Links between oral health-related quality of life in US adults and type 2 diabetes: structural equation modeling analysis.

OBJECTIVES: To analyze the effects of type 2 diabetes mellitus (T2DM), need for dental care, personal health practices and use of services on oral health-related quality of life (OHRQoL) in US adults. BASIC RESEARCH DESIGN: The sample included 2,945 participants (aged ≥ 20) selected from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 stratified probability sample that represented 124,525,899 individuals in the weighted sample. Two-stage structural equation modelling (SEM) assessed interrelationships between T2DM regressions on factors associated with OHRQoL in a simplified three-factor Andersen Behavioral Model (ABM). RESULTS: SEM supported the hypotheses that T2DM directly predicted need (perceived need, evaluated need, general health condition) with a significant path coefficient of 0.49 (ß=0.49, p⟨0.05). Need had direct (77%) and indirect (23%) effects on OHRQoL (ßdirect=0.30, ßindirect=0.09, p⟨ 0.001). Need predicted personal health practices including use of services (reason for dental visit, frequency of dental visits, smoking status) (ß=0.46, p⟨0.001). Need, in turn, predicted OHRQoL (ß=0.19, p⟨0.001). In the model, 23.8%, 59.7%, and 18.1% of the variance was explained by need, personal health practices including use of services, and OHRQoL, respectively. CONCLUSIONS: The results confirmed T2DM predicted need, which in sequence had direct and indirect effects on OHRQoL.

Physical fitness of normal, stunted and overweight children 6-13 years in Oaxaca, Mexico.

BACKGROUND/OBJECTIVE: The objective of this study is to compare the growth and physical fitness of normal, stunted and overweight/obese (owt/ob) Oaxaca children 6-13 years. SUBJECTS/METHODS: This study was a cross-sectional, included 688 school children (grades 1-3, 4-6), aged 6-13 years, from an indigenous rural community (n=361) and colonia popular (n=327) in Oaxaca, southern Mexico. MEASUREMENTS: Anthropometry-weight, height, sitting height, limb circumferences, skinfolds. Derived-body mass index, sitting height/height ratio, leg and step lengths, limb muscle areas, sum of skinfolds. Physical fitness-sit and reach, sit-ups, distance run, grip strength, standing long jump, 35 yard dash. Physical activity-steps to and from school, household chores, sports participation. ANALYSIS: Normal-not stunted, not owt/ob; stunted-not owt/ob; and owt/ob-not stunted were compared with multivariate analysis of covariance controlling for age. Two children were stunted and owt/ob, and were excluded. RESULTS: Age-adjusted means for body size, muscularity, adiposity and grip strength showed a gradient, owt/ob>normal>stunted in both sexes and grade levels (P<0.001). Relative position of stunted and owt/ob children was reversed for strength per unit mass. Stunted and normal children ran a greater distance than owt/ob children (P<0.05). Normal, stunted and owt/ob children did not differ consistently in other fitness items and indicators of activity and inactivity. CONCLUSION: Size, muscularity, fatness and strength differed significantly, owt/ob>normal>stunted, but owt/ob children had less strength per unit mass and poorer endurance. Normal and stunted children did not differ consistently in fitness. Physical activity and television time did not differ among the three groups.

Blood lead levels and growth status among African-American and Hispanic children in Dallas, Texas--1980 and 2002: Dallas Lead Project II.

