Another way of thinking about ADHD: the predictive role of early attachment deprivation in adolescents' level of symptoms.

PURPOSE: Attention deficit and hyperactivity disorder (ADHD) is one of the most frequent disorders in childhood and adolescence. Both neurocognitive and environmental factors have been related to ADHD. The current study contributes to the documentation of the predictive relation between early attachment deprivation and ADHD. METHOD: Data were collected from 641 adopted adolescents (53.2% girls) aged 11-16 years in five countries, using the DSM oriented scale for ADHD of the Child Behavior Checklist (CBCL) (Achenbach and Rescorla, Manual for the ASEBA school-age forms and profiles. University of Vermont, Research Center for Children, Youth and Families, Burlington, 2001). The influence of attachment deprivation on ADHD symptoms was initially tested taking into consideration several key variables that have been reported as influencing ADHD at the adoptee level (age, gender, length of time in the adoptive family, parents' educational level and marital status), and at the level of the country of origin and country of adoption (poverty, quality of health services and values). The analyses were computed using the multilevel modeling technique. RESULTS: The results showed that an increase in the level of ADHD symptoms was predicted by the duration of exposure to early attachment deprivation, estimated from the age of adoption, after controlling for the influence of adoptee and country variables. The effect of the age of adoption was also demonstrated to be specific to the level of ADHD symptoms in comparison to both the externalizing and internalizing behavior scales of the CBCL. CONCLUSION: Deprivation of stable and sensitive care in infancy may have long-lasting consequences for children's development.

Kangaroo Mother Care, home environment and father involvement in the first year of life: a randomized controlled study.

AIMS: This study tested the hypothesis that Kangaroo Mother Care creates a climate in the family, which enhances infants' performance on the developmental quotient scale. SETTING: The largest social security hospital in Colombia with a neonatal intensive care unit. SUBJECTS: At 12 months of corrected age, 194 families in the Kangaroo Mother Care group and 144 families in the Traditional Care group were available for analysis. INTERVENTIONS: Infants were kept 24 h/day in an upright position, in skin-to-skin contact until it was no longer tolerated by the infants. Babies in the Traditional Care were kept in incubators on the Minimal Care Unit until they satisfied the usual discharge criteria. OUTCOME MEASURES: The Home Observation for Measurement of the Environment (HOME), Father Involvement and Developmental Quotient (Griffiths) scores. RESULTS: 1) Kangaroo mothers created a more stimulating context and a better caregiving environment than mothers in the Traditional Care group; 2) this environment was positively correlated to father involvement and 3) the family environment of male infants was most improved by Kangaroo Mother Care. CONCLUSION: Kangaroo Mother Care has a positive impact on home environment. The results also suggest, first, that both parents should be involved as direct caregivers in the Kangaroo Mother Care procedure and secondly, that this intervention should be directed more specifically at infants who are more at risk at birth. The Kangaroo Mother Care intervention could be an excellent means to ensure parents' mature involvement in the future of their children.

The pedicled vascularised scapular bone flap for proximal humerus reconstruction and short humeral stump lengthening.

The vascularised scapular bone free flap is popular in mandible reconstruction, but it is less commonly used as a pedicled flap to reconstruct the upper humerus. We analysed our experience with pedicled scapular crest flaps in humerus reconstruction and compared our results with cases reported in the literature. We considered the age at surgery, the time elapsed before reconstruction, the time required to obtain solid bony union, the operative indication, the osteosynthesis procedure used and whether circumflex scapular vessels or angular vessels were used. There were eight patients (seven men and one woman, mean age=33): four humerus stump lengthenings, two upper-third humerus bone and soft tissue defects and two multioperated established humerus non-unions. Flaps were pedicled either on circumflex scapular vessels (three) or angular vessels (five). The mean size of the scapular bone used was 9.4 cm (range 7-11 cm). We associated a covering flap for seven patients. All the flaps survived and bone healed in a 3.75 month mean delay (range three to six months), and there was one accidental secondary fracture one year after reconstruction. For a vascularised reconstruction of the upper humerus, the pedicled scapular bone flap is a valuable option especially if a composite reconstruction is needed. For short humerus stump lengthening, this flap seems to provide a very satisfactory solution.

Mediators of behavioral problems in 7-year-old children born after 24 to 28 weeks of gestation.

We tested the hypothesis that prematurity acts through its association with neuromotor and intellectual functioning to explain behavior problems at school age. Sixty-one extremely preterm (EP) very low birth weight (VLBW) children (< 29 wk and < 1,500 g) born in 1987-1990 and 44 normal birth weight children (NBW) (> 37 wk and > 2,500 g) were matched for age, sex, and socioeconomic status (SES). Mediator variables were evaluated at a hospital at 5 years and 9 months. Behaviors were evaluated at school at 7 years by peers, teachers, and parents. When compared with NBW children, EP/VLBW children had poorer IQ and neuromotor development. At school, EP/VLBW children were evaluated by peers as more sensitive/ isolated, and by teachers and parents as more inattentive and hyperactive than NBW. When mediators were introduced, the previously significant relation between prematurity and behavior problems disappeared. Hyperactive and inattentive behaviors were explained by a specific working memory factor for the latter, and by a general intellectual delay for the former, whereas sensitive/isolated behaviors were best explained by neuromotor delays. Inattentive behaviors were also related to family adversity. At school age, extreme prematurity had thus an indirect effect on behaviors via specific and nonspecific intellectual and neuromotor delays.

