Prevalence and correlates of disturbed dreaming in children.

Relatively little is known about nightmares and other forms of disturbed dreaming in children. This article reviews the literature on the prevalence and correlates of nightmares in children and highlights key methodological issues in the field. Results show that regardless of how they are defined and measured, nightmares affect a significant proportion of children of all ages and there is some evidence to suggest that nightmare frequency may peak around the age of 10. Gender differences in nightmare frequency, with girls reporting more nightmares than do boys, tend to appear between the ages of 10 and 15. Although nightmares are associated with a range of psychosocial difficulties (e.g., stress, behavioural problems), elevated anxiety and concomitant sleep-related disorders (e.g., sleepwalking) are among the most robust correlates of nightmares. Very few studies have examined nightmare treatment in children, but promising results have been obtained with imagery rehearsal therapy. Overall, research in the field has been hampered by inconsistent definitions for nightmares, by extensive variability in questionnaire items used to measure nightmare frequency, and by a lack of awareness of how using parents versus children as respondents may impact results. Longitudinal studies are needed to better understand how nightmares and their correlates evolve during childhood and adolescence, to delineate their clinical significance, and to develop effective and age-appropriate treatment strategies.

Maternal cigarette smoking during pregnancy and cognitive performance in adolescence.

BACKGROUND: The incidence of cigarette smoking during pregnancy remains high. Maternal smoking during pregnancy is known to be associated with cognitive and behavioural sequelae in childhood and adolescence. We assessed the relationship between maternal cigarette smoking during pregnancy and cognitive abilities in adolescent offspring (n = 503, 12- to 18-years old) using an extensive 6-h battery of tests. METHODS: Non-exposed adolescents (controls) were matched to exposed adolescents (cases) by maternal education and school attended. Cognitive abilities were evaluated using a neuropsychological battery consisting of 33 tasks measuring verbal abilities, visuo-spatial skills, verbal and visual memory, processing speed, resistance to interference and motor dexterity. RESULTS: We found no differences between cases and controls in any of the cognitive domains whether potential confounders were included in the model or not. In addition to maternal smoking during pregnancy, we also evaluated the effect of sex and age on the various cognitive abilities in this large adolescent sample and found that most of the abilities continue to improve during adolescence to the same extent in girls and boys, with several age-independent sex differences. CONCLUSIONS: We found no effect of maternal cigarette smoking during pregnancy on cognitive abilities of the adolescent offspring when matching cases and controls by maternal education, the most common confounder of maternal cigarette smoking during pregnancy.

[The mediating role of family functioning in the relationship between family adversity and preschoolers' social adjustment]. / Le rôle médiateur du fonctionnement familial dans la relation entre l'adversité familiale et l'adaptation sociale des enfants d'âge préscolaire.

Preschoolers' social adaptation is related to their degree of exposure to environnemental risks. However, the mechanisms through which the environmental risks operate their influence on social adaptation are still poorly documented. Thus, the first goal of this study is to investigate the main effect of family adversity on preschoolers' behavioral problems and attachment security. The second goal is to test the mediating effect of family functionning in the relationship between family adversity and behavioral problems or attachment security. Five hundred and seventy-two participants (n=572) were assessed on family adversity between the age of 5 and 42 months. Behavioral problems and family functionning were assesed at 42 months. Eighty of the participants were assessed on attachment security at the age of 48 months. The results show a main effect of family adversity on behavioral problems as well as a mediating effect of family functionning in the relationship of family adversity and behavioral problems. No significant effect was found for security of attachment.

Interrelations Between Maternal Smoking During Pregnancy, Birth Weight and Sociodemographic Factors in the Prediction of Early Cognitive Abilities.

Maternal prenatal smoking, birth weight and sociodemographic factors were investigated in relation to cognitive abilities of 1544 children (aged 3.5 years) participating in the Québec Longitudinal Study of Children's Development. The Peabody Picture Vocabulary Test (PPVT) was used to assess verbal ability, the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) block design test to assess visuospatial ability, and the Visually Cued Recall (VCR) task to assess short-term memory. Prenatal smoking was related to performance on the WPPSI-R, the PPVT, and the VCR, although it did not independently predict any cognitive ability after maternal education was taken into account. Birth weight was a more robust predictor of all outcome measures and independently predicted VCR-performance. Birth weight interacted significantly with family income and maternal education in predicting visuospatial ability, indicating a greater influence of birth weight under relatively poor socio-economic conditions. Parenting and family functioning mediated associations between maternal education/family income and cognitive task performance under different birth weight conditions, although there were indications for stronger effects under relatively low birth weight. We conclude that investigations of moderating and mediating effects can provide insights into which children are most at risk of cognitive impairment and might benefit most from interventions.