OBJECTIVE: The purpose of this investigation is to analyze childhood blood lead levels and growth status (ages 2-12) in Dallas, Texas lead smelter communities in the 1980s and 2002, where smelters operated from 1936 to 1990. METHODS AND MATERIALS: A sample of convenience study design was used in two cohorts (n=360): 1980-1989 (n=191) and 2002 (n=169). Multivariate analysis of variance and covariance and tandem multiple regressions were used to evaluate the association between stature and blood lead level in two time periods. RESULTS: In 2002 average child blood lead level (1.6 microg/dL+/-0.2 SE) was significantly (p<0.001) lower compared to the 1980 cohort mean level (23.6 microg/dL+/-1.3 SE). Average height and weight in 2002 were 4.5 cm and 4.0 kg greater, respectively, than in 1980. Lowered blood lead level was associated with 3.9 cm, 3.5 kg and 1.1 units greater height, weight and body mass index (BMI), respectively. Cohort effect was associated with greater height (0.6 cm), weight (0.5 kg) and BMI (0.1). CONCLUSION: This investigation reports on child growth in a community before and after the transition from high to low blood lead levels over several decades. Using child growth as a proxy, health status of Dallas's lead smelter communities increased markedly over the past two decades, primarily because of lower blood lead levels, while the poverty rate was only marginally lower.

Blood lead level and physical fitness of schoolchildren in the copper basin of south-western Poland: indirect effects through growth stunting.

OBJECTIVE: The present study was set in the context of two questions. First, does blood lead level exert a direct effect on measures of physical fitness? And second, might blood lead influence physical fitness indirectly through growth stunting? BACKGROUND: Blood lead level is negatively associated with performances on a variety of fine motor tasks. Corresponding information on associations with measures of physical fitness and gross motor coordination are limited. MATERIALS AND METHODS: Schoolchildren 7-15 years of age (463 males, 436 females) living in the vicinity of copper smelters and refineries were tested for blood lead. In addition to body size and blood lead, physical fitness was measured: right and left grip strength, timed sit-ups, flexed arm hang, plate tapping, shuttle run, standing long jump and medicine ball throw. Simple reaction time was also measured. RESULTS: The effect of blood lead level on physical fitness was indirect and small, and operated through anthropometric dimensions that more directly influenced the measures of fitness. CONCLUSIONS: Direct effects of blood lead level on indicators of physical fitness in school age youth are not evident. Blood lead level adversely affects physical fitness indirectly through growth stunting.

Lead and growth status of school children living in the copper basin of south-western Poland: differential effects on bone growth.

OBJECTIVE: The study analyzed the relationship between blood lead (BPb) levels and growth status of upper and lower body segments among schoolchildren living in the copper basin of south-western Poland. MATERIALS AND METHODS: Schoolchildren 7-15 years of age (463 males, 436 females) living in the vicinity of copper smelters and refineries were tested for blood lead. Weight, height, symphyseal height (leg, lower segment length), and arm length were measured. Trunk (upper segment including head and neck) length was estimated as height minus symphyseal height. The BMI was calculated using weight/height2 (kg m-2). RESULTS: Mean blood lead in the total sample was 7.7 +/- 3.5 micro g dL-1 (2.0-33.9 micro g dL-1). Blood lead level was significantly and linearly related to reduced weight, height, trunk, leg, and arm lengths. The estimated reduction in height was 5 mm per 1 micro g dL-1 increase in blood lead (5.0 cm per 10 micro g dL-1). The reduction occurred in leg length (males, 64%; females 72%) compared to trunk length (males, 36%; females, 28%). Estimated reductions in arm length were 2.0 cm (males) and 2.5 cm (females) per 10 micro g dL-1 increase in blood lead. Hence, limb (leg and arm) lengths were markedly reduced. CONCLUSIONS: Linear skeletal growth was reduced with increased blood lead, even at levels below that considered for action by US CDC standards. The reduction in height occurred primarily in leg length. Arm length was also reduced, suggesting limb lengths in general were affected by blood lead. Results are consistent with lead-associated interruption of (1) major epiphyseal growth plate chondrocyte hyperplasia, hypertrophy, and interrupted matrix calcification as a primary cause of stunted long bone growth, and reduced stature; and (2) attenuated osteoblast activity (proliferation and migration) as a secondary cause of stunted growth in the study population.

Opportunity for natural selection and gene flow in an isolated Zapotec-speaking community in southern Mexico in the throes of a secular increase in size.

