Health outcomes in low-income children with current asthma in Canada

Data collected from the Canadian National Longitudinal Survey of Children and Youth (NLSCY) in 1994/95 and 1996/97 were used to measure longitudinal health outcomes among children with asthma. Over 10 000 children aged 1 to 11 years with complete data on asthma status in both years were included. Outcomes included hospitalizations and health services use (HSU). Current asthma was defined as children diagnosed with asthma by a physician and who took prescribed inhalants regularly, had wheezing or an attack in the previous year, or had their activities limited by asthma. Children having asthma significantly increased their odds of hospitalization (OR = 2.52; 95% CI: 1.71, 3.70) and health services use (OR = 3.80; 95% CI: 2.69, 5.37). Low-income adequacy (LIA) in 1994/ 95 significantly predicts hospitalization and HSU in 1996/97 (OR = 2.68; 95% CI: 1.29, 5.59 and OR = 0.67; 95% CI: 0.45, 0.99, respectively). Our results confirmed that both having current asthma and living in low-income families had a significant impact on the health status of children in Canada. Programs seeking to decrease the economic burden of pediatric hospitalizations need to focus on asthma and low-income populations.

Massive hemoptysis in an 11-year-old girl with isolated pulmonary arteritis

A 10-year-old girl developed recurrent bouts of massive hemoptysis over a 9-month period. No obvious bleeding source was detected. Her pulmonary angiogram showed a pulmonary aneurysm of the second branch of the left main pulmonary artery as well as widespread irregularities of the pulmonary arteries including areas of stenosis and pruning. Elective embolization of the aneurysm did not control hemoptysis and emergency left upper lobectomy had to be performed. Histology showed large artery wall injury with acute leucocytoclastic inflammation, fibrinoid necrosis, granulomatous inflammation, and ectasia of vessel wall. This combination of abnormalities has not been described to date and represents the first case of isolated pulmonary arteritis in children prior to puberty.

1,8-Diazabicyclo[5.4.0]undec-7-ene (DBU) and microwave-accelerated green chemistry in methylation of phenols, indoles, and benzimidazoles with dimethyl carbonate

1,8-Diazabicyclo[5.4.0]undec-7-ene (DBU) is a novel and active catalyst in promoting the methylation reaction of phenols, indoles, and benzimidazoles with dimethyl carbonate under mild conditions. Additional rate enhancement is accomplished by applying microwave irradiation. By incorporating tetrabutylammonium iodide, the same microwave reactions can be further accelerated. By combining these acceleration strategies, very slow chemical transformations that take up to several days can be performed efficiently in high yield within minutes. [reaction: see text]

Breastfeeding and asthma in young children: findings from a population-based study

OBJECTIVE

To evaluate the association between breastfeeding and asthma in young Canadian children.

METHODS

Baseline data from the National Longitudinal Survey of Children and Youth (a population-based study of child health and well-being) were used. A weighted sample of 331 100 (unweighted n = 2184) children between the ages of 12 and 24 months, whose biological mother reported data on breastfeeding and asthma, were included. Outcomes included parental report of physician-diagnosed asthma and wheeze in the previous year. Breastfeeding was categorized by duration as follows: less than 2 months, 2 to 6 months, 7 to 9 months, and longer than 9 months. Logistic regression analyses were conducted with breastfeeding duration dichotomized at various cutoffs. Important potential confounders were considered in the adjusted analyses. Published statistical methods appropriate for the sampling strategy were used.

RESULTS

The prevalence of asthma was 6.3%; and wheeze, 23.9%. Almost half of the children (44.0%) were breastfed for less than 2 months. After adjustment for smoking, low birth weight, low maternal education, and sex, a duration of breastfeeding for 9 months or less was found to be a risk factor for asthma (odds ratio, 2.39; 99% confidence interval, 0.95-6.03) and wheeze (odds ratio, 1.54; 99% confidence interval, 1.04-2.29). A dose-response effect was observed with breastfeeding duration.

CONCLUSIONS

A longer duration of breastfeeding appears to be protective against the development of asthma and wheeze in young children. More public health efforts should be directed toward increasing the initiation and duration of breastfeeding.