Salivary cortisol and aggression in a population-based longitudinal study of adolescent males.

Chronic antisocial behaviour in youth has been associated with cortisol, a measure of stress reactivity. However, some studies have found low cortisol levels, while others have found elevated cortisol levels. The present study compared variously defined aggressive subgroups for differences in salivary cortisol. A population-based sample of boys was followed longitudinally from childhood to adolescence. Assessments of different forms of antisocial behaviour were obtained from various informants at several points in time, and cortisol was collected at age 13. Higher cortisol levels were found in boys with conduct disorder (CD) than in boys without CD. In addition, boys with an aggressive form of CD had higher cortisol levels than boys who showed a covert form of CD. Furthermore, reactive aggression was strongly correlated with elevated cortisol. Adolescent boys with chronic reactive aggression and those who scored high on aggressive CD symptoms seem to have a more active hypothalamic-pituitary-adrenal system.

Minor physical anomalies and family adversity as risk factors for violent delinquency in adolescence.

OBJECTIVE: Minor physical anomalies are considered indicators of disruption in fetal development. They have been found to predict behavioral problems and psychiatric disorders. This study examined the extent to which minor physical anomalies, family adversity, and their interaction predict violent and nonviolent delinquency in adolescence. METHOD: Minor physical anomalies were assessed in a group of 170 adolescent boys from low socioeconomic status neighborhoods of Montréal. The boys had been enrolled in a longitudinal study since their kindergarten year, when an assessment of family adversity had been made on the basis of familial status and the parents' occupational prestige, age at the birth of the first child, and educational level. Adolescent delinquency was measured by using self-reported questionnaires and a search of official crime records. RESULTS: Results from logistic regression analyses indicated that both the total count of minor physical anomalies and the total count of minor physical anomalies of the mouth were significantly associated with an increased risk of violent delinquency in adolescence, beyond the effects of childhood physical aggression and family adversity. Similar findings were not found for nonviolent delinquency. CONCLUSIONS: Children with a higher count of minor physical anomalies, and especially a higher count of anomalies of the mouth, could be more difficult to socialize for different and additive reasons: they may have neurological deficits, and they may have feeding problems in the first months after birth. Longitudinal studies of infants with minor physical anomalies of the mouth are needed to understand the process by which they fail to learn to inhibit physical aggression.

Executive functions and physical aggression after controlling for attention deficit hyperactivity disorder, general memory, and IQ.

This study examined the role of ADHD in the association between physical aggression and two types of executive functions. Boys received a cognitive-neuropsychological test battery over the ages of 13, 14, and 15 years. Diagnostic Interview Schedule for Children (DISC 2.25) data were collected from the boys and one parent between ages 14 and 16, and an IQ estimate was obtained at age 15. Three groups, differing in stability and level of physical aggression since kindergarten, were formed: Stable Aggressive, Unstable Aggressive, and Non-aggressive. Composite scores of validated executive function tests of working memory representing subjective ordering and conditional association learning were formed. A MANCOVA (N = 149) using ADHD status, teacher-rated negative emotionality, general memory abilities, and IQ as covariates was performed on the two composite scores. ADHD and teacher-rated emotionality did not provide significant adjustment to the dependent variables. Number of ADHD symptoms was negatively associated only with general memory and IQ. General memory contributed significantly to adjusting for conditional association test scores. Group differences indicated lower conditional association scores for Unstable Aggressive boys relative to the other groups. Both IQ and general memory abilities interacted with subjective ordering within the groups. Specifically, Stable Aggressive boys performed poorly on this measure and did not benefit from increases in IQ whereas Nonaggressive boys performed best and were not disadvantaged by lower general memory abilities. This suggests a relationship exists between aspects of working memory and a history of physical aggression regardless of ADHD and IQ.

Hypersensitivity to social interactions in bulimic syndromes: relationship to binge eating.

