Psychosocial Stress During First Pregnancy Predicts Infant Health Outcomes in the First Postnatal Year.

OBJECTIVES: To evaluate the impact of psychosocial stress during pregnancy on infant health outcomes in the first postnatal year. METHODS: A sample of 3000 women completed a stress inventory (the Psychosocial Hassles Scale) during their third trimester before first childbirth. Infant health outcomes were measured via maternal report at 1, 6 and 12 months postpartum. Poisson regression was used to model the effect of maternal stress during pregnancy on infant health outcomes in the first year, controlling for age, race/ethnicity, education, insurance coverage, marital status, and cigarette smoking during pregnancy. RESULTS: Women who were younger, minority, unmarried, publicly insured and without a college degree were more likely to report high levels of prenatal stress. High prenatal stress was a significant predictor of maternal reporting of gastrointestinal illness (p < 0.0001), respiratory illness (p = 0.025), and total illness in the first year (p < 0.0001). High prenatal stress was also a significant predictor of urgent care visits (p < 0.0001) and emergency department visits (p = 0.001). It was not a significant predictor of hospitalizations (p = 0.36). CONCLUSIONS: Maternal prenatal stress is associated with increased maternal reporting of infant illness, as well as increased frequency of both urgent care visits and emergency department visits.

Responses to olfactory and intranasal trigeminal stimuli: relation to the respiratory cycle.

The aim of the study was to investigate whether the perception of intranasal chemosensory stimuli changes in relation to the respiratory cycle. We investigated 40 healthy subjects with normal olfactory function who participated in four sessions. The first session was used to adapt subjects to the experimental conditions, and, specifically, to train a certain breathing technique (velopharyngeal closure) which prevents intranasal respiratory air-flow. In each of the following three sessions one of three stimulants was tested, namely phenyl ethyl alcohol (PEA), hydrogen sulfide (H(2)S), or the trigeminal stimulant carbon dioxide (CO(2)). The sequence of testing the three stimulants was randomized across all participants. Sessions were separated by at least 1 day. Chemosensory event-related potentials (ERP) were recorded in response to 80 stimuli each. Following each stimulus subjects rated its intensity using a computerized visual analogue scale. Respiration was recorded using a probe in front of the subjects' mouth. While presentation of chemosensory stimuli was performed independent of the respiratory cycle, responses were averaged off-line according to the subjects' respiratory phase when the stimuli had been presented. Intensity of olfactory or trigeminal stimuli did not differ significantly in relation to the respiratory cycle. Olfactory ERP to phenylethyl alcohol were larger when stimuli were presented during inspiration. Similarly, responses to H(2)S tended to be larger when stimuli were presented during inspiratory phases. In addition, responses to CO(2) were larger when stimuli were presented during inspiration. Differences in relation to the respiratory cycle were found specifically for early ERP components. It is important to note that the changes of chemosensory information processing were found in the absence of changes of intranasal airflow. These data indicate on an electrophysiological level that there is priming of both olfactory and trigeminally mediated sensations in relation to the respiratory cycle.

An improved approach to the evaluation of the deep motor branch of the ulnar nerve.

The detection of ulnar nerve lesions at Guyon's canal requires evaluation of the distal ulnar sensory and distal motor latency to the abductor digiti minimi (ADM). In addition precision in the measurement of distal motor latencies (DL) to the first dorsal interosseous (1DI) muscle and response amplitude is necessary. This study examines a standardized technique assessing distal ulnar nerve conduction aimed to provide a more sensitive evaluation of these lesions. Fifty normals and eighteen subjects with hand symptoms were assessed to determine DL to the ADM and 1DI and response amplitudes. These standard values were then compared to values obtained from clinically proven cases of distal ulnar lesions over the previous 2 years. The main outcome measures were elimination of premotor potentials and prolongation of 1DI DL. The results revealed that the standardized technique consistently eliminates premotor potentials (PMP) and provides a significantly narrowed range of normal DL values. This enhanced precision allows for more accurate normative values, making recognition of more subtle lesions possible. Normative data compared to values from a 2 year chart review of distal ulnar lesions shows predictive trends toward prolonged 1DI DL and diminution of 1DI amplitudes (AMP).

