Witnessing violence among inner-city children of substance-abusing and non-substance-abusing women.

OBJECTIVES: To determine if children of substance-abusing mothers witness more violence than children of non-substance-abusing (control) mothers, and to determine if children who witness violence have more behavioral problems and higher stress scores than children who do not witness violence. DESIGN: Cross-sectional research design comparing exposure to violence among children of substance-abusing mothers and control mothers of low socioeconomic status. SETTING: An inner-city pediatric clinic. PARTICIPANTS: Forty substance-abusing mothers and their children, and 40 non-substance-abusing mothers and their children, examined when the children were 6 years old. MAIN OUTCOME MEASURES: Maternal report of children's exposure to violence was assessed using the Exposure to Violence Interview and the Conflict Tactics Scale. Maternal report of children's behavior was assessed using the Child Behavior Checklist and the Children's Response to Stress Inventory. RESULTS: Children of substance-abusing mothers did not witness more violence than the control children (P>.05). However, 6-year-old inner-city children in the present study witnessed a high rate of violence: 43% had seen someone beaten up, 13% had seen someone threatened with a knife, and 7% had seen someone stabbed or shot. Children witnessing violence had significantly higher aggressive, delinquent, anxious/depressed, withdrawn, attention, and social problems (P<.05) on the Child Behavior Checklist, and higher stress scores (P =.05) on the Children's Response to Stress Inventory. CONCLUSIONS: More than half of the 6-year-old inner-city children in the present study witnessed some form of violence. Witnessing violence was associated with more behavioral problems and higher stress scores as assessed through maternal report. Subsequent research should examine the long-term effects of this exposure to violence among young children.

Mother-infant interaction: effects of a home intervention and ongoing maternal drug use.

Examined the effects of a home-based intervention on mother-infant interaction among drug-using women and their infants. At 2 weeks postpartum, mothers and infants were randomly assigned to either an intervention (n = 84) or a control (n = 87) group. Control families received brief monthly tracking visits, and intervention families received weekly visits by trained lay visitors. Mother-infant interaction was evaluated at 6 months through observation of feeding. Although there were no direct effects of the intervention, in the control group, mothers who continued to use drugs were less responsive to their babies than mothers who were drug free. In the intervention group, drug use was not associated with maternal responsiveness. Weekly home-based intervention may be a protective strategy for children of drug-using women because it disrupts the relation between ongoing maternal drug use and low maternal responsiveness.

Exposure to environmental risk factors and parenting attitudes among substance-abusing women.

This study examined the amount of exposure to negative environmental risks and their association with parenting attitudes among a group of inner city substance-abusing women. Mothers (N = 198) were recruited at delivery and were part of a randomized longitudinal intervention study for substance-abusing women and their infants. When the infants were 18 months old, a cumulative environmental risk score was calculated for each mother based on nine factors: violence (both domestic and environmental), depression, homelessness, incarceration, number of children, life stress, psychiatric problems, and absence of significant other. Based on their cumulative scores, mothers were placed in a low (N = 106) or high environmental risk group (N = 92). Mothers in the high-risk group had fewer years of education and were younger when their first child was born. Multivariate analyses indicate that mothers in the high-risk group had significantly worse scores on parenting attitude scales. Given the current state of welfare reform, it is important to determine which factors besides maternal substance abuse place these mothers at risk for poor parenting.

Brief report: frequency of maternal cocaine use during pregnancy and infant neurobehavioral outcome.

OBJECTIVE: To examine the effects of frequency of prenatal maternal cocaine use on infant neurobehavioral outcome beyond the immediate postpartum period, controlling for other substance use. METHODS: At 2 weeks postpartum, the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) was administered to infants (N = 55) and their mothers were asked about their prenatal drug use. Mother/infant dyads were placed in one of two groups based on the number of days of reported cocaine use during pregnancy: high frequency (n = 23, > 75th percentile reported days of use) or low frequency (n = 32, < 75th percentile). RESULTS: Infants in the high frequency cocaine group had worse BNBAS excitability scores than infants in the low frequency cocaine group, when other substance use was controlled statistically. CONCLUSIONS: High frequency of maternal cocaine use during pregnancy is associated with poorer infant neurobehavioral outcome beyond the early postpartum period, when other substance use is controlled.

The role of calcium channel blocking agents in the prevention of migraine.

