Rates of Incidental Findings in Brain Magnetic Resonance Imaging in Children

Importance

Incidental findings (IFs) are unexpected abnormalities discovered during imaging and can range from normal anatomic variants to findings requiring urgent medical intervention. In the case of brain magnetic resonance imaging (MRI), reliable data about the prevalence and significance of IFs in the general population are limited, making it difficult to anticipate, communicate, and manage these findings.

Objectives

To determine the overall prevalence of IFs in brain MRI in the nonclinical pediatric population as well as the rates of specific findings and findings for which clinical referral is recommended.

Design, Setting, and Participants

This cohort study was based on the April 2019 release of baseline data from 11 810 children aged 9 to 10 years who were enrolled and completed baseline neuroimaging in the Adolescent Brain Cognitive Development (ABCD) study, the largest US population-based longitudinal observational study of brain development and child health, between September 1, 2016, and November 15, 2018. Participants were enrolled at 21 sites across the US designed to mirror the demographic characteristics of the US population. Baseline structural MRIs were centrally reviewed for IFs by board-certified neuroradiologists and findings were described and categorized (category 1, no abnormal findings; 2, no referral recommended; 3; consider referral; and 4, consider immediate referral). Children were enrolled through a broad school-based recruitment process in which all children of eligible age at selected schools were invited to participate. Exclusion criteria were severe sensory, intellectual, medical, or neurologic disorders that would preclude or interfere with study participation. During the enrollment process, demographic data were monitored to ensure that the study met targets for sex, socioeconomic, ethnic, and racial diversity. Data were analyzed from March 15, 2018, to November 20, 2020.

Main Outcomes and Measures

Percentage of children with IFs in each category and prevalence of specific IFs.

Results

A total of 11 679 children (52.1% boys, mean [SD] age, 9.9 [0.62] years) had interpretable baseline structural MRI results. Of these, 2464 participants (21.1%) had IFs, including 2013 children (17.2%) assigned to category 2, 431 (3.7%) assigned to category 3, and 20 (0.2%) assigned to category 4. Overall rates of IFs did not differ significantly between singleton and twin gestations or between monozygotic and dizygotic twins, but heritability analysis showed heritability for the presence or absence of IFs (h2 = 0.260; 95% CI, 0.135-0.387).

Conclusions and Relevance

Incidental findings in brain MRI and findings with potential clinical significance are both common in the general pediatric population. By assessing IFs and concurrent developmental and health measures and following these findings over the longitudinal study course, the ABCD study has the potential to determine the significance of many common IFs.

21. GONORRHOEA INFECTION IN SYDNEY WOMEN

Background: Gonorrhoea is associated with undesirable reproductive health outcomes in women including pelvic inflammatory disease and tubal factor infertility. However there is low prevalence in the general community and some authors have suggested that only those women with risk factors should be tested. But can we predict who will have a positive gonorrhoea result? Methods: A retrospective, case controlled, study was undertaken in an inner Sydney public Sexual Health clinic between January 2000 and December 2005. Cases were all women with culture proven cervical n.gonorrheoea infection in the time period. These were case matched with subsequent women with a negative gonorrhoea culture test. Variables examined included demographics, sex worker status, country of birth, injecting drug use (IDU) status, presence of symptoms and concurrent STIs. Results: There were 40 women who were n.gonorrhoea culture positive during the study period and 27 cases and 23 controls reported any genital symptoms. (what were the confidence intervals?) The relative risk of having gonorrhoea if discharge was described was 1.75 (p�<�0.05). The cases had a high rate of concurrent STI including chlamydia. Conclusions: The only significant predictor of gonorrhoea in this group was the symptom of vaginal discharge. Thus in our clinic population behaviour, demographic data or cannot be used to determine who gets tested for gonorrhoea.

Sexual health problems managed in Australian general practice: a national, cross sectional survey

OBJECTIVES

To ascertain how frequently Australian general practitioners (GPs) identify sexual health (SH) problems, to gain understanding of how SH problems are managed in general practice and to determine the characteristics of GPs who manage them.

METHODS

A secondary analysis of data from the BEACH programme April 2000-March 2003. BEACH is a cross sectional national survey of GP activity: approximately 1000 GPs per year, each records details of 100 consecutive patient encounters. Initially, patient reasons for encounter (RFE), suggestive of a SH problem, were used to derive a list of SH problems (that is, doctor's diagnosis/problem label). Management of these problems was then investigated for all encounters with patients aged 12-49 years. The frequency of SH problems, their management and the characteristics of GPs managing them, were analysed using SAS.

