Retrospective review reveals few complications of ovarian pedicle tie in 15,927 cats undergoing ovariohysterectomy at a large HQHVSN clinic and training facility in the United States: 2017-2018.

OBJECTIVE: To determine the rate of complications associated with the ovarian pedicle tie procedure in cats undergoing ovariohysterectomy and examine whether cat characteristics or surgeon experience level were associated with complications. ANIMALS: 15,927 cats that underwent ovariohysterectomy with the ovarian pedicle tie procedure between January 1, 2017, and December 31, 2018. PROCEDURES: Data were extracted from electronic and paper medical records. Complications were coded by a veterinarian blinded to surgeon experience level. Complications (pedicle drop or tear, pedicle hemorrhage, and pedicle-related death) were summarized as counts and percentages. Univariate associations between cat characteristics (eg, age, weight, reproductive status, and ownership) and surgeon experience level (clinic veterinarian vs training veterinarian or veterinary student) and each outcome were estimated separately for veterinarian and student training clinics. RESULTS: A pedicle drop or tear occurred in 0.3% (n = 49) of cats and was significantly more likely among veterinary students. Most (41/49 [84%]) pedicle drops and tears did not result in hemorrhage. Only 19 of 15,927 (0.12%) cats had pedicle-related hemorrhage, and in all instances, hemorrhage was corrected intraoperatively without serious complication or death. Cat characteristics and surgeon experience level were not related to pedicle hemorrhage. CLINICAL RELEVANCE: Results support previous evidence that the ovarian pedicle tie procedure is safe in cats undergoing ovariohysterectomy when performed by experienced surgeons or novice surgeons under supervision. Given the reduced anesthetic time associated with the procedure, the ovarian pedicle tie should be considered an acceptable standard practice in all practice settings.

Community Veterinary Medicine Programs: Pet Owners' Perceptions and Experiences.

Many American pet owners struggle financially, and the COVID-19 pandemic has only exacerbated this problem. Yet, the positive effects that companion animals have in people's lives create the need for supportive systems to ensure that financial limitations, and other barriers, do not preclude pet ownership. To help address these barriers, and reach underserved communities, various forms of community-based veterinary medicine programs have been developed across the country. This study assesses two community-based veterinary programs in North Carolina, USA. In addition to perceptions surrounding veterinary services, this study paid specific attention to communication and respect; two additional elements needed for successful community-based veterinary programs. Surveys were given to clients accessing Asheville Humane Society (AHS) mobile veterinary care clinic and Asheville Humane Society (AHS) Affordable Pet Care Clinic. Results of the anonymous survey indicate that the majority of clients had positive veterinary care experiences in terms of both veterinary services and client communication. In conclusion, low-cost or free community veterinary programs-with effective communication, empathy, and cultural competence-can help open the door to future positive veterinary experiences for disadvantaged pet owners.

Alcohol use patterns and alcohol use disorders among young adult, ethnically diverse bariatric surgery patients.

BACKGROUND: Research suggests that young adults and racial/ethnic minorities are at an increased risk for problematic alcohol use. Recent studies have also documented patterns of problematic alcohol use among a subset of weight loss surgery (WLS) patients. However, to date, there are no published studies investigating the intersection of these demographic and clinical characteristics. METHODS: This study used descriptive and inferential analyses to examine alcohol use patterns, prevalence of pre- and post-WLS alcohol use disorders (AUDs), and predictors of increased alcohol use and problematic alcohol use post-WLS among young adult (mean age 26.5 years, SD = 5.5 years) ethnically diverse (57% Hispanic, 28% non-Hispanic black) WLS patients (N = 69). RESULTS: Over 21% of the sample had a history of a lifetime AUD, and 4.2% of the sample developed an AUD post-WLS. In the past 30 days, 14.5% of respondents reported binge drinking, and 42% reported drinking until intoxication. History of a pre-WLS AUD was associated with an increased frequency of alcohol use post-WLS (P = .012). Age, time since WLS, the gastric bypass procedure, and pre-WLS history of an AUD were not significant predictors of binge drinking or drinking to intoxication post-WLS. CONCLUSIONS: Ethnically diverse, young adults may have an elevated prevalence of AUD diagnoses pre-WLS. Having a pre-WLS AUD appears to be a risk factor for increased alcohol use post-WLS. Young adult WLS patients might also demonstrate high rates of binge drinking and drinking to intoxication. Binge drinking could be especially problematic considering that WLS could increase sensitivity to alcohol. Further investigation is warranted with this important subpopulation to explore risk factors for problematic alcohol use post-WLS; future assessments of alcohol use should consider potential heightened alcohol sensitivity resulting from WLS.

