Serotype-specific differences in short- and longer-term mortality following invasive pneumococcal disease.

Invasive pneumococcal disease (IPD), caused by infection with Streptococcus pneumoniae, has a substantial global burden. There are over 90 known serotypes of S. pneumoniae with a considerable body of evidence supporting serotype-specific mortality rates immediately following IPD. This is the first study to consider the association between serotype and longer-term mortality following IPD. Using enhanced surveillance data from the North East of England we assessed both the short-term (30-day) and longer-term (⩽7 years) independent adjusted associations between individual serotypes and mortality following IPD diagnosis using logistic regression and extended Cox proportional hazards models. Of the 1316 cases included in the analysis, 243 [18·5%, 95% confidence interval (CI) 16·4-20·7] died within 30 days of diagnosis. Four serotypes (3, 6A, 9N, 19 F) were significantly associated with overall increased 30-day mortality. Effects were observable only for older adults (⩾60 years). After extension of the window to 12 months and 36 months, one serotype was associated with significantly increased mortality at 12 months (19 F), but no individual serotypes were associated with increased mortality at 36 months. Two serotypes had statistically significant hazard ratios (HR) for longer-term mortality: serotype 1 for reduced mortality (HR 0·51, 95% CI 0·30-0·86) and serotype 9N for increased mortality (HR 2·30, 95% CI 1·29-4·37). The association with serotype 9N was no longer observed after limiting survival analysis to an observation period starting 30 days after diagnosis. This study supports the evidence for associations between serotype and short-term (30-day) mortality following IPD and provides the first evidence for the existence of statistically significant associations between individual serotypes and longer-term variation in mortality following IPD.

Congenital cerebral and cerebrovascular anomalies: magnetic resonance imaging.

Magnetic resonance is the imaging modality of choice for the evaluation of infants and children with known or suspected cerebral and cerebrovascular abnormalities. Entities described include cephaloceles, holoprosencephaly, dysgenesis of corpus callosum, and anomalies of neuronal migration. Congenital vascular lesions described include aneurysm, arteriovenous malformation, cavernous malformation, and Galenic malformations.

The role of maternal hostility and family environment upon cardiovascular functioning among youth two years later: socioeconomic and ethnic differences.

Two hundred sixty-eight African-American and white children and their biological mothers participated in the study. The purpose of the study was to examine the potential collective impact of maternal hostile coping styles and perceptions of family functioning upon youths' cardiovascular (CV) functioning 2.4 years later, within the context of SES and ethnicity. The mother completed a set of questionnaires that included the Cook-Medley Hostility Scale and three scales from the Family Environment Scale (FES). Childrens' systolic and diastolic blood pressure (SBP and DBP) and impedance cardiography derived total peripheral resistance (TPR) was measured at rest two years later. Mothers with lower SES and African-American mothers reported higher levels of hostility compared to those with higher SES and white mothers, respectively. Lower SES mothers reported lower levels of family cohesion and expressiveness than higher SES mothers. Whites reported more family conflict and expressiveness than African Americans. African-American and lower SES youth exhibited higher SBP and DBP values than whites and higher SES youth. Among lower SES African-American youth, CV functioning tended to be impacted negatively when their mothers rated themselves high in hostility. Findings suggest that ethnicity and SES may have independent as well as interactive impacts on the influence of maternal coping styles on the CV functioning of their children, particularly those from lower SES backgrounds.

Relationship of John Henryism to cardiovascular functioning at rest and during stress in youth.

John Henryism, a coping style characterized by a strong predisposition to confront daily psychosocial stressors in an active and effortful manner, has been associated with cardiovascular (CV) disease risk in adults. This study examined the relationship of John Henryism to CV functioning at rest and during laboratory stressors (i.e. forehead cold stimulation, postural change, and treadmill exercise) in 173 normotensive 10-to 17-year-old African-American and White children. High John Henry scores were associated with higher blood pressure, higher total peripheral resistance, and lower cardiac index at rest. These relationships were qualified by an interaction with socioeconomic status (SES) such that those from lower SES backgrounds who were high on John Henryism had particularly high levels of resting CV measures. No significant associations were observed with CV reactivity to the stressors. Findings are discussed in terms of possible impact of coping styles to environmental stress upon physiological functioning and health.

Relationship between family environment and children's hemodynamic responses to stress: a longitudinal evaluation.

Because interpersonal relationships may have an impact on the risk of developing cardiovascular disease, the authors examined the prospective relationship of family functioning upon hemodynamic stress responses in 87 6- to 8-year-old children. The parents completed the cohesion, conflict, expressiveness, and control subscales of the Family Environment Scale; 2 years later, the authors assessed the children's hemodynamic responses to postural change, forehead cold stimulation, and treadmill exercise. Maternal reports of greater cohesion and expressiveness were related to less increases in systolic pressure and systemic vascular resistance in response to the forehead cold. Mothers' reports of expressiveness were related to lower systolic pressure and cardiac index reactivity to postural change. Fathers' reports of greater control were associated with greater diastolic pressure and vascular resistance increases to forehead cold and to greater vascular resistance responses to exercise. Paternal reports of greater conflict were associated with greater systemic vascular resistance increases and with lower cardiac index increases to exercise. Results suggest family functioning may predict later hemodynamic reactivity to stress. The findings are discussed in terms of previous research on parent-child interaction patterns and children's cardiovascular health.

Cochlear effects of locally applied inhibitors.

The round window has been used as a route for introducing ototoxic substances into the inner ear in order to bypass barriers between the systemic circulation and the inner ear. We have used this method to administer locally sodium potassium-ATPase inhibitors and chloride transport inhibitors to the inner ear of the chinchilla. Drugs dissolved in saline solution were applied on the round window membrane. Endocochlear potential (EP) was recorded from the basal turn using the round window approach. The EP was not altered following application of saline solution as a control. Following application of ouabain (1 mM), the EP steadily declined. After vanadate (27 mM), the EP initially increased, and subsequently declined. Sanguiarine did not alter the EP. The loop diuretics furosemide and piretanide caused a marked decline in the EP after local application. However, the stilbene derivative DIDS did not alter the EP after topical application. These findings raise questions about whether the loop diuretics have any effect on chloride transport in the cochlea and make appear unlikely that active chloride transport contributes to the normal EP.