Ecdysteroid biosynthesis in crayfish Y-organs: feedback regulation by circulating ecdysteroids

In crustaceans, ecdysteroid synthesis in the Y-organs is negatively regulated by the molt-inhibiting hormone (MIH). Reduction or cessation of MIH release from the sinus gland in the eyestalk, probably due to environmental cues, is one of possibly several signals for an increase of edysteroid production and subsequently enhancement of 20-hydroxyecdysone (20E) levels in the hemolymph. The present study asks the question whether the 20E peak in premoult stages D2/D3 is explained solely bythe cessation of MIH release or whether positive feedback mechanisms are also involved. Ecdysteroid production by the Y-organ of the crayfish Orconectes limosus was found to be under negative feedback control by circulating ecdysteroids. Exogenous 20-hydroxyecdysone (20E) as well as RH-5849, a non-steroidal ecdysteroid agonist, reduced ecdysteroid synthesis significantly when injected into intermoult animals. A direct, short loop inhibitory feedback effect was demonstrated by in vitro incubations of Y-organs with RH-5849. Thus, the results presented here do not point to a stimulatory effect of 20E on Y-organ activity but suggest that during intermolt a negative feedback by ecdysteroids plays a role in addition to MIH. Arch. Copyright 1999 Wiley-Liss, Inc.

Psychotic men remanded in custody to Brixton Prison

All referrals to medical officers in Brixton Prison over a five-month period in 1989 were examined. This paper reports the progress through this remand prison of those men who were considered to be suffering from a major psychiatric disorder. Many men had been charged with relatively minor offences. The net effect of medical intervention was to delay release from custody. Because of the administrative delays inherent in the system of medical referral and hospital admission under section 37 of the Mental Health Act 1983, it was those prisoners who were most ill who tended to remain in prison for the longest periods. Judged in terms of its efficiency to ensure speedy treatment for mentally ill remanded offenders, the present system is regarded as cumbersome and extremely inefficient. It is suggested that greater use should be made of section 48 of the 1993 Act to divert mentally ill, remanded offenders from prison.

A follow-up of remanded mentally ill offenders given court hospital orders

A follow up study of 101 men who were remanded to Brixton prison and who were given hospital orders by courts is reported. In 93% of cases the hospitals who responded to our enquiries reported that the admission had been appropriate. Only 5 (11%) of the 46 men who had been discharged from hospital had absconded or discharged themselves without medical approval. The process of referral and admission to hospital resulted in these men having to spend, on average, between two and three times longer in custody when compared to men charged with similar offences. It is generally recognized that the acutely ill should not be imprisoned, and encouragement has been given to the diversion of such people from the Criminal Justice System. However, London presents particular problems in this respect and it is argued that, since such problems will always be present, there is a need for special psychiatric facilities to be opened in order to serve the needs of the Capital.

Remands and psychiatric assessments in Holloway. Prison II: The non-psychotic population

Non-psychotic remand prisoners who were referred by Holloway's doctors to outside psychiatrists, or who were the subject of court reports, or who were diagnosed as mentally handicapped, were followed up to the time of sentence. Most of the referred women were minor offenders with diagnoses of mental handicap or personality disorder. They were usually refused beds on treatability criteria and then released with non-custodial sentences. Some were highly disturbed, and it seemed that the police who charged them, the courts who remanded them and the prison psychiatrists who referred them, all found it hard to accept that psychiatry had so little to offer these people. Local health and social services need to address the problems raised by this small group of women. Arsonists more often obtained beds than minor offenders, and were likely to be imprisoned when hospital places were not forthcoming.

Remands and psychiatric assessments in Holloway Prison. I: The psychotic population

Remand prisoners diagnosed as psychotic by Holloway's psychiatrists were followed up to time of sentence. Most were referred to outside psychiatrists and then offered beds. Courts invariably enabled the beds to be used. Few women had committed serious offences, and most had been remanded because the courts thought they needed help. The study showed custodial remands to be an unsatisfactory way of seeking treatment for psychotic offenders. Alternatives need to be developed urgently. For psychotic people who continue to be remanded in custody, transfers rather than court orders should initially be used to effect admission.

Detention in Broadmoor. Factors in length of stay

When the length of stay of restricted patients admitted to Broadmoor under the legal category of psychopathic disorder was examined, the factor found to be of primary importance was the gravity of the admission offence. If the men's offences did not cause personal injury, they had a good chance of early release. Patients convicted of violent or sexual offences, and particularly those who attacked strangers, made up the great majority of the long-term group. For the mentally ill there was no relationship between length of stay and admission offence: instead the data suggested that severity and chronicity of illness were the main relevant factors.