Prenatal Cocaine Exposure and Cardiometabolic Disease Risk Factors in 18- to 20-Year-Old African Americans.

OBJECTIVE: The long-term effects of prenatal cocaine exposure (PCE) on physical health are largely unknown. No human studies support or refute a relationship between PCE and the long-term risk for cardiovascular and/or metabolic disease. We investigated the association of PCE on primary cardiometabolic disease risk factors in African Americans (AA) aged 18 to 20 years. DESIGN: Cohort, longitudinal, prospective. SETTING: Miami-Dade County, Florida, and the University of Miami Miller School of Medicine/Jackson Memorial Medical Center. PARTICIPANTS: Healthy full-term inner-city AA adolescents (aged 18 to 20 years, n=350) previously enrolled at birth from 1990-1993. MAIN OUTCOME MEASURES: Fasting serum insulin, glucose, lipids, and high-sensitivity C-reactive protein; systolic and diastolic blood pressures; and the components and prevalence of the metabolic syndrome. RESULTS: There were no PCE-associated differences in cardiometabolic disease risk factors including the metabolic syndrome and its individual components in AAs aged 18 to 20 years. CONCLUSIONS: The results of our study do not support an association between PCE and increased cardiometabolic disease risk in AAs aged 18 to 20 years. Whether PCE is associated with cardiovascular or metabolic disease in adulthood would require further investigation.

Assessing latent effects of prenatal cocaine exposure on growth and risk of cardiometabolic disease in late adolescence: design and methods.

Prenatal cocaine exposure has been linked to neurocognitive and developmental outcomes throughout childhood. The cardiovascular toxicity of cocaine is also markedly increased in pregnancy, but it is unknown whether this toxicity affects anthropometric growth and the development of cardiometabolic disease risk factors in the offspring across the lifespan. During the early 1990s, the Miami Prenatal Cocaine Study enrolled a cohort of 476 African American children (253 cocaine-exposed, 223 non-cocaine-exposed) and their biological mothers at delivery in a prospective, longitudinal study. The MPCS has collected 12 prior waves of multidomain data on over 400 infants and their mothers/alternate caregivers through mid-adolescence and is now embarking on an additional wave of data collection at ages 18-19 years. We describe here the analytical methods for examining the relationship between prenatal cocaine exposure, anthropometric growth, and cardiometabolic disease risk factors in late adolescence in this minority, urban cohort. Findings from this investigation should inform both the fields of substance use and cardiovascular research about subsequent risks of cocaine ingestion during pregnancy in offspring.

Longitudinal effects of prenatal cocaine use on mother-child interactions at ages 3 and 5 years.

OBJECTIVE: To assess the effect of maternal prenatal and past-year cocaine use on mother-child interactions across preschool years. METHODS: The sample is drawn from the Miami Prenatal Cocaine Study, a longitudinal follow-up of prenatal cocaine exposure (PCE) in a large cohort of African-American infants prospectively enrolled at birth. Analyses are based on the 366 children (168 PCE and 198 non-cocaine-exposed) in the care of their biological mothers and with completed mother-child interaction measures at the 3- and/or 5-year assessments. Videotaped interactions were coded using a modified Egeland Teaching Task scheme. Generalized linear models with a generalized estimating equations approach were used to evaluate the effect of PCE on the overall quality of maternal-child interaction, measured by the Egeland total score at both study visits, and on the individual Egeland subscales at the 5-year visit, while adjusting for other suspected influences on interactions. RESULTS: PCE dyads demonstrated less optimal overall mother-child interactions compared with non-cocaine-exposed dyads. The estimated PCE-associated difference did not shift appreciably with statistical adjustment for child sex, child age at examination, or other birth covariates. PCE dyads with past-year maternal cocaine use had significantly lower Egeland summary scores compared with children with neither exposure. In subscale analyses, PCE was most strongly associated with greater maternal intrusiveness and boundary dissolution at the 5-year visit. CONCLUSIONS: Prenatal and past-year maternal cocaine use seems to be associated with poorer quality in mother-child interaction during early childhood. These dynamics should be considered when examining the association between PCE and child cognitive, behavioral, and academic outcomes.

Estimated effect of prenatal cocaine exposure on examiner-rated behavior at age 7 years.