RESULTS

During 299,000 encounters with 2990 GPs, 3499 (1.17 per 100 encounters) STI/SH problems were managed, the majority (81.1%) in females. The most common in women were genital candidiasis, vaginal symptoms, urinary symptoms, and intermenstrual bleeding, and in men were testicular symptoms, genital warts, and urethritis. Tests to exclude specific STIs were seldom taken and symptomatic management was common. GPs managing SH problems were younger, more likely to be female, have fewer years in practice, work in larger practices; hold FRACGP status (all p = <0.001) than those GPs who managed none.

CONCLUSION

Patients seeking medical attention for SH problems are often managed by GPs. Tests to diagnose or exclude specific sexually transmitted infections are seldom ordered and symptomatic management is common. Strategies to improve management of SH problems in general practice need to be developed and evaluated.

[Medical problems of Israelis travelling to tropical countries]

Questionnaires were sent to 1500 Israelis who traveled overseas following evaluation and preparation in a travel advisory clinic. Of 517 who responded, 227 were males, and the mean age was 25 years. The most commonly encountered medical problems were insect bites (25%), diarrhea (67%), skin conditions (23%), high altitude problems (19%), tropical diseases (11%) and respiratory tract diseases (12%). Of the 476 who took antimalarial prophylaxis, there were possible side effects in 81 (17%). Insect repellents and water purification were used by 435 and 312 travelers, respectively, and condoms by 103. Young Israelis commonly tour for prolonged periods through Asia, Africa and Latin America, and often acquire a wide spectrum of medical diseases, both infectious and noninfectious. A program of professional consultation and immunization is important in the prevention of travel-related disease.

A pictorial visual analog scale for rating severity of childhood asthma episodes

The purpose of this study was to determine whether the use of pictorial anchors improved a visual analog scale (VAS) designed to assess asthma episodes. The sample consisted of 77 children with moderate to severe asthma attending a summer camp. They rated one of two VASs, either nonpictorial (39 subjects in year 1) or pictorial (38 subjects in year 2), three times a day for 2 weeks to report the severity of their asthma symptoms. Immediately after the subjects rated the VAS, pulmonary function testing was obtained. The mean VAS scores increased 64% using the pictorial VAS while the mean PEFRs in the 2 years were almost identical, suggesting that changes on the VAS were not due to differences in pulmonary functioning. For boys, the increase in individual mean VAS score in year 2 using the pictorial VAS was 44%; for girls, the increase in individual mean VAS scores was 112%. Use of a pictorial VAS increases the range of severity of symptoms reported by children with asthma. The instrument may be a useful tool in the systematic quantifiable assessment of subjective symptomatology in pediatric asthma.

Childhood risk factors in dually diagnosed homeless adults

Although the negative long-term effects of specific childhood risk factors--sexual and physical abuse, parental mental illness and substance abuse, and out-of-home placement--have been recognized, most studies have focused on just one of these risks. This article examines the prevalence of these five childhood risk factors among dually diagnosed (mentally ill and substance abusing) homeless adults in rehabilitation programs. It further assesses the impact of each risk factor individually and in combinations of two on the social functioning skills and rehabilitation progress of these multiply disadvantaged clients.

Serotonin in the leech central nervous system: anatomical correlates and behavioral effects