Our object in this paper is to analyze the opportunity for natural selection and gene flow in an isolated Zapotec-speaking community in the valley of Oaxaca, southern Mexico, that is undergoing a secular increase in body size. Surveys were conducted in the community in 1968, 1978, and 2000, including anthropometric and census data. No secular change was found in the growth status of schoolchildren and adult height between 1968 and 1978; subsequently, major secular gains in height occurred among children and adolescents between 1978 and 2000. The 1978 household data were used to compute gene flow (3.3%) and opportunity for selection intensity (I = 1.312). Migration and other demographic information was obtained from household census data for 1978 and 2000, and mortality information was extracted from community records and archives. These data were used to compute gene flow and opportunity for natural selection. Gene flow increased from 3.3% to 4.7% and intensity of natural selection decreased from 1.312 to 0.272 from 1978 to 2000. Variance in fertility increased slightly over time (12.25 to 13.69). Opportunity for selection was dominant during the prereproductive period in 1978, but approached 0 for the mortality component in 2000, resulting in a marked decrease in the mortality component (Im) of selection (0.626 and 0.019, respectively) and total opportunity for selection (I = 1.312 and 0.272, respectively). Secular increase in height and markedly decreased opportunity for natural selection (1) were associated with better health and nutritional conditions. Genotype-environment interaction and environmental influences are apparently the predominant causes of the secular trend. If natural selection plays a role in causing the secular trend, it is a small one.

Familial similarity in body size in an isolated Zapotec-speaking community in the valley of Oaxaca, southern Mexico: estimated genetic and environmental effects.

OBJECTIVE: The study used path analysis to estimate genetic and environmental determinants of familial similarity in anthropometric characteristics among children from a rural subsistence agrarian community in the Valley of Oaxaca in southern Mexico. METHODS: Anthropometric dimensions included height, weight, arm circumference and triceps skinfold; the BMI was calculated. Parent-offspring pairs (n = 34) were constructed from pedigrees and prior studies using listwise case deletion for parent-male child and parent-female child, respectively. Path coefficients for genetic and environmental effects were computed using linear regression. Age effects were held constant by computing residuals after parameter regression on age and age2. Environmental effects were analysed using a previously published factor analysis of village ecology. RESULTS: By path analysis, the paternal effect was low-to-moderately strong on males (0.21-0.57) but low on females (0.13-0.23). Maternal effects were low, inconsistent and negligible on males (-0.16-0.09), but high on females (0.57-0.81), except for height (0.19). Estimated environmental effects on sibling similarity were low (0.12-0.27). CONCLUSION: The environment exerts a relatively consistent effect on growth status, and probably accounts for the low path coefficients (i.e. sibling correlations, parent-offspring regressions). Sex-specific effects are apparent in a strong paternal influence on male offspring height and moderate influences on weight, triceps skinfold, and arm circumference. Maternal influences are small on the anthropometric characteristics of males, but are exceptionally large on female weight, triceps skinfold and arm circumference. Estimated environmental effects on sibling similarity are low-to-moderately high.

Secular change in height, sitting height and leg length in rural Oaxaca, southern Mexico: 1968-2000.

