Psychiatric diagnoses in adolescents seropositive for the human immunodeficiency virus.

OBJECTIVE: To provide a descriptive analysis of the prevalence of past and current psychiatric disorders in adolescents positive for the human immunodeficiency virus (HIV). DESIGN: Structured interview in a convenience sample in a primary care urban adolescent clinic in Washington, DC. PARTICIPANTS: Thirty-four HIV-seropositive adolescents ranging in age from 16 to 21 years. MAIN OUTCOME MEASURES: The Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition (SCID-P) was administered by a child psychiatrist or a clinical child psychologist. Extensive review of medical records was also conducted. RESULTS: A majority of the HIV-infected adolescents in our sample had received psychiatric diagnoses prior to their treatment at the clinic (53%), had a documented history of sexual abuse (50%), and had a history of substance use (82%). Psychiatric diagnoses determined by the SCID-P indicated that 85% of the sample had a current Axis I disorder, with 44% reporting ongoing depressive disorders. CONCLUSIONS: The majority of subjects in this sample had had a previous psychiatric diagnosis, and almost half had a current affective disorder. Psychiatric disorders, especially affective disorders, may be a risk factor for high-risk sexual behaviors and substance use that increases the risk for HIV infection in adolescent populations.

Qualitative identification of rigid gas permeable contact lens materials by densitometry.

PURPOSE: We describe a practical method to qualitatively identify polymethylmethacrylate (PMMA) and rigid gas permeable (RGP) contact lens materials. METHODS: By progressive dilution of a saturated saline solution made with distilled or tap water and sodium chloride, we recorded comparative densitometry of rigid contact lens materials using a small hydrometer or by liquid displacement. RESULTS: The method was sensitive enough to separate the polymethylmethacrylate, all silicon-methacrylates, and all but two fluorine-containing silicon-methacrylates. The hydrometer had a precision of three decimals rounded to the nearest 0.005. There was only one RGP product that could have been confused with the PMMA material. Most silicon-methacrylates had lower densities than fluorine containing silicon-methacrylates. Only four of 25 products under 1.117 gm/cm3 contained fluorine. CONCLUSIONS: Densitometry with a hydrometer is an effective non-destructive method to identify RGP materials and to verify their quality. The method is easier when lens blanks are tested, but in spite of differences in shape, size, and weight, densitometry may also be used with new or used contact lenses. Its simplicity and low cost makes densitometry feasible for any contact lens laboratory or clinic to use on a routine basis. Only silicon-methacrylates had an inverse relationship between density and oxygen permeability. As the silicon content of the contact lens increases, the Dk increases and the density decreases.

The Miami pediatric quality of life questionnaire: parent scale.

Because there were limited measures available to assess health-related quality of life (HRQL) in children with chronic illnesses, this study was initiated to develop an empirically derived questionnaire for use in evaluating HRQL issues in children treated for cancer. Extensive interviews were conducted with 30 families of children with cancer, 10 of pre-school age, 10 of school age and 10 of adolescent age. Responses were videotaped and transcribed, then categorized to develop a pool of 56 items, which were administered to 132 children with cancer and to their parents. This report focuses on parental responses to objective items and ratings of importance of each of these items. Three primary categories, Self-Competence, Emotional Stability and Social Competence, were identified, each of which had solid internal consistency, sensitivity and reliability across 1-month intervals. The measure demonstrated the ability to discriminate between children with different types of cancer, offers an alternative to measures relying on expert judgment to assess HRQL and may lead to greater inclusion of psychological and social concerns as primary factors in determining HRQL in children participating in clinical trials.

A new tetracycline resistance determinant cloned from Proteus mirabilis.

The chromosomal inducible Tcr determinant from Proteus mirabilis was cloned and the nucleotide sequence of both the structural and repressor genes determined. The deduced amino acid sequence of the structural protein shows the highest similarity to TetA(H) from Pasteurella multocida (78.4%), followed by TetA(B) from Tn10 (50.9%). Based on this analysis, we suggest that this new determinant can be assigned to a new class, TetJ.

Early asthma onset: risk of emotional and behavioral difficulties.

The relationship between age of asthma onset and behavioral adjustment was analyzed using data from a longitudinal prospective investigation of 150 children identified prenatally as at genetic risk for developing asthma (the W. T. Grant Asthma Risk Study). The children's development and asthma status were monitored regularly for 6 years. Mothers were interviewed yearly using the Behavioral Screening Questionnaire (BSQ). Children who had an early onset of asthma (by 3 years of age) had significantly more behavior problems at age 4 than children who developed asthma later (between 3 and 6 years of age). Furthermore, the early-onset group had significantly more problems at age 6 than both children who developed asthma later and children who never developed asthma. Children with early asthma onset were compared to children who were asthma free on individual problem items of the BSQ, revealing a profile of behavior problems that included waking at night, depressed mood, and some indication of increased fearfulness. This profile is consistent with an earlier report of behavior problems among severely asthmatic preschool children (Mrazek, Anderson, & Strunk, 1984), who displayed the same internalizing behavior problems on the BSQ. These results suggest that early asthma onset may have predictable negative influences on behavioral adjustment over a wider range of asthma severity than has previously been reported.

The detection and management of mental health disorders in pediatric primary care.

We reviewed the literature on the detection and management of mental health disorders within the context of pediatric primary care. Pediatricians have displayed a low sensitivity and high specificity in research investigating the detection of mental health impairment in children. Active management efforts characterize approaches to identified cases with more recently trained primary care pediatricians displaying a wider range of skills in managing mental health disorders. Few efforts have been made by pediatric psychologists to develop strategies for enhancing detection rates and management or to empirically evaluate the integration of pediatric psychology services into the primary care context. A conceptual model of factors influencing detection rates and ongoing management of mental health disorders within pediatric primary care is presented. Recommendations are made for more direct involvement of pediatric psychologists within the primary care context.

Enhanced parenting knowledge and skills in mothers of preschool children with sickle cell disease.

Compared 25 preschool children with sickle cell disease (SCD) to demographically matched healthy comparison children on maternal reports of child-rearing beliefs and practices and maternal and child behaviors related to social adjustment. Mothers of children with SCD possessed significantly more knowledge of appropriate discipline techniques. The groups did not differ on maternal reports of socially relevant child behavior. However, when mother-child interactions were observed in free play and structured play settings, mothers of children with SCD treated their children as competent significantly more, and treated their children as incompetent significantly less, than comparison mothers. Mothers of children with SCD also used significantly more reinforcement during the final toy pick-up condition. There were no observed differences between groups in the children's behavior.

Placental abruption and placental hemorrhage: correlation of sonographic findings with fetal outcome.

Sixty-nine cases of placental abruption and placental hemorrhage detected with ultrasonography (US) were reviewed retrospectively to determine whether US findings correlate with fetal outcome. Four patients were lost to follow-up, and in the remaining 65 patients fetal outcome included demise in 12 cases (18%), termination of pregnancy in six (9%), premature delivery of a living infant in 15 (23%), term delivery of an infant who was small for gestational age in four (6%), and normal term delivery in 28 (43%). Fetal mortality correlated best with the estimated percentage of placental detachment, but was also significantly (P less than .01) associated with the location (retroplacental) and size (greater than 60 ml) of hemorrhage. Premature labor was associated (P less than .001) only with gestational age at the time of clinical presentation. No sonographic finding was identified as a risk factor for small-for-gestational-age infants. Sonographic findings of placental abruption correlate with fetal outcome, and this information may be useful for guiding obstetric management.