Why screen newborns for cocaine: service patterns and social outcomes at age one year.

OBJECTIVE: To compare baseline characteristics, service provision, and child placement for infants exposed to cocaine in utero based on postnatal screening results. METHODS: We studied a retrospective cohort of 40 consecutive drug-exposed, but seemingly healthy term infants who underwent urine drug screening in the newborn nursery of a community hospital. Using clinical and service agency data, two cocaine-exposed cohorts were compared (a) screen-positive at birth (n = 22) versus (b) screen-negative at birth (n = 18). RESULTS: Both cocaine-exposed groups had similar infant birth weights, levels of paternal involvement, maternal ages, gravidity, parity, and lengths of gestation. Mothers in both groups had similar histories of prostitution, poor home environment, drug use, and prenatal drug rehabilitation. Mothers of screen-positive infants were more likely than mothers of screen-negative infants to have other children in foster care (27% vs. 6%, p = .07), to have experienced previous interventions by child protective services (CPS) (55% vs. 17%, p < .01), to have had no prenatal care (32% vs. 6%, p = .09), and fewer prenatal visits (4.7 vs. 8.6, p = .02). Compared to screen-negative infants, more screen-positive infants were referred to a high-risk infant tracking program (91% vs. 6%), referred to CPS (100% vs. 33%), placed outside the mother's home (50% vs. 22%), and had their mothers referred to drug rehabilitation (36% vs. 11%), (p < .01 for each). By 1 year of age, support services differed little between exposed cohorts. However, 6 of 22 screen-positive infants were in foster care and 3 were placed for adoption, while only 1 of the 18 screen-negative infants was in foster care and only 1 had been placed for adoption. There were no services available in this community to provide coordinated or comprehensive services or drug treatment specific to the needs of drug using mothers and drug exposed infants. CONCLUSIONS: Despite similarities between cocaine-exposed infants cared for in a normal newborn setting (with and without positive urine drug screens at birth), differences in referral services were noted. More striking than these differences was that services for families with drug-exposed infants are inadequate to even meet the needs of those families in our setting deemed to be at highest risk. Neonatal drug screening needs to be paired with effective services.

[Effect of preventive fluorographic mass screening on the prognosis of lung cancer and tuberculosis]. / Vliianie profilakticheskikh fliuorograficheskikh obsledovanii naseleniia na prognoz raka i tuberkulëza lëgkikh.

A survey of mass X-ray examinations of the thoracic cavity carried out in Leningrad in 1983-1991 showed the number of screenees to drop from 3.2 to 2.1 mln per year within the last three years (1988-1990). This finding is matched by an increased number of patients with primary lung cancer, a decrease in the numbers of cases of radical surgical treatment and those with lung tuberculosis identified by X-ray, and a steady increase in tuberculosis mortality.

Bilateral internal carotid artery aneurysms.

Two patients were treated for bilateral internal carotid artery aneurysms. One had resection and restoration of continuity on the right side nine years after ligation of the left internal carotid artery. The second had sequential resection and reconstruction of both vessels. Complications of carotid aneurysms include embolization, rupture, and thrombosis. Preferred treatment is resection with reconstitution of the flow. Patients with carotid aneurysms should be investigated for similar lesions on the opposite side. Patients who have had one carotid aneurysm treated should be followed up for the possible occurrence of a contralateral aneurysm.