OBJECTIVE: To evaluate secular changes in height, sitting height and estimated leg length between 1968 and 2000 in residents in a rural Zapotec-speaking community in Oaxaca, southern Mexico. MATERIALS AND METHODS: Height and sitting height were measured in school children 6-13 years (1968; 1978, 2000), in adolescents 13-17 years (1978, 2002) and adults 19-29 years (1978, 2000). Leg length was estimated as height minus sitting height. The sitting height/ height ratio was calculated. Subjects were grouped by sex into four age categories: 6-9, 10-13, 13-17 and 19-29 years for analysis. The Preece-Baines Model I growth curve was fitted to cross-sectional means for 1978 and 2000. RESULTS: There were no differences between children 6-9 and 10-13 years in 1968 and 1978 with the exception of the sitting height ratio in girls 6-9 years. Children of both sexes 6-13 years and adolescent boys 13-17 years were significantly larger in the three dimensions in 2000 compared to 1978; adolescent girls differed only in height and sitting height. Adult males in 2000 were significantly taller with longer legs than those in 1978, but the samples did not differ in sitting height and the ratio. Adult females in 1978 and 2000 did not differ significantly in the three dimensions. Rates of secular change in height and sitting height between 1978 and 2000 were reasonably similar in the three age groups of male children and adolescents, but the rate for estimated leg length was highest in 10-13-year-old boys. Secular gains were smaller in adult males, but were proportionally greater in estimated leg length. Girls 6-9 and 10-13 years experienced greater secular gains in height, sitting height and estimated leg length than adolescent and young adult females, while secular gains and rates decreased from adolescent girls to young adult women. Ages of peak velocity for height, sitting height and estimated leg length declined in boys, while only ages of peak velocity for height and estimated leg length declined in girls. CONCLUSIONS: There are major secular increases in height, sitting height and estimated leg length of children and adolescents of both sexes since 1978. Secular gains in height are of similar magnitude in boys and girls 6-13 years, but are greater in adolescent and young adult males than females. The secular increase in height of young adults of both sexes is smaller than that among adolescents. Estimated leg length accounts for about 60% of the secular increase in height in children of both sexes. Estimated leg length and sitting height contribute equally to the secular increase in height in adolescent boys, whereas estimated leg length accounts for about 70% of the secular increase in height in young adult males. Sitting height contributes about two-thirds of the secular increase in height in adolescent and young adult females.

Secular change in age at menarche in rural Oaxaca, southern Mexico: 1968--2000.

OBJECTIVE: To evaluate secular change in the age at menarche between 1978 and 2000 in residents of a rural Zapotec-speaking community in Oaxaca, southern Mexico, using status quo and retrospective methods. MATERIALS AND METHODS: Status quo menarcheal status of girls 9-18 years of age in 1978 (n= 101) and 2000 (n=238) and retrospective ages at menarche of adult women 19+ years of age in 1978 (n = 228) and 2000 (n = 246) were obtained via interview. Probit analysis was used to estimate median ages at menarche and 95% confidence intervals (CI) for the status quo data. Analysis of variance and linear regression was used to compare the retrospective data across surveys. RESULTS: The median ages at menarche of adolescents are 14.8+/-1.2 years (0.24 year, 95% CI 14.2-15.4 years) in 1978 and 13.0+/-1.0 years (0.10 year, 95% CI 12.7-13.3 years) in 2000. Age at menarche has declined by 1.8 years over about 23 years, 0.78 year/decade (95% CI = 0.65-0.91 year/decade). Recalled ages at menarche do not differ by age group in the 1978 survey, but differ significantly by age group in the 2000 survey (p <0.001). Within the 2000 survey, the two youngest age groups (< 29, 30-39 years) do not differ, but attain menarche earlier than women in the four older age groups (p < 0.05), who do not differ from each other in age at menarche. The estimated rates of secular decline in age at menarche in adult women vary between 0.38 and 0.42 years/decade (0.26-0.56 year/decade). CONCLUSIONS: There is a major secular decline in the age at menarche of adolescent girls and young adult women between 1978 and 2000. The estimated rate of decline in adult women is about one-half of that in adolescent girls. The secular decline in age at menarche is consistent with corresponding secular gains height, sitting height and estimated leg length of children and adolescents in the community; corresponding secular gains are smaller in young adults 19-29 years.

Anthropometric asymmetry in chronically undernourished children from Southern Mexico.

In previous studies, environmental stress has been associated with increased structural asymmetry, indicating differential rates of development on either side of the median plane. To analyse the effect of environmental stress upon anthropometric asymmetry, six bilateral measurements and one derived measurement were compared between chronically mild-to-moderately undernourished school children (7-13 years of age) and a well-nourished control sample (5-35 years of age). The undernourished sample was from a subsistence agricultural community in Southern Mexico. The well-nourished comparison (control) sample was middle class, White children and young adults in Texas. Anthropometric asymmetry of the skeleton was not consistently increased in the undernourished school children compared to the well-nourished controls. Arm and estimated mid-arm muscle circumferences had significantly increased asymmetry, but these differences are likely due more to laterality in function or physical work than to undernutrition. Genetic influences are hypothesized to underlie skeletal asymmetry (i.e. differences in development on either side of the median plane).