Changes in the sentencing of diminished responsibility homicides

The majority of men convicted of manslaughter by reason of diminished responsibility used to receive hospital orders, but are now receiving prison sentences. A sample of offenders convicted between 1966 and 1977 was studied to see the reasons for the change. It was found that the make-up of the offender population did not change materially over the period, nor did the willingness of judges to make hospital orders. What changed was the pattern of treatment recommendations made by the examining doctors in their court reports.

Cystic meningiomas: a clinicoradiological study

✓ A group of eight cystic meningiomas is considered, with particular reference to preoperative radiological evaluation. Computerized tomography (CT) scanning alone is inadequate for diagnosis, and the authors offer an assessment of the current methods for preoperative identification of cystic supratentorial tumors, while reviewing the multiple etiologies suggested for the CT appearance. No single process explains all the aspects of peri- or intratumoral cyst formation in meningiomas.

Asymptomatic cerebral aneurysm: assessment of its risk of rupture

In view of the widely divergent opinions regarding the necessity for operation in cases of asymptomatic and multiple cerebral aneurysms, an attempt is made to derive the true lifetime risk of rupture for a cerebral aneurysm in the asymptomatic patient. Prevalence data from autopsy and angiographic studies are utilized to derive a lifetime incidence for the rupture of such asymptomatic aneurysms. A decremental life table analysis method is used. The case of multiple asymptomatic aneurysms in a patient with another symptomatic aneurysm must be considered separately. Implications of these calculations are drawn regarding operation for unruptured or incidental aneurysms.

Further observations on the "bobble-headed doll syndrome"

Two patients are presented with a head-bobblng "tic" classically associated with a suprasellar cyst. The first of these showed hypothalamic, neuroendocrinological and limbic abnormalities not previously described, although with a classic arachnoidal suprasellar cyst. The second of these patients showed head-bobbling behaviour during the first years of life as a manifestation of one out of many episodes of ventricular shunt obstruction. This case is therefore the first reported whose head bobbling was observed with an acute lesion.

Frontal lobe astrocytoma following radiotherapy for medulloblastoma

A young woman had a frontal lobe astrocytoma 14 years after successful treatment of a posterior fossa medulloblastoma by surgery and whole-neuraxis irradiation. The association of these two tumors is rare, and it is unlikely that the second tumor was the result of metastasis and differentiation of residual or recurrent medulloblastoma. We review the evidence supporting this view and also the likelihood that the astrocytoma was induced by the prior radiation.

Period of risk hypothesis after prophylactic radiotherapy

A critical review is given of the period of risk hypothesis (Collins's law) in regard to treated medulloblastoma. Exceptions to the law are seen to be of two types. The first type involves recurrence of the primary tumor, either local or disseminated, and is normally observed close to the limit of the risk period. The second type usually presents a malignant astrocytoma at a considerable multiple of the risk period. The relevant pathological and cellular kinetic data are reviewed to answer the question whether glial tumor recurrence is due to dedifferentiation of the primary cell line or is secondary to the therapeutic irradiation.

Transfer of special hospital patients to the NHS

In 1976, 163 patients were approved by the Department of Health and Social Security for transfer from the Special Hospitals to the open wards of the National Health Service. By autumn 1978, a quarter were still waiting for admission. Patients meeting most difficulty were the severely handicapped non-offenders, who were usually refused unseen on the ground that local subnormality hospitals were full. The role of the DHSS and of the Regional and Area Authorities was in general restricted to bewailing problems they could not help to solve. Some two years after their transfer, enquiries were made in the NHS about the 105 transferred patients. Removal back to the Special Hospital had been requested for seven, and another three had been removed by the police and prosecuted.

Alteration of Purkinje cell activity from transfolial stimulation of the cerebellum in the cat

The activity of single Purkinje cells and other single neural units was recorded extracellularly from the cerebellar cortex of anesthetized cats during surface cerebellar stimulation with parameters similar to those used in human beings with epilepsy. At a stimulation rate of 0.5 Hz, most Purkinje cells responded with a simple stimulus-locked suppression of activity, although some showed more complex sequences of suppression and activation. At a stimulus rate of 10 Hz, essentially all responsive Purkinje cells showed a suppression of activity. Most of the other units responded to stimulation in the same manner. These effects were observed immediately adjacent to the stimulating electrodes and as far away as 6.5 mm. Therefore, surface stimulation of the cerebellum with parameters equivalent to those used in epileptic patients suppresses rather than activates Purkinje cells. These findings do not support the hypothesis that Purkinje cell activation accounts for seizure suppression in epileptic patients.