Vascular headache pathophysiology and manifestations are reviewed along with the role that calcium channel blocking agents play in prevention of these vascular headaches. Of the calcium channel blockers presently marketed in the U.S., verapamil has been the most widely studied. Verapamil has been shown to produce a significant improvement in frequency and duration of migraine as compared with placebo. Calcium channel blocking agents that have been studied and used outside of the U.S. are flunarizine and nimodipine, both of which provide significant improvement in measures of migraine severity, duration, frequency, and other pain and severity indices. There have been no controlled trials comparing these agents with each other as with beta-blocking agents and other prophylactic agents presently marketed in the U.S. Calcium channel blocking agents may become the drugs of first choice in migraine prophylaxis due to their effectiveness and mild side effect profile.

The analgesic and anti-inflammatory profile of ketorolac and its tromethamine salt.

Ketorolac tromethamine[(+/-)-5(benzoyl)-2,3-dihydro-1N-pyrrolizine-1-carboxylic acid tris hydroxymethylaminomethane salt] is a highly potent member of a new class of compounds having analgesic and anti-inflammatory activity. When given orally in tests involving underlying inflammation it was a potent analgesic, whereas it was inactive in tests for narcotic activity. It was also highly active orally in rat models of acute and chronic inflammation and pyresis. These properties are mediated primarily via the compound's potent prostaglandin cyclooxygenase inhibitory activity. The agent elicited mild CNS and cardiovascular activity only at doses far in excess of those required for analgesic and anti-inflammatory activity. A single 10 mg tablet given orally to human volunteers following surgery provided pain relief equivalent to that provided by 10 mg of morphine given intramuscularly. When given intramuscularly to rabbits (0.25 ml of a 0.31-5% solution) or man (3 ml of a 1-3% solution), no drug-related irritation or changes in creatine phosphokinase were seen. Solutions (less than or equal to 0.5%) applied to the eyes of animals and man were not irritating. When applied topically in rat and rabbit models of ocular inflammation, less than or equal to 0.5% solutions of ketorolac tromethamine inhibited the inflammatory response.

The analgesic and anti-inflammatory profile of (+/-)-5-benzoyl-1,2-dihydro-3H-pyrrolo[1,2a]pyrrole-1-carboxylic acid (RS-37619).

RS-37619 showed highly potent analgesic activity when given p.o. in tests utilizing underlying inflammation. It inhibited phenylquinone-induced writhing in the mouse and rat (350 and 180 x aspirin respectively) and the pain induced by flexing the adjuvant-inflamed rat paw (approximately 800 x aspirin). The agent increased the pain threshold of compressed yeast-inflamed rat paws (3-10 x naproxen). RS-37619 did not increase the pain threshold of the non-inflamed paw and was inactive in the mouse hot plate test; therefore it is probably not a centrally acting or morphine-like agent. RS-37619 was also highly active p.o. in rat models of acute and chronic inflammation. It inhibited carrageenan-induced paw edema (36 x phenylbutazone), cotton pellet-induced granuloma (less than or equal to 1 x indomethacin) and in an 18-day test, prevented the development of adjuvant-induced arthritis (approximately 2 x naproxen). RS-37619 exhibited antiphlogistic activity in adrenalectomized rats. It did not have corticosteroid activity. When given p.o., RS-37619 lowered yeast-induced pyrexia (20 x aspirin). Gastrointestinal irritation was seen in the rat with doses greater than or equal to 6.4 mg/kg/day p.o. The agent elicited mild CNS and cardiovascular activity only at doses far in excess of those required for analgesic and anti-inflammatory activity.

Inhibition of histamine-induced gastric secretion by flavone-6-carboxylic acids.

Twenty-five flavone-6-carboxylic acids were synthesized and tested as to their ability to inhibit histamine-induced gastric acid secretion in the rat. 3-Isopropoxy-4'-methoxyflavone-6-carboxylic acid (41) showed consistent oral activity while being devoid of any other noteworthy pharmacological effects. In vitro, this compound was found to be inactive as a histamine H2 antagonist, and its mode of action remains unknown.

A central nervous system depressant-antidepressant.

A new tricyclic agent with an allenyl side chain experimentally shows antidepressant activity similar to amitriptyline and imipramine but also exerts marked CNS depression. Such dual activity should be of clinical interest for treatment of mixed anxiety and depression.