UNLABELLED: Prenatal cocaine exposure has been linked to increased child behavior difficulties in some studies but not others. OBJECTIVE: The primary aim was to estimate the relationship between in utero cocaine exposure and child behavioral functioning at age 7 years with ratings made by blinded examiners during a structured testing session. A second aim was to examine whether caregiver drug use and psychological problems might mediate suspected relationships between prenatal cocaine exposure and aspects of examiner-rated behavior. METHODS: 407 children (212 cocaine-exposed, 195 non-exposed) participating in the longitudinal Miami Prenatal Cocaine Study (MPCS) were rated with regard to their behavior during a neuropsychological assessment conducted at age 7 years. Raters were trained research psychometricians blinded to drug exposure status. Individual behavioral items were summarized and the cocaine-behavior relationship was estimated within the context of latent variable modeling, using Mplus software. RESULTS: Two latent variables, Behavioral Regulation and Sociability, were derived via exploratory latent structure analysis with promax rotation. Prenatal cocaine exposure, statistically controlling for child sex, test age, and prenatal exposure to alcohol, tobacco, and marijuana, was associated with Behavioral Regulation (estimated slope ß=-0.25; 95% CI=-0.48, -0.02; p=0.04) but not Sociability (estimated slope ß=-0.03; 95% CI=-0.26, 0.20; p=0.79). Neither postnatal drug use by caregivers nor the severity of their psychological problems at age 5 follow-up predicted levels of child Behavioral Regulation or Sociability at age 7 years (p>0.10). CONCLUSIONS: Examiner ratings of child behavior at age 7 revealed less optimal behavioral regulation for prenatally cocaine-exposed compared to non-exposed children, in contrast with what had been previously found from parent-report data. This evidence highlights the potential value of trained observers in assessing behavioral outcomes of children exposed in utero to drugs and other toxicants.

Estimated effects of in utero cocaine exposure on language development through early adolescence.

The potential longitudinal effects of prenatal cocaine exposure (PCE) on language functioning were estimated from early childhood through early adolescence in a large, well-retained urban sample of 451 full-term children (242 cocaine-exposed, 209 non-cocaine-exposed) participating in the Miami Prenatal Cocaine Study (MPCS). The sample was enrolled prospectively at birth, with documentation of prenatal drug exposure status through maternal interview, and toxicology assays of maternal and infant urine, and infant meconium. Age-appropriate versions of the Clinical Evaluation of Language Fundamentals (CELF) were used to measure total, expressive, and receptive language at ages 3, 5, and 12years. Longitudinal latent growth curve (LLGC) modeling of the data revealed an association between PCE (measured dichotomously as yes/no) and lower functioning in expressive and total language scores, after considering other sources of variation including child's age at testing, sex, prenatal exposure to alcohol, marijuana, and tobacco, and additional medical and social-demographic covariates. Analyses of level of PCE showed a gradient, i.e. dose-dependent, relationship between PCE level and expressive, receptive, and total language scores in the models controlling for age, child's sex, and other prenatal drug exposures. With additional covariate control these findings were most stable for the total language score. The evidence supports an inference about an enduring stable cocaine-specific effect on children's language abilities, with no effect on language growth over time in the longitudinal trajectory of language development.

Prenatal drug exposure: infant and toddler outcomes.

This manuscript provides an overview of the current scientific literature on the impact of maternal drug use, specifically opioids and cocaine, during pregnancy on the acute and long-term outcomes of infants and toddlers from birth through age 3 years. Emphasis with regard to opioids is placed on heroin and opioid substitutes used to treat opioid addiction, including methadone, which has long been regarded as the standard of care in pregnancy, and buprenorphine, which is increasingly being investigated and prescribed as an alternative to methadone. Controlled studies comparing methadone at high and low doses, as well as those comparing methadone with buprenorphine, are highlighted and the diagnosis and management of neonatal abstinence syndrome is discussed. Over the past two decades, attention of the scientific and lay communities has also been focused on the potential adverse effects of cocaine and crack cocaine, especially during the height of the cocaine epidemic in the United States. Herein, the findings are summarized from prospective studies comparing cocaine-exposed with non-cocaine-exposed infants and toddlers with respect to anthropometric growth, infant neurobehavior, visual and auditory function, and cognitive, motor, and language development. The potentially stigmatizing label of the so-called "crack baby" preceded the evidence now accumulating from well-designed prospective investigations that have revealed less severe sequelae in the majority of prenatally exposed infants than originally anticipated. In contrast to opioids, which may produce neonatal abstinence syndrome and infant neurobehavioral deficits, prenatal cocaine exposure appears to be associated with what has been described as statistically significant but subtle decrements in neurobehavioral, cognitive, and language function, especially when viewed in the context of other exposures and the caregiving environment which may mediate or moderate the effects. Whether these early findings may herald more significant learning and behavioral problems during school-age and adolescence when the child is inevitably confronted with increasing social and academic challenges is the subject of ongoing longitudinal research.