This study used a 6- to 22-day experience-sampling procedure to test for hypersensitivity to social interactions in bulimic individuals. Ratings on daily social interactions, self-concepts, moods, and eating behaviors from 55 actively bulimic, 18 formerly bulimic, and 31 noneating-disordered women were obtained. Hierarchical linear modeling analyses showed negative social interactions to be associated with significant increases in self-criticism (SC) and deteriorations in mood in all participants. However, bulimic participants (active or in remission) showed larger increases in SC following negative social interactions than did normal eaters (and thus seemed to be hypersensitive to interpersonal experiences). Additional analyses indicated that binge episodes tended to be preceded by poorer than average social experiences, self-concepts, and moods and followed by deteriorations in self-concept, mood, and social perception. The authors discuss possible perpetuating influences of interpersonal sensitivity in bulimic syndromes.

Tryptophan depletion, executive functions, and disinhibition in aggressive, adolescent males.

Low serotonin has been associated with aggressive behavior and impulsivity. Executive functions (cognitive abilities involved in the initiation/maintenance of goal attainment) have also been related to aggression. We tested whether dietary depletion of tryptophan, the amino acid precursor of serotonin, would increase disinhibition (impulsivity) in aggressive male adolescents. Cognitive-neuropsychological variables predictive of disinhibition were explored. Stable aggressive and nonaggressive adolescent men received balanced and tryptophan-depleted, amino acid mixtures separately (counterbalanced, double-blind). Commission errors on a go/no-go learning task (i.e., failures to inhibit responding to stimuli associated with punishment/nonreward) measured disinhibition. Aggressive adolescent males made more commission errors as compared to nonaggressives. Lower executive functioning was significantly related to commission errors over and above conventional memory abilities. Tryptophan depletion had no effect on commission errors in the aggressive adolescents, possibly because of a ceiling effect.

Long-term results with the Sorin Pericarbon valve in the aortic position: a multicenter study.

BACKGROUND AND AIM OF THE STUDY: A multicenter study was designed to evaluate the Pericarbon pericardial bioprosthesis for up 10 years after implantation in the aortic position. METHODS: Between January 1986 and November 1996, 321 patients (mean age 75.8 +/- 7.3 years) received 325 Pericarbon pericardial valves in the aortic position. Four patients underwent redo surgery and each received a second Pericarbon prosthesis. Associated cardiac procedures in 80 patients were mainly coronary bypass (n = 66). Follow up extended up to 10 years (cumulative follow up of 931.0 patient-years; mean follow up 3.1 +/- 2.2 years). RESULTS: There were 19 late deaths, with seven valve-related. Twelve patients suffered an embolic complication (transient cerebral attack in four, peripheral in six and induction of a myocardial infarction in two). Of these complications, five occurred within 30 days of surgery and seven beyond the first year. Ten patients were reoperated on, six for primary tissue failure, two for prosthetic endocarditis and two for paraprosthetic leak. Primary failure was due in all cases to leaflet mineralization. No primary tear of the leaflet was reported. Actuarial freedom after 10 years from primary tissue failure was 83.9 +/- 7.4% and from major embolic events 97.6 +/- 1.0%. Freedom from valve-related mortality at 10 years was 92.1 +/- 4.9%. CONCLUSIONS: These results indicate that, over a period of up to 10 years, the Pericarbon pericardial bioprosthesis compares favorably with other replacement valves.

Risk for hypertension and pain sensitivity in adolescent boys.

Reduced pain perception has been observed in many studies of spontaneously hypertensive rats and human hypertensive patients. To determine whether a reduced sensitivity to pain could be observed in a group of clearly normotensive individuals who may be at risk for hypertension, a mild to moderate pain stimulus was administered to 177 14-year-old boys. Boys with a normatively elevated resting systolic blood pressure tolerated mechanical finger pressure significantly longer than boys with lower blood pressure. As well, boys with both normatively elevated resting systolic blood pressure and a parental history of hypertension reported significantly less pain during finger pressure than lower risk participants. These findings could not be explained by personality factors and suggest that hypertension-related hypoalgesia is associated with processes involved in the development of the disorder.

Ginkgo biloba extract (EGb 761) pretreatment limits free radical-induced oxidative stress in patients undergoing coronary bypass surgery.

