The phenotype of recovery VIII: Association among delay discounting, recovery capital, and length of abstinence among individuals in recovery from substance use disorders.

INTRODUCTION: Research defines recovery capital as the amount of tangible and intangible resources (e.g., human/personal, physical, social, and cultural) available to initiate and sustain recovery from substance use disorders (SUDs). An individual's amount of recovery capital is dynamic over time and influenced by a number of factors such as baseline amount at initiation of recovery/treatment, length of abstinence, access/availability of resources, and individual factors such as the decision to utilize available resources. Research has been proposed delay discounting (DD), which reflects an individual's relative preference for immediate versus delayed rewards, as a candidate behavioral marker for SUDs but has not yet examined it in the context of recovery capital, and DD may be an important aspect of human capital. Thus, the aim of the current study was to examine associations among recovery capital, DD, and length of abstinence. METHODS: The study included in its analysis data from 111 individuals in recovery from SUDs from the International Quit and Recovery Registry, an ongoing data collection program used to further scientific understanding of recovery. The study assessed recovery capital using the Assessment of Recovery Capital (ARC) and assessed discounting rates using an adjusting-delay task. The study team performed univariate linear regression to examine the relationship between total ARC score and demographic variables, length of abstinence, and DD. The research team performed a mediation analysis to understand the role of length of abstinence in mediating the relationship between DD and ARC score. RESULTS: Total ARC score was significantly negatively associated with DD and positively associated with length of abstinence, even after adjusting for covariates. Mediation analysis indicated that length of abstinence significantly partially mediated the relationship between DD and ARC score. CONCLUSION: These findings support the characterization of DD as an important aspect of human capital and a candidate behavioral marker for SUDs. Future research may wish to investigate whether interventions designed to increase the value of future rewards also increase recovery capital.

American Academy of Pediatrics. Committee on Practice and Ambulatory Medicine and Committee on Medical Liability. Pediatric physician profiling.

Employers, insurers, and other purchasers of health care services collect data to profile the practice habits of pediatricians and other physicians. This policy statement delineates a series of recommendations that should be adopted by health care purchasers to guide the development and implementation of physician profiling systems.

Effect of androgens on plasma somatomedin-C/insulin-like growth factor I responses to growth hormone.

In search of the mechanism for the relatively high plasma somatomedin-C (Sm-C) concentrations in pubertal boys and girls, we have measured the plasma Sm-C responses to exogenous growth hormone (GH) in prepubertal hypopituitary boys before and after testosterone administration. Sm-C responses were determined in 5 hypopituitary boys (9-14 years of age) who were given two successive injections of GH (0.1 U/kg) 48 h apart. Eight days later, after administering 200 mg testosterone IM, their Sm-C responses to the same GH challenge were reassessed. There were no significant differences between the pre-testosterone Sm-C response to GH and the post-testosterone response, despite evidence for reductions in 24 h urinary nitrogen excretion and serum urea nitrogen concentrations in response to testosterone. The results provide no evidence that androgen augments the effect of GH to raise plasma Sm-C during puberty, or that androgen has a direct stimulatory effect on Sm-C production. By inference and from published reports, it appears more likely that a sex hormone-stimulated increase in GH secretion is responsible for the increased Sm-C observed during puberty.

High incidence of perinatal insult in children with idiopathic hypopituitarism.

The perinatal histories of 46 children with idiopathic hypopituitarism were assessed in order to define the relationship between perinatal insult and the development of hypopituitarism. Compared to normal control siblings, the pregnancies resulting in hypopituitary children were complicated by a significantly higher incidence of vaginal bleeding at various times during gestation (13 pregnancies). Twenty-four percent of the hypopituitary children were delivered by breech, three times the incidence of control siblings and seven times the incidence of breech deliverery in the general population. Prolonged or unusually short labors were more common in the hypopituitary children (13 patients), as were signs of intrapartum distress and asphyxia (10 patients). At the time of the study, 19 hypopituitary children had neurologic abnormalities; of these, 15 had histories of significant perinatal insult. The findings in this study suggest that, in many cases, perinatal insults may cause hypopituitarism.