ABSTRACT
Objective: To examine the impact of maternal risky behaviors on the behaviors of children born to adolescent and young mothers. Methods: Adolescents and young Chinese mothers were recruited from an integrated young mother supportive program in Hong Kong between January and June 2015. Eligible mothers were asked to complete a questionnaire on their sociodemographic characteristics and history of risky behavior as well as their children's behaviors. Multiple regression analyses were conducted to explore the association between maternal risky behaviors and their children's behaviors. Results: Among 201 respondents, there were 187 (93.0%) ex-drinkers, 136 (67.7%) ex-smokers, and 83 (41.3%) ex-addicts. Compared to the reference group, children of mothers with drug use behaviors were more likely to have abnormal SDQ total difficulties scores (odds ratio 2.60, P=0.01), those of ex-drinking mothers had more behavioral difficulties and more conduct problems (B=3.82 and 1.37, P both=0.01) and those of ex-smoking mothers had more conduct problems (B=0.74, P=0.01) after adjustment for confounders. Children of active drug-taking mothers also had more emotional symptoms (B=1.77, P=0.04) and hyperactivity/inattention problems (B=2.14, P=0.03). Conclusion: The history of mother's risky behavior was significantly associated with the behavioral problems of the children.
Subject(s)
Child Behavior Disorders , Child Behavior , Mother-Child Relations , Pregnancy in Adolescence , Adolescent , Child , Child, Preschool , Female , Humans , Mothers , Odds Ratio , Pregnancy , Risk Factors , Surveys and Questionnaires , Young AdultSubject(s)
Genetic Predisposition to Disease/epidemiology , Genetic Testing/methods , Health Education/organization & administration , Huntington Disease/genetics , Diffusion of Innovation , Female , Genetic Counseling , Humans , Huntington Disease/diagnosis , Huntington Disease/therapy , Male , Needs AssessmentABSTRACT
Recent reports suggest that a growing number of human immunodeficiency virus (HIV)-infected persons show signs of persistent cognitive impairment even in the context of combination antiretroviral therapies (cART). The basis for this finding remains poorly understood as there are only a limited number of studies examining the relationship between CNS injury, measures of disease severity, and cognitive function in the setting of stable disease. This study examined the effects of HIV infection on cerebral white matter using quantitative morphometry of the midsagittal corpus callosum (CC) in 216 chronically infected participants from the multisite HIV Neuroimaging Consortium study currently receiving cART and 139 controls. All participants underwent MRI assessment, and HIV-infected subjects also underwent measures of cognitive function and disease severity. The midsagittal slice of the CC was quantified using two semi-automated procedures. Group comparisons were accomplished using ANOVA, and the relationship between CC morphometry and clinical covariates (current CD4, nadir CD4, plasma and CSF HIV RNA, duration of HIV infection, age, and ADC stage) was assessed using linear regression models. HIV-infected patients showed significant reductions in both the area and linear widths for several regions of the CC. Significant relationships were found with ADC stage and nadir CD4 cell count, but no other clinical variables. Despite effective treatment, significant and possibly irreversible structural loss of the white matter persists in the setting of chronic HIV disease. A history of advanced immune suppression is a strong predictor of this complication and suggests that antiretroviral intervention at earlier stages of infection may be warranted.
Subject(s)
AIDS Dementia Complex/pathology , Anti-HIV Agents/administration & dosage , Antiretroviral Therapy, Highly Active , Corpus Callosum/pathology , HIV Infections/pathology , HIV/physiology , Magnetic Resonance Imaging/methods , Neuroimaging/methods , AIDS Dementia Complex/blood , AIDS Dementia Complex/etiology , AIDS Dementia Complex/immunology , AIDS Dementia Complex/virology , Adult , CD4 Lymphocyte Count , CD4-Positive T-Lymphocytes/immunology , Case-Control Studies , Cognition , Corpus Callosum/drug effects , Corpus Callosum/virology , Female , HIV Infections/blood , HIV Infections/complications , HIV Infections/drug therapy , HIV Infections/immunology , HIV Infections/virology , Humans , Immunosuppression Therapy/adverse effects , Linear Models , Longitudinal Studies , Male , Middle Aged , RNA, Viral/blood , Severity of Illness Index , Viral Load/physiologyABSTRACT
BACKGROUND: Few reports have described the clinical and microbiological features of cryptococcosis in immunocompetent patients. AIM: To compare clinical presentations and outcomes of cryptococcosis in immunocompetent vs. immunocompromised patients. DESIGN: Retrospective case series. METHODS: All culture- or histology-confirmed cases (n = 46) of cryptococcosis in two acute hospitals in Hong Kong (1995-2005) were included. Clinical presentations, rates of fungaemia, cerebrospinal fluid (CSF) parameters and clinical outcomes were recorded. RESULTS: Twenty patients (43.5%) were apparently immunocompetent, 17 (37.0%) had predisposing factors other than HIV infection, and 9 (19.6%) were HIV-positive. Thirty-one (67.4%) presented with meningitis, four (8.7%) with pulmonary cryptococcosis, and 11 (23.9%) with extraneural, extrapulmonary cryptococcosis. Of the immunocompetent patients with retrievable isolates (n = 8), three (37.5%) were Cryptococcus gattii; all isolates (n = 6) from immunocompromised patients were Cryptococcus neoformans var. grubii. Immunocompetent patients more commonly presented with meningitis (80.0% vs. 47.1%, p = 0.03), and tended toward lower rates of fungaemia (10.0% vs. 35.3%, p = 0.06) and mortality (25.0% vs. 52.9%, p = 0.06). Death was associated with fungaemia (p = 0.01) and underlying malignancy (p < 0.01). In cryptococcal meningitis, immunocompetent patients had longer mean time from illness onset to presentation (34.4 vs. 12.6 days, p = 0.02), more intense inflammatory responses (CSF: white blood cells 108 vs. 35 x 10(9)/l, p = 0.03; protein 1.61 g/l vs. 0.79 g/l, p = 0.07), less fungaemia (0% vs. 26.7%, p = 0.04) and more satisfactory clinical outcomes (81.3% vs. 46.7%, p = 0.04). DISCUSSION: A substantial proportion of patients with cryptococcosis are apparently immunocompetent. C. neoformans var. grubii and C. gattii are the common causes. Immunocompetent patients tend to present with localized, indolent neurological disease, with more intense inflammatory responses but better clinical outcomes.
Subject(s)
Cryptococcosis/immunology , Immunocompetence/immunology , Adult , Aged , Cryptococcosis/epidemiology , Cryptococcosis/microbiology , Cryptococcus/classification , Female , Hong Kong/epidemiology , Humans , Immunocompromised Host , Male , Middle Aged , Polymorphism, Restriction Fragment Length , Retrospective Studies , Risk FactorsABSTRACT
Stimulated by frustration, we have begun an effort to quantify the impact of illegibility of prescriptions on both potential error rates and time consumed in filling prescriptions. In an experimental situation, despite more than 14 seconds being expended on each prescription, almost 30% of the interpretations were erroneous. The implications for patient care and for negligence allegations, plus for the costs of both, are obvious.
Subject(s)
Drug Prescriptions/standards , Handwriting , Medication Errors , Pharmacists , Students, Health OccupationsABSTRACT
The techniques of pharmacist-patient communication are discussed. Ways in which the pharmacist can identify the patient's information needs, control communication timing, define communication objectives, develop methods of communication and evaluate the effectiveness of his instructions are covered.