A growing body of evidence supports the trigger role of free radicals in the delayed functional and metabolic myocardial recovery following cardiopulmonary bypass (CPB) in humans, thus opening the field to specific therapies. This clinical study was designed to evaluate, in 15 patients undergoing aortic valve replacement, whether the extent of CPB- and reperfusion-induced lipid peroxidation, ascorbate depletion, tissue necrosis, and cardiac dysfunction is reduced by orally administered EGb 761, a Ginkgo biloba extract with potent in vitro antiradical properties. Patients received either EGb 761 (Tanakan, 320 mg/day, n = 8) or a matching placebo (n = 7) for 5 days before surgical intervention. Plasma samples were obtained from the peripheral circulation and the coronary sinus at crucial stages of the operation (i.e., before incision, during ischemia, and within the first 30 minutes post-unclamping), and up to 8 days postoperatively. Upon aortic unclamping, EGb 761 inhibited the transcardiac release of thiobarbituric acid-reactive species (p < 0.05), as assessed by high-performance liquid chromatography, and attenuated the early (5-10 minute) decrease in dimethylsulfoxide/ascorbyl free radical levels, an electron spin resonance index of the plasma ascorbate pool (p < 0.05). EGb 761 also significantly reduced the more delayed leakage of myoglobin (p = 0.007) and had an almost significant effect on ventricular myosin leakage (p = 0.053, 6 days postoperatively). The clinical outcome of recovery of treated patients was improved, but not significantly, compared with untreated patients. Our results demonstrate the usefulness of adjuvant EGb 761 therapy in limiting oxidative stress in cardiovascular surgery and suggest the possible role of highly bioavailable terpene constituents of the drug.

Preservation of three-dimensional annular movement with the SJM-Seguin mitral annuloplasty ring.

BACKGROUND AND AIMS OF THE STUDY: In order to achieve optimal annuloplasty during mitral valve repair, we developed a new device, the SJM-Seguin annuloplasty ring, with the aim of remodeling, correcting dilatation, and preserving physiologic annulus function. This ring has variable flexibility; that is, it is sufficiently rigid in its anterior region to maintain intercommissural distance, yet sufficiently flexible in its posterior region so as not to interfere with left ventricular function and to permit the natural three-dimensional annular mobility. METHODS: Following successful studies in animals, 75 patients were operated on for mitral regurgitation between January 1994 and May 1996. The patients' mean age was 60.4 +/- 13.2 years; 53.8% were men. The cause of mitral insufficiency was degenerative in 77.4% of patients, rheumatic in 12%, ischemic in 5.3%, and infectious in 5.3%. Associated procedures were carried out in 36% of the cases. RESULTS: There were no intraoperative deaths, but two in-hospital deaths and one late death, all of which were unrelated to the annuloplasty ring. Mitral regurgitation, monitored by transesophageal echocardiography decreased from +3.42 +/- 0.6 before repair to +0.31 +/- 0.12 after repair (p < 0.005). Follow up was 100% at a mean of 14.2 months (range: 3 to 26 months). There were no annuloplasty-related complications, and especially no echocardiographically discernible systolic anterior motion. There were no transient ischemic attacks. One reoperation was performed due to endocarditis at nine months after initial repair. The average transmitral gradient was 1.94 mmHg. CONCLUSIONS: This new annuloplasty ring provides, with the absence of any valve-related complications, correction of annular dilatation and remodeling of the annulus while respecting physiologic annulus function such as natural three-dimensional mobility.

Pain sensitivity and stability of physical aggression in boys.

It is unclear whether stably aggressive boys would be characterized by high or low pain sensitivity. Adolescent boys in whom physical aggression, executive functioning, anxiety, and family adversity had been assessed longitudinally formed three groups who differed in stability of physical aggression: stable, unstable, and non-aggressive. Stable aggressives were the least pain sensitive, whereas unstable aggressives were the most pain sensitive. While at low levels of executive functioning pain sensitivity could not be distinguished between the aggressive groups, at high levels unstable aggressives reported even more pain, whereas stable aggressives reported even less pain. Variations in anxiety were associated strongly with pain sensitivity in unstable aggressives. High pain ratings were found in boys who had a moderate level of family adversity, and low pain ratings in boys with low or high adversity. The differences in pain sensitivity between the groups may be motivationally important to the frequency and type of aggression.

Advance in mitral valve repair using a device flexible in three dimensions. The St Jude Medical-Séguin annuloplasty ring.