Estimated Risk of Developing Selected DSM-IV Disorders Among 5-Year-Old Children with Prenatal Cocaine Exposure.

This study estimated childhood risk of developing selected DSM-IV Disorders, including Attention-Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), and Separation Anxiety Disorder (SAD), in children with prenatal cocaine exposure (PCE). Children were enrolled prospectively at birth (n=476) with prenatal drug exposures documented by maternal interview, urine and meconium assays. Study participants included 400 African-American children from the birth cohort, 208 cocaine-exposed (CE) and 192 non-cocaine-exposed (NCE) who attended a 5-year follow-up assessment and whose caregiver completed the Computerized Diagnostic Interview Schedule for Children. Under a generalized linear model (logistic link), Fisher's exact methods were used to estimate the CE-associated relative risk (RR) of these disorders. Results indicated a modest but statistically robust elevation of ADHD risk associated with increasing levels of PCE (p<0.05). Binary comparison of CE versus NCE children indicated no CE-associated RR. Estimated cumulative incidence proportions among CE children were 2.9% for ADHD (vs 3.1% NCE); 1.4% for SAD (vs 1.6% NCE); and 4.3% for ODD (vs 6.8% NCE). Findings offer suggestive evidence of increased risk of ADHD (but not ODD or SAD) in relation to an increasing gradient of PCE during gestation.

Impact of prenatal cocaine exposure on attention and response inhibition as assessed by continuous performance tests.

OBJECTIVE: This study examined the influence of prenatal cocaine exposure on attention and response inhibition measured by continuous performance tests (CPTs) at ages 5 and 7 years. METHODS: The baseline sample consisted of 253 cocaine-exposed and 223 non-cocaine-exposed children enrolled prospectively at birth and assessed comprehensively through age 7 years in the longitudinal Miami Prenatal Cocaine Study. This report includes a subsample of 415 children (219 cocaine-exposed, 196 non-cocaine-exposed) who completed at least one CPT assessment at ages 5 and/or 7 years. Prenatal cocaine exposure was measured by maternal self-report and maternal and infant bioassays. Deficits in attention and response inhibition are estimated in relation to prenatal cocaine exposure using generalized estimating equations within the general linear model. RESULTS: Results indicate cocaine-associated increases in omission errors at ages 5 and 7 as well as increases in response times for target tasks (i.e., slower reaction times) and decreased consistency in performance at age 7. There were no demonstrable cocaine-associated deficits in commission errors. Estimates did not change markedly with statistical adjustment for selected prenatal and postnatal covariates. CONCLUSION: Evidence supports cocaine-associated deficits in attention processing through age 7 years.

Profiles of current disruptive behavior: association with recent drug consumption among adolescents.

Instead of using scale thresholds and standard diagnostic criteria, latent class analysis was used to elucidate distinct subgroups of adolescents based on symptom profiles of the 24 Youth Self-Report items assessing attention-deficit hyperactivity, oppositional and conduct problem behaviors. We then investigated the extent to which being classified into different classes of disruptive behavior was associated with drug consumption in the month prior to the survey assessment. Three latent classes of disruptive behavior emerged along a continuum of severity. Youth classified into a class representing multiple and more serious behavior problems were found to have the highest rates of drug use, particularly involving inhalants and marijuana. Contrary to our hypotheses, younger adolescent females in this class reported a higher rate of past month drug use than similarly aged males. Drug use also was found to be common among youth in a class with a greater proportion of subclinical levels of behavior problems. Adolescents evidencing multiple behavior problems, particularly emerging conduct problems, need to be thoroughly assessed for recent drug involvement.

Learning disabilities and intellectual functioning in school-aged children with prenatal cocaine exposure.

