarriage did not have a significant impact on children's behaviour when the legacy of divorce was controlled. Although the results suggest that children of divorced parents show difficulty in many areas of functioning, the effects of family transition on behavioural development were dependent on the child's age and the specific behavioural dimension assessed. Compared to other points in development, early childhood divorce was associated with long-term increases in anxious, hyperactive, and oppositional behaviour during later childhood. The effects of divorce on children's fighting were short-lived. Unlike previous prospective studies that suggest predivorce effects, we did not observe behavioural disturbance prior to divorce or remarriage.

Boys' behavioral inhibition and the risk of later delinquency

BACKGROUND

In some studies, shyness and anxiety have protected at-risk boys from developing delinquency. In others, shyness and withdrawal have increased risk. We argue that this is because behavioral inhibition, which is the protective factor, has been confounded with social withdrawal and other constructs. Our study addresses 3 major questions: (1) is behavioral inhibition, as distinguished from social withdrawal, a protective factor in the development of delinquency; (2) does the protective effect depend on whether disruptiveness is also present; and (3) does inhibition increase the risk of later depressive symptoms even if it protects against delinquency?

METHODS

The subjects were boys from low socioeconomic status areas of Montreal, Quebec. Age 10- to 12-year predictors were peer-rated inhibition, withdrawal, and disruptiveness; age 13- to 15-year outcomes were self-rated depressive symptoms and delinquency. Eight age 10- to 12-year behavioral profiles were compared with 4 age 13- to 15-year outcome profiles.

RESULTS

Inhibition seemed to protect disruptive and nondisruptive boys against delinquency. Disruptive boys who were noninhibited were more likely than chance to become delinquent; disruptive boys who were inhibited were not. Inhibition did not increase the risk for depression among disruptive boys. Among nondisruptive boys, only nondisruptive-inhibited boys were significantly less likely than chance to become delinquent. However, withdrawal was not protective. Disruptive-withdrawn boys were at the greatest risk for delinquency or delinquency with depressive symptoms.

CONCLUSION

Inhibition and social withdrawal, although behaviorally similar, present different risks for later outcomes and, therefore, should be differentiated conceptually and empirically.

Disruptiveness, friends' characteristics, and delinquency in early adolescence: a test of two competing models of development

This study tested 2 competing models of friends' influence on the development of delinquency in disruptive boys. In so doing, we examined whether highly disruptive, moderately disruptive, moderately conforming, and highly conforming boys' delinquency increased or decreased depending on their friends' characteristics. A sample of 868 boys was classified into the 4 groups according to teacher ratings at ages 11 and 12. Each group was then subdivided by mutual friends' peer-rated aggressiveness-disturbance at the same ages: aggressive-disturbing friends, average friends, nonaggressive-nondisturbing friends, and no friends. Subgroups were next compared on self-reported delinquency at age 13 while controlling for average self-reported delinquency and socioeconomic variables at ages 11 and 12. Results indicate that moderately disruptive boys with aggressive-disturbing friends were more delinquent at age 13 than other subgroups of moderately disruptive boys. Highly disruptive and conforming boys, however, were unaffected by their friends' characteristics. We conclude that the results partially support each theoretical model, suggesting that both individual characteristics and deviant peer association might play causal roles.