Abnormal allometric size of vital body organs among sudden infant death syndrome victims.

Sudden infant death syndrome (SIDS) victims are difficult to describe physically because they seem outwardly indistinguishable in nearly all characteristics from infants (alive or dead) of comparable chronological age. Relative (allometric) size of vital organ and body weights has not been examined among SIDS victims. In the present study, autopsy organ and body weights for 152 SIDS deaths (1-12 months) were compared with the results of 115 controls that were trauma or illness-related death (0.25-12 months). A pattern of abnormal relative size in vital organs (brain, heart, liver, and kidney) was revealed. In allometric regressions, increase in the weights of the organs relative to total body weight among SIDS victims were approximately three times the increase among controls in the first year of life. This finding indicates a disturbance of normal patterns of vital organ size of SIDS victims that is of unknown etiology. Am. J. Hum. Biol. 12:382-387, 2000. Copyright 2000 Wiley-Liss, Inc.

Prevalence of obesity among school children in the United Arab Emirates.

The objective of this study was to investigate the prevalence of obesity among schoolchildren in the United Arab Emirates, using the body mass index (BMI) as the indicator. The sample included 1,787 males and 2,288 females 6-16 years. Physicians and trained nurses measured height and weight, and the BMI (kg/m(2)) was calculated. The 50(th) centile of the BMI was not different from that for the US. Similarly, the height and weight of UAE children approximate the US reference data. About 8% of UAE boys and girls have BMI's >/=95(th) percentile of US reference values. Using the 85(th) percentile as the criterion, 16.5% and 16.9% of males and females, respectively, are classified as overweight. This composite figure does not differ from the expected 15% based on reference data. The data thus indicate that high levels of obesity are present among UAE children and adolescents. These findings have public health implications for this generation of UAE youth during their adult years, including heart disease and diabetes, because the rate of morbid obesity is approximately twice that expected in reference data. Am. J. Hum. Biol. 12:498-502, 2000. Copyright 2000 Wiley-Liss, Inc.

Pharmacokinetics during pregnancy: evidence-based maternal dose formulation.

OBJECTIVE: To review the literature regarding how drug pharmacokinetics differ between pregnant and nongravid women. DATA SOURCES: Articles published between 1963 and 1997 were retrieved from the database of the National Library of Medicine for review, using the key words "pregnancy," "pharmacokinetics," and "human." Additional articles and book chapters were identified from the bibliographies of articles retrieved. METHODS OF STUDY SELECTION: Articles had to include primary data that were not previously published. Data abstracted from articles meeting the inclusion criteria included: sample size, estimated gestational age, area under the curve, volume of distribution, maximum plasma concentration, steady-state concentration, half-life, time to maximum plasma concentration, clearance, and data from nonpregnant controls. TABULATION, INTEGRATION, AND RESULTS: Of more than 1000 articles published, 61 articles and book chapters reported relevant pharmacokinetic data, such as those listed, based on primary data. Only two studies synthesized pharmacokinetic data into guidelines for individualized clinical regimens. CONCLUSION: Available data regarding the pharmacokinetics of therapeutic regimens during pregnancy do not provide clinically relevant guidelines for the formulation of therapy for individual patients. Pharmacokinetic investigations during pregnancy that produce evidence-based guidelines for treating individual patients were identified as a major area of need. Minimum requirements are recommended for reporting pharmacokinetic studies in obstetrics.

Prevention of herpes simplex virus infection and latency by prophylactic treatment with acyclovir in a weanling mouse model.

