Periodic limb movement in sleep in children with Williams syndrome.

OBJECTIVE: Williams syndrome (WS) is associated with neurobehavioral abnormalities that include irritability and attention-deficit/hyperactivity disorder. Parents often report children having difficulties initiating and maintaining sleep because of restlessness and arousals. Therefore we evaluated a group of children with WS for the presence of a movement arousal sleep disorder. METHODS: Twenty-eight families of children with WS participated in a telephone survey aimed to screen for a movement arousal disorder. Of the 16 children identified as having such a disorder, 7 (mean age, 3.9 +/- 2.2 years) underwent polysomnography. Their studies were compared with those of 10 matched control subjects (mean age, 5.3 +/- 2.0 years). RESULTS: The 7 subjects with WS who were screened by the survey had sleep latency, total sleep time, arousals, and awakenings that were similar to those of control subjects. However, they presented with a disorder of periodic limb movement in sleep (PLMS). The PLMS index in the subjects with WS was 14.9 +/- 6.2 versus 2.8 +/- 1.9 in control subjects (P < .0001). In addition, arousal and awakening in subjects with WS were strongly associated with PLMS. Moreover, children with WS spend more time awake during sleep periods than control subjects (10.0% +/- 7.0% vs 4.4% +/- 4.7%; P < .05). Five children were treated with clonazepam, and in 4 a significant clinical response was noted. CONCLUSION: We report an association between WS and PLMS. Clonazepam may reduce the clinical symptoms of PLMS in some of these children.

A cross-national study of self-evaluations and attributions in parenting: Argentina, Belgium, France, Israel, Italy, Japan, and the United States.

This study investigated and compared ideas about parenting in Argentine, Belgian, French, Israeli, Italian, Japanese, and U.S. mothers of 20-month-olds. Mothers evaluated their competence, satisfaction, investment, and role balance in parenting and rated attributions of successes and failures in 7 parenting tasks to their own ability, effort, or mood, to difficulty of the task, or to child behavior. Few cross-cultural similarities emerged; rather, systematic culture effects for both self-evaluations and attributions were common, such as varying degrees of competence and satisfaction in parenting, and these effects are interpreted in terms of specific cultural proclivities and emphases. Child gender was not an influential factor. Parents' self-evaluations and attributions help to explain how and why parents parent and provide further insight into the broader cultural contexts of children's development.

Sociological and serological profiles of some men with recurrent sexually transmitted infection in Western Jamaica - abstract

In early 1991, a sociological and serological study of a sample of 98 specially selected men was done at the Cornwall Regional Hospital (CRH) in Montego Bay. These men were all returning to the Sexually Transmitted Disease (STD) clinic for treatment of at least their second episode of infection. Low repeaters and high repeaters were compared. There was a tendency for men who were living either with a parent or with their steady female partner to have fewer repeat infections than men who lived alone or with other relatives or friends. The average number of sexual partners reported was relatively small. No one admitted to having homosexual contacts. Twenty-five men had never used condoms and most of the others used them sporadically. The prevalence of antibodies to syphilis was 25.5 percent, hepatitis B core antibodies 21.1 percent, hepatitis B surface antigen 3.3 percent and HIV antibodies 10 percent. HIV seropositivity correlated significantly with evidence of exposure to syphilis an with prostitute contact. Sixty-four per cent of the men used alcohol, 50 percent used ganja and 4 percent used ganja with crack or cocaine shortly before or during their last sexual contact. Everyone knew about HIV and AIDS, and 87 percent felt at some risk for catching HIV. This study shows a relatively high prevalence of syphilis and HIV infection in STD Clinic attenders in the Montego Bay area, and underlines the reality that knowledge about diseases and perception of risk do not always guarantee safe sexual behaviour. Men who get repeated episodes of STDs are important core transmitters of these diseases and should be targeted for special education. (AU)

The attitudes, experiences and needs of private practioners in the Kingston Metropolitan area in relation to HIV-infected patients - abstract

A questionnaire survey of 83 private practioners in the Kingston Metropolitan area (representing 20 percent of practioners in the area) showed that, in the past 5 years, 51(61 percent) had established 185 doctor-patient relationships with suspected and confirmed HIV/AIDS patients. Only 77 percent of the 108 confirmed cases were reported to the Ministry of Health, suggesting a need to better integrate the private practitioners into the notification system. There was a disparity between the number of practitioners who were willing to do HIV testing (50; 60 percent) and those willing to do the necessary counselling (30; 36 percent). Deep reservations were felt, such that only 24 percent were willing to maintain a therapeutic relationship with an HIV-infected patient. Three of the 4 reservations expressed could be partially alleviated by an educational programme aimed at the private practitioners and their support staff; 75 percent of the practitioners were desirous of a consistent referral system for further care. The establishment of an HIV/AIDS research/treatment centre may answer this need through a supporting role to co-ordinate an islandwide programme for the medical, social and legal management of HIV-infected patients. (AU)

Isolation of enterovirus and reovirus from sewage and treated effluents in selected Puerto Rican communities.

Sewage treatment plant effluents were surveyed for viral contributions to gastroenteritis outbreaks in Puerto Rico. Of the 15 sewage treatment plants studied, all discharged their effluents upstream from water treatment plant intakes. No base-line data on the degree of viral challenge to these sewage treatment plants or the subsequent reduction of viruses before discharge existed. Enterovirus counts were generally much higher than those found in the continental United States. At four plants, viruses in the incoming sewage exceeded 100,000 PFU/liter, and one of these, a trickling filter plant, was discharging 24,000 PFU/liter to receiving waters. Virus identification showed that more than 80% of the enterovirus isolates were coxsackievirus B5. These overwhelming viral numbers pointed to defects in the sewage treatment processes. Without reasonable barriers to protect receiving waters, several of the downstream communities were using raw waters that posed extraordinary demands on the ability of their water treatment plants to supply virologically safe drinking water.