Risk for developing a learning disability (LD) or impaired intellectual functioning by age 7 was assessed in full-term children with prenatal cocaine exposure drawn from a cohort of 476 children born full term and enrolled prospectively at birth. Intellectual functioning was assessed using the Wechsler Intelligence Scale for Children-Third Edition (Wechsler, 1991) short form, and academic functioning was assessed using the Wechsler Individual Achievement Test (WIAT; Wechsler, 1993) Screener by examiners blind to exposure status. LDs were categorized based on ability-achievement discrepancy scores, using the regression-based predicted achievement method described in the WIAT manual. The sample in this report included 409 children (212 cocaine-exposed, 197 non-cocaine-exposed) from the birth cohort with available data. Cumulative incidence proportions and relative risk values were estimated using STATA software (Statacorp, 2003). No differences were found in the estimate of relative risk for impaired intellectual functioning (IQ below 70) between children with and without prenatal cocaine exposure (estimated relative risk = .95; 95% confidence interval [CI] = 0.65, 1.39; p = .79). The cocaine-exposed children had 2.8 times greater risk of developing a LD by age 7 than non-cocaine-exposed children (95% CI = 1.05, 7.67; p = .038; IQ >/= 70 cutoff). Results remained stable with adjustment for multiple child and caregiver covariates, suggesting that children with prenatal cocaine exposure are at increased risk for developing a learning disability by age 7 when compared to their non-cocaine-exposed peers.

Prenatal cocaine exposure: an examination of childhood externalizing and internalizing behavior problems at age 7 years.

AIM: This study examines the relationship between prenatal cocaine exposure and parent-reported child behavior problems at age 7 years. METHODS: Data are from 407 African-American children (210 cocaine-exposed, 197 non-cocaine-exposed) enrolled prospectively at birth in a longitudinal study on the neurodevelopmental consequences of in utero exposure to cocaine. Prenatal cocaine exposure was assessed at delivery through maternal self-report and bioassays (maternal and infant urine and infant meconium). The Achenbach Child Behavior Checklist (CBCL), a measure of childhood externalizing and internalizing behavior problems, was completed by the child's current primary caregiver during an assessment visit scheduled when the child was seven years old. RESULTS: Structural equation and GLM/GEE models disclosed no association linking prenatal cocaine exposure status or level of cocaine exposure to child behavior (CBCL Externalizing and Internalizing scores or the eight CBCL subscale scores). CONCLUSIONS: This evidence, based on standardized ratings by the current primary caregiver, fails to support hypothesized cocaine-associated behavioral problems in school-aged children with in utero cocaine exposure. A next step in this line of research is to secure standardized ratings from other informants (e.g., teachers, youth self-report).

Maternal cocaine use: estimated effects on mother-child play interactions in the preschool period.

The study objective was to evaluate the quality of parent-child interactions in preschool-aged children exposed prenatally to cocaine. African-American mothers and their full-term newborns (n = 343) were enrolled prospectively at birth and classified as either prenatally cocaine-exposed (n = 157) or non-cocaine-exposed (n = 186) on the basis of maternal self-report and bioassays. Follow-up evaluations at 3 years of age (mean age, 40 mo) included a videotaped dyadic play session and maternal interviews to assess ongoing drug use and maternal psychological distress. Play interactions were coded using a modified version of Egeland et al's Teaching Task coding scheme. Regression analyses indicated cocaine-associated deficits in mother-child interaction, even with statistical adjustment for multiple suspected influences on interaction dynamics. Mother-child interactions were most impaired in cocaine-exposed dyads when the mother continued to report cocaine use at the 3-year follow-up. Multivariate profile analysis of the Egeland interaction subscales indicated greater maternal intrusiveness and hostility, poorer quality of instruction, lower maternal confidence, and diminished child persistence in the cocaine-exposed dyads.

Behavioral outcome of preschoolers exposed prenatally to cocaine: role of maternal behavioral health.

OBJECTIVE: To examine the impact of prenatal cocaine exposure and maternal behavioral health (recent drug use and psychological functioning) on child behavior at age 5 years. METHOD: In this longitudinal investigation, maternal report of child behavior was assessed using the Achenbach Child Behavior Checklist (CBCL) in 140 cocaine-exposed and 181 noncocaine-exposed (61 alcohol, tobacco, and/or marijuana-exposed, and 120 nondrug-exposed) low-income, African American children. Structural equation modeling was used to estimate suspected causal relationships between indicators of maternal behavioral health at 5-year follow-up, according to self-report on a modified Addiction Severity Index (ASI) and CBCL scores. RESULTS: Prenatal cocaine exposure was not related to child behavior at age 5. Recent maternal drug use and psychological functioning had relationships with CBCL Internalizing and Externalizing scores. However, when considered within a combined model, only maternal psychological functioning remained significant. CONCLUSIONS: Findings highlight the importance of maternal functioning in the behavioral outcome of children exposed prenatally to cocaine.