OBJECTIVE: Acyclovir is an antiviral agent that inhibits acute herpes simplex virus replication and decreases the frequency of reactivation, but it is not currently used to prevent primary disease or the establishment of latency. The purpose of this study was to reexamine the efficacy of acyclovir in preventing acute and latent herpes simplex virus infection. STUDY DESIGN: Mice were infected by footpad inoculation with 2 viral recombinants that express beta-galactosidase. Half of each group was treated prophylactically with intraperitoneal acyclovir and then given acyclovir in the drinking water. Four days after infection, the dorsal root ganglia were removed, fixed, and stained, and the number of cells expressing beta-galactosidase were counted. RESULTS: Compared with placebo, prophylactic acyclovir completely inhibited acute viral replication as evidenced by the absence of beta-galactosidase activity (P < .001) and significantly decreased the number of neurons harboring latent infection (P = .01). CONCLUSION: Acyclovir prophylaxis prevented acute and reduced latent ganglionic infection with herpes simplex virus in a weanling mouse model.

Lithium During Pregnancy : Drug Effects and Their Therapeutic Implications.

Lithium is used as a primary treatment or augmentation therapy for several psychiatric conditions, such as bipolar depression, mania and unipolar depression. For many patients with bipolar disorder, it is the most effective mood stabiliser.More than half of the patients maintained on lithium are women, and many are of reproductive age. An unknown proportion of women who are receiving lithium maintenance therapy become pregnant, posing numerous clinical issues for the obstetrician, psychiatrist and patient. The specific problems associated with lithium exposure vary during different stages of gestation. The risk of the serious heart defect, Ebstein's anomaly, exists if the drug is taken during weeks 2 to 6 post-conception; risks of fetal/neonatal complications occur if lithium is taken during the second and third trimesters.Given the effects of lithium on the conceptus, potentially safer alternatives may be required. The best case scenario is to counsel fecund women who require lithium to plan pregnancy, allowing for a temporary change in treatment regimen during the period of embryogenesis. If lithium therapy is reinstituted during the second and third trimesters, fetal monitoring for altered renal and endocrine function is important. Lithium requirements usually increase in the third trimester, but should be decreased in the peripartum period to avoid drug toxicity in the neonate and mother. Ultimately, the risk/benefit considerations must guide clinicians and patients in the decision to use lithium during pregnancy.

Differential potencies of cocaine and its metabolites, cocaethylene and benzoylecgonine, in suppressing the functional expression of somatostatin and neuropeptide Y producing neurons in cultures of fetal cortical cells.

Using aggregate cultures derived from 17-day-old fetal rat cortex, we addressed the question: Does cocaine alter the functional expression of neuropeptide Y (NPY) and somatostatin (SRIF) neurons and, if so, are cocaethylene (CE) and benzoylecgonine (BZE) as active as cocaine? NPY/SRIF production in response to brain-derived neurotrophic factor (BDNF) or phorbol-12-myristate-13-acetate (PMA) was used as a functional criterion. A 5-day exposure to cocaine did not affect basal or stimulated (BDNF or PMA) production of NPY but it markedly suppressed BDNF- or PMA-stimulated production of SRIF. Exposure to CE led to a drastic suppression of basal as well as stimulated (BDNF or PMA) production of both NPY and SRIF. These effects of cocaine and CE were concentration dependent (1-100 microM). BZE did not alter any of these functional parameters. Next, we evaluated the fate of cocaine, CE, and BZE in the culture medium. Cocaine was converted to BZE, whereas BZE was not converted to cocaine. CE was converted to cocaine and BZE, with substantial amounts of cocaine and CE remaining in the medium after 72 hr (approximately 20% each). In summary, cocaine, CE, and BZE exhibited differential potencies in suppressing the expression of cultured NPY and SRIF neurons: CE was more potent than cocaine and BZE was inactive. SRIF neurons were more susceptible than NPY neurons to the effects of cocaine. The higher potency of CE may be due to a property of the compound and/or to CE serving as a source for a slow, continuous formation of cocaine by the brain cells themselves.

