Comparison of Institutionally Reared and Maltreated Children on Socioemotional and Biological Functioning.

The current study compared behavioral and adrenocortical functioning of maltreated (N = 91) and comparably aged (1.5-3 years) institutionally-reared children soon after (1.5-2.5 months) placement in foster care or adoptive homes, respectively. Foster and adoptive parents reported on the children's socioemotional competence and behavior problems, experimenters scored fear and positive affect to laboratory tasks, and diurnal cortisol measures were obtained. We sought to address whether these early contexts, characterized by different types of neglect and deprivation, have differential effects on young children's development. We found little support for the argument that either context results in uniformly poorer functioning soon after removal from adversity. Maltreated children were less fearful and more positive when exposed to both positive and novel events than institutionally-reared children. However, maltreated children were reported to have more behavior problems than did institutionally-reared children, and institutionally-reared children showed more typical declines in cortisol throughout the day than the maltreated children. These findings increase our ability to construct more targeted and effective interventions for these populations.

Neck dissection for squamous cell carcinoma of the head and neck.

OBJECTIVES: To investigate the successes and failures of 172 patients receiving neck dissections for squamous cell carcinoma (SCC) managed through a multidisciplinary head and neck clinic and to observe factors in predicting failure (death with head and neck cancer or local regional recurrence) or local regional recurrence alone. STUDY DESIGN: A retrospective, 14-year surgical audit. METHODS: The information from patient medical records was correlated with that of a database. Multivariate analysis was performed with the use of a logistic regression model. RESULTS: The most common site for head and neck SCC was the oral cavity (42%), with 17% of patients having tumors of unknown primary site. The disease-free survival probability was 76.7% at five years. Patients who were older at neck dissection, were nonsmokers, or who did not have radiotherapy to the primary site were more likely to die with head and neck cancer or to have local regional recurrence (P < 0.1). Patients with more radical neck dissections did not have better survival or recurrence outcomes. Lymphatic invasion appears to be the only important factor in predicting local regional recurrence alone (P = 0.1), of which 67% occurred within the first postoperative year. CONCLUSIONS: Patients with smoking-related SCC are likely to have a less aggressive disease. Adjuvant radiotherapy plays an important role in the treatment of patients with head and neck SCC. Follow-up, especially within the first postoperative year, is essential in managing head and neck SCC. Head and neck surgeons can confidently continue their practice away from more radical neck dissections.