Human cystic echinococcosis in a Uruguayan community: a sonographic, serologic, and epidemiologic study.

A prevalence and transmission study of human cystic echinococcosis (CE), due to infection with the dog tapeworm Echinococcus granulosus, was undertaken in the village of La Paloma in central Uruguay. The human population was registered and screened for CE by abdominal ultrasound scan as well as a number of serologic tests. Dogs were screened for E. granulosus infection by arecoline purgation as well as specific coproantigen testing. The total prevalence of human CE (new cases and those with a previous history) was 5.6% (64 of 1,149); 3.6% (40) of the cases were new ultrasound detected asymptomatic cases (mean age = 45 years). Age prevalence increased from 1.1% in the 4-6-year-old group to > 11% in the > 60-year-old group; the 20-29-year-old group had a significantly higher CE rate of 7.4%, compared with younger and older age groups, and there was no difference between sexes. A CE rate of 3.9% (20 of 514) was also recorded by ultrasound for new cases in the population residing outside the village. Most of the hydatid cysts were located in the liver presenting as either univesicular cysts or a solid mass, and of those 71% and 63%, respectively, with such cyst presentations were seropositive against E. granulosus cyst fluid antigens. Two of eight individuals who were filter paper blood spot seropositive, but ultrasound scan negative, were subsequently diagnosed respectively with pulmonary hydatidosis after radiography, and hepatic hydatidosis after computed tomography scan. Of 36 households with a CE patient, 32 were single cases while four households each harbored two CE cases. This did not represent a clustered distribution within families (23 of 117). Almost 20% of the dogs from La Paloma were found infected with E. granulosus after purge examination, with a mean worm number of 67 (range = 1-1,020). An additional eight dogs that were purge negative were Echinococcus coproantigen positive. The study showed that human CE is highly endemic in Uruguay, with one of the highest local prevalence rates in the world. Transmission appears to occur readily within well-developed towns, as well as on rural sheep ranches. Mass screening by ultrasound scanning with confirmatory serologic testing is an effective approach to case detection at the community level.

Kangaroo mother care and the bonding hypothesis.

BACKGROUND: Based on the general bonding hypothesis, it is suggested that kangaroo mother care (KMC) creates a climate in the family whereby parents become prone to sensitive caregiving. The general hypothesis is that skin-to-skin contact in the KMC group will build up a positive perception in the mothers and a state of readiness to detect and respond to infant's cues. METHOD: The randomized controlled trial was conducted on a set of 488 infants weighing <2001 g, with 246 in the KMC group and 242 in the traditional care (TC) group. The design allows precise observation of the timing and duration of mother-infant contact, and takes into account the infant's health status at birth and the socioeconomic status of the parents. BONDING ASSESSMENT: Two series of outcomes are assessed as manifestations of a mother's attachment behavior. The first is the mother's feelings and perceptions of her premature birth experience, including her sense of competence, feelings of worry and stress, and perception of social support. The second outcome is derived from observations of the mother and child's responsivity to each other during breastfeeding at 41 weeks of gestational age. INTERVENTIONS: KMC has three components. The first is the kangaroo position. Once the premature infant has adapted to extrauterine life and is able to breastfeed, he is positioned on the mother's chest, in a upright position, with direct skin-to-skin contact. The second component is kangaroo nutrition. Although breastfeeding is the prime source of nutrition, infants also may receive preterm formula whenever necessary and vitamin supplements. The third component is the clinical control; infants are monitored on a regular basis, daily until they are gaining at least 20 g per day. Afterward, weekly clinic visits are scheduled until term, which constitutes the ambulatory minimal neonatal care. In the TC group, infants are kept in incubators until they are able to self-regulate their temperature and are thriving (ie, have an appropriate weight gain). Infants are discharged according to current hospital practice, usually not before their weight is approximately 1700 g. Afterward, as with the KMC group, weekly clinic visits are scheduled until term. RESULTS: We observed a change in the mothers' perception of her child, attributable to the skin-to-skin contact in the kangaroo-carrying position. This effect is related to a subjective "bonding effect" that may be understood readily by the empowering nature of the KMC intervention. Moreover, in stressful situations when the infant has to remain in the hospital longer, mothers practicing KMC feel more competent than do mothers in the TC group. This is what we call a resilience effect. In these stressful situations we also found a negative effect on the feelings of received support of mothers practicing KMC. We interpret this as an isolation effect. To thwart this deleterious effect, we would suggest adding social support as an integral component of KMC. The observations of the mothers' sensitive behavior did not show a definite bonding effect, but rather a resilience effect. This is attributable to the KMC intervention; mothers practicing KMC were more responsive to an at-risk infant whose development has been threatened by a longer hospital stay. Otherwise, we observed that the mothers (in both the KMC group and the TC group) had behavioral patterns that were adapted to the child's at-risk health status and to the precarious condition of some premature infants requiring intensive care. We conclude that the infant's health status may be a more prominent factor in explaining a mother's more sensitive behavior, which overshadows the kangaroo-carrying effect. CONCLUSION: These results suggest that KMC should be promoted actively and that mothers should be encouraged to use it as soon as possible during the intensive care period up to the 40 weeks of gestational age. Thus, KMC should be viewed as a means of humanizing the process of g

Contingency detection and the contingent organization of behavior in interactions: implications for socioemotional development in infancy.