1. Serotonin is sequestered by a limited population of identified neurons in the 32 ganglia of the leech nervous system. A major fraction of the serotonin in each ganglion is contained in the paired Retzius cells, colossal effector neurons whose size varies longitudinally. The 5 other classes of identified serotonin-containing neurons, one effector cell and 4 interneurons, are approximately twice as numerous in anterior as in posterior ganglia. 2. We dissected 6 longitudinal samples from the ventral nerve cords of hungry Hirudo medicinalis, and measured their serotonin content using high pressure liquid chromatography with electrochemical detection. A consistent neurochemical pattern emerged in which segmental ganglia 2-4 had the highest quantity of serotonin: 18.51 pmol per ganglion. The anterior cerebral ganglion contained 14.78 pmol, and the content of the 4 posterior samples, segmental ganglia 7-10, 12-15, 17-20 and the caudal ganglion, decreased continuously from 16.35, 15.08, 10.75 to 2.51 pmol per ganglion, respectively. Morphometric analyses indicated that this pattern of ganglionic serotonin correlated primarily with longitudinal variations in the number of serotonin neurons per ganglion and secondarily with volume of the Retzius cells. Retzius cell volume correlated highly with the mass of their innervated body segments both of which are largest in mid-body domains. 3. Serotonin expresses leech feeding, and its ganglionic levels are a potentially useful index of behavioral state. We measured serotonin in the ganglionic samples from hungry and satiated leeches. The samples from recently fed animals contained 28% less serotonin than those from hungry ones. The amounts of serotonin in the cerebral and all the segmental samples from satiated leeches were significantly lower than equivalent samples of hungry animals. A similar pattern of depletion was seen in leeches which fed for a prolonged period (90 to 120 min) rather than the normal period of 30 min. 4. The effects of ingestion on serotonin-containing neurons was examined with the glyoxylic acid-induced histochemical fluorescence. The levels of fluorescence in all serotonin neurons in fed leeches were consistently lower than those in equivalent neurons in hungry animals, corroborating the ganglionic decrease in serotonin in satiated leeches. 5. To examine effects of body wall distension on serotonin levels, hungry leeches were fed to satiation, and half of them were relaxed by removing their distending blood meals. After 6 weeks, ganglionic serotonin in leeches with relaxed bodies was 21% higher than in those with distended bodies. 6. Ingestive behavior depletes serotonin from leech neurons and body wall distension appears to interfere with its synthesis.(ABSTRACT TRUNCATED AT 400 WORDS)

Joint custody: historical, legal, and clinical perspectives with emphasis on the situation in Canada

The search for ways to mitigate the effects of family breakdown on parents and children includes legislative and clinical efforts which to some extent influence each other. In the past year much public interest has been aroused in Canada, and particularly in Ontario, in the issue of legislative changes which would make joint custody the usual or "preferred" legal disposition of custody cases. This paper provides a discussion of the legislated preference, or "rebutable presumption" of joint custody from a historical, legal and clinical point of view. Definition and elaboration of what joint custody is from the legal and practical perspectives is provided with an emphasis on Canadian laws and practice. The legal rights of the non-custodial parent are explained, and relevant case law is highlighted. The relationship between joint custody, support orders and relitigation rates are elaborated. Following this is a critical overview of the empirical research on joint custody as it relates to the adjustment of children and parent satisfaction is included. It is concluded that while there is little question that shared parenting can be beneficial to children, the enthusiasm of legislators for joint custody has not been supported by empirical data. It is necessary to examine under what circumstances and for which kinds of parents and children joint custody might be beneficial since it is unlikely that one solution will fit the needs of all families and all stages of family life.

Ingestive behaviour and physiology of the medicinal leech

Ingestion lasts 25 min in Hirudo medicinalis and is characterized by pharyngeal peristalsis which fills the crop. This peristalsis has an initial rate of 2.4 Hz which decays smoothly to 1.2 Hz at termination of ingestion. During ingestion, the leech body wall undergoes peristalsis which appears to aid in filling the crop diverticula. Body peristalsis begins at a rate of 10 min-1 and decreases linearly to 2 min-1 at termination. The body also undergoes dorsoventral flexions when blood flow is occluded. Blood meal size increases slightly with leech size: 8.4 g for 1-g leeches and 9.7 g for 2-g leeches. However, relative meal size decreases markedly with increasing animal size; from 8.15 times body mass for 1-g to 4.80 times for 2-g leeches. When intact leeches were exposed to micromolar concentrations of serotonin, there was an increase in the rate of pharyngeal peristalsis and the size of the blood meals. Leeches excrete the plasma from their ingested blood meals. Excretion is activated during ingestion, which increases feeding efficiency by increasing the proportion of blood cells in the ingestate. Excretion continues for 4-6 days following ingestion, removing all the remaining plasma from the ingestate. Leech ingestion comprises stereotyped muscular movements, secretion of saliva and excretion of plasma. A strikingly similar feeding physiology is seen in the blood-sucking insect Rhodnius, and we suggest that efficient sanguivory may require the convergent evolution of similar ingestive mechanisms.