Ethnicity in America and feeling "American".

Ethnic group acculturation remains a concern in the United States today. In the present study, the authors explored the extent to which members of three ethnic groups (White American women, African American women, and Cuban American women) perceived themselves to be "American," how much each group felt that its members were perceived as being American by White Americans, and how these perceptions related to beliefs about their own group's economic and social status. The results showed that African Americans felt American but felt that they were not perceived as such by White Americans. African Americans also reported feeling economically and socially excluded. In contrast, Cuban Americans reported neither feeling they were American nor believing they were perceived as such by White Americans, but feelings of inclusion increased with length of residence. Implications of these results for the common ingroup identity model are discussed.

Annual incidence of shaken impact syndrome in young children.

We looked at the incidence and demography of nonaccidental head injury in children in a prospective population-based study of paediatric units in Scotland during 1998-99. Shaken impact syndrome occurs with an annual incidence of 24.6 per 100000 children younger than 1 year (95% CI 14.9-38.5). Cases are more common in urban regions, and during autumn and winter months. The risk of a child suffering non-accidental head injury by age 1 year is one in 4065. These brain injuries occur almost exclusively in young infants (median age 2.2 months).

Early posttraumatic seizures in non-accidental head injury: relation to outcome.

To document the characteristics of early posttraumatic seizures (EPTS) in non-accidental head injury (NAHI), and examine their relation with outcome, a retrospective study was carried out. All children with NAHI admitted to the Royal Hospital for Sick Children, Edinburgh, since 1981 were identified. The characteristics of EPTS, EEG, and outcome were noted. Forty-four cases were identified. The average age of children at presentation was 5.9 months. Thirty-two of these children had EPTS. The median length of follow-up was 3 years. The mortality rate was six in 44 (14%). The neurodevelopmental outcome correlated significantly with the presence and severity of EPTS (Tau=0.317,p=0.017). Of survivors, 22% developed late posttraumatic epilepsy; the outcome in those with epilepsy was significantly worse than those without (p<0.0001). It was concluded that the severity of the primary brain injury dictates the severity of the EPTS and neurodevelopmental status at follow-up.

Magnetic resonance imaging in acute non-accidental head injury.

Making the diagnosis of non-accidental head injury, particularly in the acute illness, can be difficult. The aim of this retrospective study was to evaluate the use of magnetic resonance imaging in the acute presentation of non-accidental head injury. Twelve cases admitted to the Royal Hospital for Sick Children, Edinburgh with a diagnosis of non-accidental head injury, and who had magnetic resonance imaging in the acute illness, were identified. The average age was 5.7 mo (range 1 to 34 mo). The mechanism of the primary injury was whiplash-shaking injury syndrome with impact in four cases and without evidence of impact in seven; in one case there was a compression injury. The magnetic resonance imaging findings reflected the pathological consequences of rotational acceleration-deceleration injury and did not differ between those cases with evidence of impact and those without. Subdural haematomas were identified in all cases; the commonest location for subdural blood was the subtemporal region. It is surprising and important that the most frequent location of subdural blood was in the subtemporal area. This is an area difficult to assess by computerized tomography. Evidence of repeated injuries was found in two cases. These findings confirm the value of magnetic resonance imaging in the acute phase of non-accidental head injury.

The relation between intracranial pressure and outcome in non-accidental head injury.

The aim of this retrospective study was to ascertain whether physiological derangement and potential secondary brain insult from raised intracranial pressure (ICP) or reduced cerebral perfusion pressure (CPP) in non-accidental head injury (NAHI) influences outcome. Any child who had a diagnosis of NAHI and had ICP monitoring or measurements during the acute illness was entered in the study. Seventeen children with an average age 5.1 months (range 1 to 20 months) were identified. Details of the acute encephalopathy, lowest mean arterial blood pressure (MAP), mean of maximum ICP measured, lowest CPP, and neurodevelopmental outcome at follow up were obtained from the hospital case notes. Seshia's (1994) outcome classification scale was used. The lowest CPP was very significantly related to outcome (P=0.0047, tau=-0.544). Mean of maximum ICP did not correlate with outcome. The lowest MAP was significantly related to outcome (P=0.039). It was concluded that the degree of secondary brain insult from reduced CPP influences outcome.

A retrospective epidemiological analysis of non-accidental head injury in children in Scotland over a 15 year period.

A retrospective analysis of the epidemiological characteristics of non-accidental head injury (NAHI) in children in Scotland over the last fifteen years from 1981 until March 1996 was performed. The information was provided by the Information and Statistics Division of the Scottish Health Service. The average incidence of NAHI calculated over this period was 0.04 cases per year per 1000 children under 5 years. Fifty-five per cent of all cases occurred in those children who were less than a year old. 41% of cases were inflicted by a parent but in 47% the perpetrator could not be identified. The mortality rate was found to be 2%. Non-accidental head injury cases identified using the ICD-9 coding classification system gives a surprisingly low incidence. This number is probably an underestimate and the reasons for this are discussed. A prospective epidemiological analysis of NAHI in children in Scotland is being undertaken to determine the true incidence.

Dizygotic twins discordant for HIV and hepatitis C virus.

Twin girls were born at 37 weeks' gestation to a mother infected by HIV and hepatitis C virus. Twin 1 had symptomatic HIV infection by 9 months but was negative for hepatitis C virus antibody and RNA. Twin 2 became HIV antibody negative by 15 months but was positive for antihepatitis C virus and RNA.

Parental consanguinity in the blepharophimosis, heart defect, hypothyroidism, mental retardation syndrome (Young-Simpson syndrome).

In 1987 Young and Simpson reported a child with hypothyroidism, congenital heart disease, severe mental retardation, and striking facial dysmorphism. Two subsequent reports have described patients sharing some of the features of their case, although in both there were enough discordant features to make it uncertain that the same entity was being described. Here we present a female infant with virtually identical features to Young and Simpson's original case. Her Caucasian parents are first cousins, raising the possibility of autosomal recessive inheritance of this new syndrome.