In this report, the authors review studies addressing the issue of contingencies in social and nonsocial contexts during infancy. The review is divided into 4 groups of studies that suggest that (a) young infants detect contingencies unrelated to their behavior; (b) infants detect contingencies involving their behavior; (c) the study of contingency is pertinent for addressing behavioral organization within parent-infant interaction; and (d) there is a link between behavioral contingency in early infancy and global measures of socioemotional development that are predictive of social functioning at later points during childhood. Throughout the report, the pertinence of infant emotional responses during contingency-related tasks is emphasized. Finally, the authors delineate certain enduring questions regarding contingency experience in infancy and suggest ways of organizing research to address some of them.

[Stress and health at work for day care workers : the alleviating role of social support.]. / Stress et santé au travail chez les éducatrices en garderie : le rôle atténuateur du soutien social.

This study, which focuses on the child care work environment, asks four questions : Is the state of stress among child care workers greater than that observed in a normal population? Are there aspects of the work itself that are more associated with the worker's personal state of stress? What link can we establish between the state of stress and the state of health of this group? Finally, can supportive relationships lessen the negative impact of certain work environments? 165 female workers, of which 85% are teachers, took part in the study on a volunteer basis after their child care centre had been selected arbitrarily. Subjects answered five questionnaires to measure the state of their stress, mental health, physical health, the emotional support of their spouse and the importance given to stress-related factors in the workplace. Results show that the state of stress of these workers is, on the average, no higher than that found in a normal population. However, work situations involving child supervision, interpersonal relations among staff, as well as feelings of being overworked are considered the most stressful. These work situations, even the most stress-producing, are not associated to a worker's state of physical or mental stress. It's the stress state itself, in its role as an intermediate variable, that makes the connection between sources of stress and the person's state of health. Finally, emotional support is linked to the state of stress, but has no direct link to the state of physical or mental health. A spouse's support is nonetheless considered as regular and effective protection against increases in the state of stress. A number of methodological implications are also discussed.

Salivary IgA is a weak stress marker.

Several studies support the hypothesis that psychological stress may negatively affect immunocompetence. The present study sought to determine whether a relationship can be established between a measure of psychological state of stress and level of immunoglobulin of the A class (IgA) in saliva. To this end, 44 dentistry students were tested on four occasions; two occasions were stress inductive (examination situation), and two occasions were free of any academic stressor. At each session, the participants were asked to fill out the stress rating instrument, and unstimulated whole saliva samples were obtained. Salivary IgA was measured by a microplate Enzyme Linked Immunosorbent Assay (ELISA). A significant difference in the level of salivary IgA was observed only for the most polarized contrast, ie, between final exam and end of summer vacation (p less than .01). A weak negative correlation between the level of salivary IgA and the stress rating was observed (r = -0.25) only at the final exam. Our results suggest that assaying immunoglobulin A in saliva to measure stress may not be as useful in psychophysiological research as expected.

Electrocardiogram in progressive systemic sclerosis. Analysis of 73 cases.

Electrocardiographic abnormalities were found in 53 out of 73 patients (72,6%) affected with progressive systemic sclerosis or scleroderma. Along with some modifications of little value, like heart rate increase or decrease, sporadic premature beats, slight ST depression or T-wave flattening, other more important abnormalities were recorded. One patient had atrial fibrillation and one supraventricular tachycardia. In 21 cases (28.8%) conduction disorders were found, including A-V block, right bundle branch block, left anterior hemiblock and bifascicular block. Low QRS voltages were present in 15 cases (20,6%), confined in all but one to the peripheral leads. In 13 patients (17,8%) Q or QS aspects suggesting myocardial necrosis were observed, but a clinical history or clinical picture of myocardial infarction syndrome was lacking in all cases but one. Electrocardiographic patterns of myocardial necrosis in scleroderma may indicate not only myocardial infarction, which seems to be a rather rare occurrence in such disease, but also intraventricular conduction system defects or progressive replacement of myocardium by fibrous tissue.

Bullous dermatosis and myeloma. Monoclonal anticytoplasmic antibody activity.

A case of a recurrent bullous eruption in a patient who had myeloma is reported. This eruption was differentiated from pemphigus and bullous pemphigoid by the histological and immunological findings. In addition, antibodies against the cytoplasm of basal cell layer cells in the human epidermis were detected in the patient's serum and in diseased skin. The myelomatous monoclonal protein and the antibody fixed on the cell cytoplasm had an identifical isotypical marker.