Immunosuppressant therapy during gestation.

Use of immunosuppressants during pregnancy is indicated for anti-rejection therapy in transplantation patients and treatment of autoimmune diseases. Maternal side effects include nephrotoxocity and hepatotoxicity. All immunosuppressant drugs cross the placenta. Immunosuppressant use during the first trimester is not strongly associated with an increased risk of congenital anomalies, although some agents (eg, azathioprine) may be associated with slightly increased frequencies of birth defects. Effects of exposure to this class of drugs during the second and third trimesters affects the fetus' immune system. The result is an infant with a transiently compromised immune system at an increased risk of slightly lower birth weight. Other direct toxic effects of the drugs on the infant's pancreas, liver, and lymphocytes are reported. Certain agents (eg, penicillamine, chloroquine) should be avoided during pregnancy, if possible. However, their use cannot be discontinued during pregnancy given the life-threatening nature of the indication for use of immunosuppressants.

Is there a cocaine syndrome? Dysmorphic and anthropometric assessment of infants exposed to cocaine.

It was suggested that a "fetal cocaine syndrome" exists. The objective of this study was to systematically investigate whether or not a "cocaine syndrome" exists. The setting was Parkland Memorial Hospital, a large urban public hospital in Dallas, TX, where approximately 15,000 infants are delivered annually. Infants who tested positive by urinalysis for cocaine (n = 25) were included in this study. Controls negative for cocaine (n = 25) were matched to cocaine-exposed infants for estimated gestational age, sex, and race. A standardized dysmorphology examination (135 features) and a series of anthropometric measures (n = 22) were done for each cocaine-exposed and control infant by an observer blinded to drug-exposure status. Fetal growth retardation characterized cocaine-exposed infants. No characteristic pattern of minor dysmorphic or anthropometric features of the face, limbs, or torso was observed among cocaine-exposed infants. Cocaine-exposed infants lack a facial gestalt or torso/limb features that would characterize a syndrome. If a "cocaine syndrome" that can be characterized dysmorphologically and/or anthropometrically exists, its occurrence seems infrequent.

Placental transfer of selected substances of abuse.

The placenta was classically considered a barrier, but in 1957 this notion was shattered. This organ is only a selective filter and metabolic site. In this review, the placental transfer of the top 17 substances of abuse are analyzed. In the National Library of Medicine only 41 papers that documented placental transfer of the major substances of abuse could be located, and these data excluded approximately one-sixth of the most commonly abused substances. Nonetheless, it was possible to evaluate placental transfer of all substances of abuse based on their physical chemical properties. It is with despair that it must be reported that virtually all substances of abuse freely cross the placenta, exposing the embryo/fetus to whatever substances the mother may be using.

Whole blood levels of dodecanoic acid, a routinely detectable forensic marker for a genetic disease often misdiagnosed as sudden infant death syndrome (SIDS): MCAD deficiency.

We investigated whether or not elevated whole blood dodecanoic acid concentration was due to a beta-oxidation defect in fatty acid metabolism previously reported. We prospectively analyzed blood from 55 consecutive sudden infant death syndrome (SIDS) cases for fatty acid concentrations by gas chromatograph. Three of 55 cases had elevated dodecanoic acid concentrations (> or = 18.4 mg/L). The three SIDS cases with elevated blood dodecanoic acid were confirmed to have medium chain acyl-CoA dehydrogenase (MCAD) deficiency by outside laboratories, indicating that elevated dodecanoic acid is highly specific and sensitive for predicting MCAD deficiency in SIDS victims. Dodecanoic acid was easily detected in routine toxicology for acid and neutral drugs done at autopsy. MCAD deficiency is an autosomal recessive genetic disease, carrying a 25% recurrence risk. Families should be notified that siblings, both presently living and yet to be born, should be screened for this deficiency because MCAD deficiency can be treated, and sudden, unexplained infant deaths of living and subsequent offspring can be prevented.