Quantification of error in measurement of radial inclination angle and radial-carpal distance.

Posteroanterior wrist radiographs of eight patients were evaluated by eight orthopedists. Radial inclination angle and radial-carpal distance were measured by use of a standardized technique. The standard deviation for radial inclination angle was 2 degrees. The standard deviation for radial-carpal distance was 1 mm. The measured rotational variation of radial inclination and radial-carpal distance is 1 degree and 1 mm, respectively, through a 10-degree arc of supination and pronation.

Long-term results of the minimal resection Darrach procedure.

Eighteen patients had a minimal resection Darrach procedure at the distal radial-ulnar joint for treatment of posttraumatic arthritis. The follow-up averaged 8 years (range, 2 to 18 years). Fourteen patients were completely satisfied with the result achieved with the procedure and four were mostly satisfied. No patient had either subjective or objective evidence of distal ulnar instability. Grip strength for patients without radiocarpal arthritis was 84% of the uninvolved side. Preoperative ulnar variance was plus 4 mm and at follow-up minus 4 mm. At follow-up examination, four patients had ulnar carpal translocation. The average radial inclination angle of the patients with ulnar carpal translocation was 24 degrees, compared with 18 degrees for patients without ulnar carpal translocation. The minimal resection Darrach procedure gives excellent relief of pain without the instability attributed to the Darrach procedure. It must be used judiciously in patients who have a radial inclination angle above 23 degrees.

Relationship between radial inclination angle and ulnar deviation of the fingers.

Fifty wrists (thirty-two patients) with rheumatoid arthritis and ulnar drift of the fingers were examined radiologically and compared to fifty normal wrists radiographs. Statistically significant differences were found for measurements of radial inclination angle, carpal-radial distance, third metacarpal-phalangeal angle, and carpal height ratio. Third metacarpal-phalangeal angle of ten degrees or greater on standard posteroanterior radiograph appears to accurately represent digital ulnar drift. Elevated radial inclination angle was highly correlated with digital ulnar drift (p much less than 0.001). Radial inclination angle greater than twenty-two degrees is associated with the development of digital ulnar drift through two mechanisms, radial carpal rotation, and ulnar carpal translocation.

Experience with a pre-basic fitness program at Fort Jackson, South Carolina.

One hundred seventy-five consecutive recruits entering the Fort Jackson Fitness Company were evaluated for Upper Body Strength, Flexibility, and Cardiovascular Fitness, and the results were compared with those of 60 soldiers entering Basic Training directly from the Reception Station. Injury rate and end-cycle performance were compared between Fitness Company graduates and their regular basic trainee cohort. The study showed that the Push-up repetition and two-mile run times were still below the standard for the Post. Sick call rate was also significantly higher among the less conditioned troops. Sit-up repetition and other basic soldiering skills, however, as well as EPTS (discharges for medical conditions existing prior to service) and ELS (entry level separation) rates, were equal. Increase of Fitness Company graduation requirements and dissemination of standards and requirements to potential recruits in high schools, colleges, and other public institutions are recommended.

Doppler mapping in hypothenar syndrome: an alternative to angiography.

Four patients with hypothenar hammer syndrome were evaluated preoperatively with Doppler mapping and angiography. Both tests documented ulnar artery occlusion. In one patient, the proximal extent of thrombosis could not be identified by angiography. In all cases Doppler mapping accurately documented the extent of occlusion as confirmed by surgical exploration. Doppler mapping is a noninvasive alternative to angiography in the evaluation of hypothenar hammer syndrome.

Urodynamics in spinal shock patients.

