Theory of Mind Development is Impaired in 4-year-old Children with Prenatal Exposure to Maternal Tobacco Smoking.

AIMS: Theory of Mind (ToM) is an important component of social cognition. Deficits in ToM are found in various neurodevelopmental disorders and social and environmental factors have been found to influence ToM development. Little previous research has focused on effects of exposure to toxins; this report examines the impact of tobacco. PLACE OF STUDY: Department of Psychiatry, University of Colorado School of Medicine, between April 2006 - August 2012. METHODOLOGY: 101 children, 18 with prenatal exposure to tobacco, underwent ToM testing at 40 (n=89) and 48 (n=77) months of age. Test questions received dichotomous pass/fail scores and percentage of correct responses was utilized as the primary dependent variable. RESULTS: At 40 months of age children were rarely able to correctly answer false belief questions and there were no significant differences according to prenatal tobacco exposure. At 48 months of age, there was a significant effect of prenatal tobacco exposure with non-exposed 48-month-olds correctly answering 45±40.6% of content false belief questions correctly, compared to 13.9±25.3% for 48-month-olds with prenatal tobacco exposure (F=4.79, df= 1,73, p=.032). CONCLUSION: ToM abilities are rapidly developing between 40 and 48 months of age. Prenatal exposure to tobacco is associated with impairment at 48 but not 40 months of age. This finding supports consideration of nicotinic mechanisms as contributors to early development of social cognition.

Screening for mental illness in a trauma center: rooting out a risk factor for unintentional injury.

BACKGROUND: Injury prevention and screening efforts have long targeted risk factors for injury recurrence. In a retrospective study, our group found that mental illness is an independent risk factor for unintentional injury and reinjury. The purpose of this study was to administer a standard validated screening instrument and psychosocial needs assessment to admitted patients who suffer unintentional injury. We aimed to prospectively measure the prevalence of mental illness. We hypothesize that systematic screening for psychiatric disorders in trauma patients is feasible and identifies people with preexisting mental illness as a high-risk group for unintentional injury. METHODS: In this prospective study, we recruited patients admitted to our Level I trauma center for unintentional injury for a period of 18 months. A bedside structured interview, including the Mini International Neuropsychiatric Interview, and a needs assessment were performed by lay research personnel trained by faculty from the Department of Psychiatry. The validated needs assessment questions were from the Camberwell Assessment of Need Short Appraisal Schedule instrument. Psychiatric screening and needs assessment results, as well as demographic characteristics are reported as descriptive statistics. RESULTS: A total of 1,829 people were screened during the study period. Of the 854 eligible people, 348 were able to be approached by researchers before discharge with a positive response rate of 63% (N = 219 enrolled). Interviews took 35 minutes ± 12 minutes. Chi-squared analysis revealed no difference in mechanism in those with mental illness versus no mental illness. Men were significantly more likely to be found to have a mental health disorder but when substance abuse was excluded, no difference was found. Four-way diagnostic grouping revealed the prevalence of mental illness detected. CONCLUSIONS: This inpatient pilot screening program prospectively identified preexisting mental illness as a risk factor for unintentional injury. Implementation of validated psychosocial and mental health screening instruments is feasible and efficient in the acute trauma setting. Administration of a validated mental health screening instrument can be achieved by training college-level research assistants. This system of screening can lead to identification and treatment of mental illness as a strategy for unintentional injury prevention.

Trauma, transfusions, and use of recombinant factor VIIa: A multicenter case registry report of 380 patients from the Western Trauma Association.

BACKGROUND: This study describes the current use of recombinant activated factor VII (rFVIIa) for hemorrhage after trauma in the United States. We hypothesized that we could describe the setting in which rFVIIa would be most successful in arresting hemorrhage after injury. STUDY DESIGN: This case registry study of patients with traumatic injuries at risk for death from hemorrhage at Level I and II trauma centers in the United States analyzed the administration of rFVIIa from admission to death from hemorrhage. Secondary outcomes measures of interest were the use of blood products, days in the ICU, organ failure, and thrombotic complications. RESULTS: Three hundred and eighty injured patients who received rFVIIa as an adjunct for hemorrhage control were included in this analysis. The mean time from admission to administration of rFVIIa was 4.6 hours, with an average transfusion of 18 U blood before administration (range 0 to 99 U). Death from hemorrhage rate was 30%. Predictors of a poor response to rFVIIa were a pH <7.2 (p < 0.0001), a platelet count <100,000 (p = 0.046), and blood pressure ≤90 mmHg (p < 0.0001) at the time of administration. CONCLUSIONS: Based on this case registry review, the precise role of rFVIIa in traumatic hemorrhage is unclear. Surgeons choosing to use this drug as an adjunctive measure to reverse coagulopathy are advised to first correct shock, acidosis, and thrombocytopenia.