To allow remodeling of the annulus while respecting natural three dimensional annular movements during mitral valve repair, a new annuloplasty ring (St Jude Medical [SJM]-Séguin annuloplasty ring) was developed. This ring has variable flexibility; that is, it is sufficiently rigid on the anterior portion to maintain intercommissural distance, and sufficiently flexible on the posterior portion to respect left ventricular function and natural three dimensional annular mobility. Fifty patients operated on for pure mitral regurgitation between January, 1994 and June, 1995 were studied. Mean age was 58 years. The cause of mitral insufficiency was degenerative in 80% of the patients, rheumatic in 12%, ischemic in 4%, and infectious in 4%. The operative technique to restore normal valve coaptation was quadrangular resection in 31 cases, commissurotomy and chordal fenestration in 8, use of polytetrafluoroethylene chordae in 6, and chordal shortening or transposition in 5. Annuloplasty with a SJM-Séguin annuloplasty ring was realized in all 50 cases. Transesophageal echocardiographic mitral regurgitation decreased from 3.6 +/- 0.8 to 0.3 +/- 0.2 after repair (p < 0.005). Two post operative deaths due to non valve related complications, were observed. There were no ring related complications, especially no left ventricular outflow tract obstruction due to systolic anterior motion. Patients were all reviewed at a mean follow-up of 12.1 months (range, 9-27 months). All are well, in New York Heart Association functional Class I. Echocardiography showed a mean 0.4 +/- 0.3 mitral regurgitation, absence of any systolic anterior motion, and satisfactory mobility of the annuloplasty ring after the movements of the natural annulus, including non planar deviation. These preliminary results suggest that this annuloplasty ring 1) provides excellent correction of annular dilatation and remodeling of the annulus, 2) avoids systolic anterior motion observed with rigid rings, and 3) preserves physiologic three dimensional annulus motion.

Cognitive and neuropsychological characteristics of physically aggressive boys.

Cognitive-neuropsychological tests were given to adolescent boys (N = 177) to investigate processes associated with physical aggression. Factor analysis yielded 4 factors representing verbal learning, incidental spatial learning, tactile-lateral ability, and executive functions. Physical aggression was assessed at ages 6, 10, 11, and 12, and 3 groups were created: stable aggressive, unstable aggressive, and nonaggressive. The authors found main effects for only the executive functions factor even when other factors were used as additional covariates in a step-down analysis; nonaggressive boys performed better than stable and unstable aggressive boys. The covariates family adversity and anxiety were both related only to the verbal learning factor. This study highlights the importance of deficits in executive function in the expression of physical aggression relative to other cognitive-neuropsychological functions.

Use of active shunt for surgical repair of intrapericardial inferior vena caval injury.

We report a case of intrapericardial inferior vena caval disruption due to goring by a bull, and we describe the surgical repair of this uncommon penetrating cardiac injury. Review of the literature indicates that, as with other penetrating cardiac injuries, this rare lesion requires aggressive treatment involving an emergency thoracotomy. The use of an atrial caval active shunt was necessary for successful surgical management, and therefore we conclude that surgical treatment of this lesion is comparable with surgical repair of hepatic veins and retrohepatic vena caval injuries incurred during blunt vascular trauma or penetrating abdominal injuries.

Repair of the aortic arch with fibrin glue in type A aortic dissection.

Location of the intimal tear in the aortic arch in type A aortic dissection is for many authors an indication for replacement of the aortic arch, but this operation has a high in-hospital mortality rate: 20% to 40%. Instead, we suggest repairing the aortic arch by injecting fibrin glue, which contains a human sealer protein concentrate, between the two dissected layers under circulatory arrest while replacing the ascending aorta. To evaluate this technique, we reviewed 45 successive patients operated on for type A acute aortic dissection between January 1989 and July 1993, of which 6 had the intimal tear located on or extending into the aortic arch. Mean age was 71 +/- 4.2 years (range 68 to 74). After proximal supracoronary anastomosis with a collagen-impregnated graft, aortic arch repair was achieved by injecting fibrin glue between the two layers, using circulatory arrest at a mean temperature of 22 degrees C, with a mean duration of 24 minutes. This obliterated the dissection in the arch and also the intimal flap. The distal part of the graft was then anastomosed to the proximal portion of the aortic arch at the origin of the innominate artery under circulatory arrest. There were no early or late deaths. All patients were asymptomatic at a mean follow-up of 2.6 years. Follow-up angioscan showed obliteration of the dissection in the aortic arch in all patients; there were two patients with dilatation of the distal aortic arch of 40 and 45 mm.(ABSTRACT TRUNCATED AT 250 WORDS)