We investigated 17 spinal shock patients with traumatic complete cord lesions with cystometry, urethral pressure profile, anal and rectal pressure recordings, and electromyography of the pelvic floor sphincters. Bladder filling was accompanied by an elevation of resistance in the bladder neck area, with a concomitant increase of pressure in the external sphincter zone but without a simultaneous increase of the electromyographic activity. These results indicate an increased sympathetic activity in the smooth muscle component of the entire urethra. In the majority of patients the continuous withdrawal pressure profile had higher values in the membranous urethra than the interrupted withdrawal pressure profile had higher values in the membranous urethra than the interrupted withdrawal pressure profile, revealing the importance of sensory afferents from the urethral mucosal receptors in producing artifactual reflex activity in the pelvic floor muscles. In the majority of interrupted withdrawal urethral pressure profiles higher pressures were recorded in the juxtabulbous region than in the mid part of the membranous urethra. A somewhat decreased electromyographic activity was found in the anal and urethral sphincters at rest. It did not often relate to the amount of resistance recorded in either sphincter. High urethral sphincter pressures and somatic activity of the conus medullaris reflexes show that external urethral and anal sphincters escape spinal shock, the primary characteristic of which is areflexia.

Striated sphincter participation in distal passive urinary continence mechanisms: studies in male subjects deprived of proximal sphincter mechanism.

Striated urethral sphincter function was studied in passive incontinent and continenet male subjects who were deprived of the proximal sphincter mechanism. Functional assessment of striated urethral sphincter include electromyography and electrostimulation. Varying degrees of diminished striated sphincter excitability and reflex activity were observed in passive incontinent male subjects who also had varying degrees of somatomotor neuron lesions. The studies indicate that the participating role of periurethral striated musculature in distal passive continence mechanisms cannot be ignored.

Electrodiagnosis of striated urethral sphincter dysfunction.

In many centers urethral striated sphincter electromyography has become an essential component of urodynamic testing. The urologist who uses this modality of investigation in an attempt to understand the pathophysiology of striated sphincter dysfunction must have some basic knowledge of electromyography. Attempts have been made to provide such basic information, especially relating to the methods of evaluation and interpretation. We also have incorporated our own views based on our experience with more than 200 subjects with neuropathic vesicourethral dysfunctions.

Pes cavus and claw toes deformity in patients with spinal cord injury and multiple sclerosis.

Patients with spinal cord injury or multiple sclerosis were surveyed for the presence of extreme foot deformities and spasticity. Pes cavus and claw toes were found in eight of 80 spastic spinal cord injury and two of 20 multiple sclerosis patients. Pes cavus and claw toes were not found in 29 flaccid spinal cord injury patients. Pes cavus and claw toes were associated with flexor reflexes which could be elicited by pin prick proximal to the knee, suggesting extreme spasticity--and by low excitatory thresholds for the anterior tibialis as indicated electromyographically. Complications of severe spasticity associated with spinal cord injury and multiple sclerosis include pes cavus and claw toes, mediated in part by spasms of the anterior tibialis.

Cannabis and the peripheral nervous system.

The possible ill-effects of cannabis on the peripheral nervous system were examined in 27 male subjects with respect to their motor and sensory nerve conduction. They were classified by their previous cannabis use into casual and heavy users. The nerve conduction studies were done after a baseline period of five days and then repeated after a three-week period during which the subjects could acquire and smoke standardized cannabis cigarettes. The casual users smoked a mean of 54-3 and the heavy users a mean of 109-5 cigarettes during the smoking period. No deterioration of peripheral nerve function could be demonstrated.

Electrodiagnostic evidence of subclinical disease states in drug abusers.

One hundred drug abusers, free of clinical signs or symptoms of disease, were examined by electrodiagnostic techniques. Sensory conduction of median, ulnar and sural nerves was evaluated in terms of latency, velocity and amplitude of evoked potential. Motor nerve latencies and conduction velocities of median, ulnar and personeal nerves were determined. Definite changes in the evoked sensory potentials of median and sural nerves of subjects using heroin or LSD were demonstrated. The sensory amplitude changes were suggestive of axonal degreneration because of normal duration. Maximum motor conduction velocity was abnormal in one patient who admitted using a variety of drugs; five heroin and two barbiturate users showed dispersed motor responses suggesting small fiber involvement. No abnormality could be shown in marjuana smokers. Signifcance of these findings is explained, emphasizing important potential for recognition of subclinical abnormalities and the opportunity for disease prevention.