Blood pressure at rest and during maximal dynamic and isometric exercise as predictors of systemic hypertension.

This study sought to verify evidence that transient high blood pressure (BP) at rest and during dynamic and isometric exercise is often predictive of later hypertension. In addition these 3 predictors were compared. One hundred office patients (all men) with BPs less than 140/90 mm Hg, ages 28 to 79 years, who had little or no heart disease and were not taking medication, had BPs taken at rest and during treadmill and handgrip dynamometer. Within 14 years, 16 subjects developed hypertension and 84 remained normotensive. Multivariate statistical comparisons for systolic and diastolic BPs and their interactions were used to discriminate between later hypertensive and normotensive subjects. The best single predictor was resting diastolic BP, classifying 88% of hypertensive and 69% of normotensive subjects correctly, followed closely by handgrip and treadmill diastolic BP and resting, treadmill and handgrip systolic BP. The best prediction was by the interaction between resting diastolic BP X handgrip diastolic BP; this classified 88% of hypertensive and 80% of normotensive subjects correctly. Of the few known precursors of hypertension, high BP at rest and during dynamic and isometric stress provides a means of alerting to careful follow-up and early treatment.

Birth injury as the cause of mental retardation.

Mental retardation, on initial impression, may appear to be caused by the birth process, but may be disproved by later clinical or autopsy examination. However, information often is lacking as to the basic pathology that may have been responsible for attributing the cause of the mental retardation to traumatic birth. From a 39-year period (1944 to 1983) 1146 records were evaluated at a state hospital for mentally retarded persons to determine how the intake impression compared with the final clinical and autopsy diagnoses of perinatal damage. Clinical evaluations provided some corrections of the intake diagnoses; autopsies provided more, but a combination provided the most reliable final diagnoses. Of 258 patients diagnosed as birth injury on intake, only 49.2% were confirmed by the best clinical and/or autopsy diagnoses. Although the cause of mental retardation was not ascertainable by either clinical or autopsy studies in 14.8% of cases, 31.4% were corrected to prenatal influences, and 4.6% to postnatal brain damage. Patients with perinatal cause of mental retardation usually were institutionalized at a young age and died young. If they do not require institutionalization until they are older, their life expectancy is longer, although still much less than that of normal persons.

Inability to cope with environmental stress: peptic ulcers in mentally retarded persons.

Mentally retarded persons in the protective environment of an institution developed more peptic ulcers than the general population. We sought to determine whether their physical and mental handicaps may have a relationship to this disease. Thirty seven mentally retarded institutionalized ulcer patients were compared to 37 non-ulcer controls matched for age and sex, who were also similar in IQ and mental retardation diagnoses. A stepwise discriminant analysis demonstrated that the ulcer group was more limited by chronic diseases and inability to ambulate. Also differentiating the groups were ulcer patients having more cerebral palsy, more visual deficit, and more limited motor and sphincter control than non-ulcer subjects. We conclude that helplessness in responding to environmental demands produces stress sufficient to induce peptic ulcers, even in severely mentally retarded persons.

Life expectancy of children in a persistent vegetative state.

The persistent vegetative state (PVS) is a state of wakeful unconsciousness occurring in adults and children. Despite preservation of vegetative functions, PVS patients have a shortened life-span, although accurate information concerning this issue remains limited. The survival of children in PVS was examined to determine whether age, etiology of the vegetative state, or type of residence in which the patient lived affected the estimated survival. The data of 155,851 developmentally disabled California state residents were reviewed using the Client Development Evaluation Report (CDER). Criteria from the CDER were selected to define the vegetative state and included: lack of interaction with peers; absence of auditory, visual, and expressive or receptive language function; no hand or arm use; inability to eat, sit, roll over, or lift head; and no bowel or bladder control. There were 847 patients who met these criteria on the initial and follow-up CDERs. A product limit survival model was used to develop survival curves and to calculate the median survival time for patients grouped by age, etiology, and type of residence. Median survival (yrs) for patients who remained in PVS for the following age groups was: < 1 yr: 2.6, 1 < 2 yrs: 4.2, 2-6 yrs: 5.2, 7-18 yrs: 7.0, > or = 19 yrs: 9.9. Median survival based on etiology varied from 3.0 to 8.6 years; no consistent relationship existed between etiology and duration of survival. Survival (yrs) for patients younger than age 18 years based on type of residence included: own home: 4.5, institutions: 5.2, skilled nursing facility/private hospital: 3.2, and other community care facilities: 3.7.(ABSTRACT TRUNCATED AT 250 WORDS)

Life expectancy of persons with Down syndrome.

The longevity of people with Down syndrome being served by the California Department of Developmental Services was examined in terms of a number of variables known to be related to early mortality. The findings indicated that the predictors of survival for people with Down syndrome were not different from the variables related to mortality among people with mental retardation in general. A lack of mobility or feeding skills were better predictors of an early death than were medical problems associated with congenital heart disease. Life expectancy estimates of clients with Down syndrome who lacked mobility or eating skills were found to be poor as compared to individuals who had Down syndrome but did not have these problems regardless of the presence of heart disease.

Mortality of people with mental retardation in California with and without Down syndrome, 1986-1991.

Mortality of people with mental retardation receiving services in California was examined. The large population (N = 118,653) enabled us to work directly with mortality rates at specific ages. Up to about age 35, mortality rates of people with Down syndrome were comparable to those of people with mental retardation due to other causes. Subsequently, the increase was much more rapid in the group with Down syndrome. Mortality rates of individuals with Down syndrome doubled every 6.4 years compared to 9.6 years for people without Down syndrome. Life tables were constructed; the remaining life expectancy of a 1-year-old child with Down syndrome with mild/moderate retardation was 55 years and with profound mental retardation, 43 years.

Who are the dually diagnosed?

The evaluation of mental health problems among persons with mental retardation is complicated by difficulties in diagnosis as well as by system variables that may also determine who will be assigned a dual diagnosis. In this study a state data base of 78,603 individuals with mental retardation receiving state services was examined. The relations of observed behavior problems, other characteristics of the individual, and residential placement patterns to the likelihood of being given a dual diagnosis were examined. Extrapunitive maladaptive behaviors, cognitive abilities, and social skills were associated with diagnoses of mental health problems among persons with mental retardation. The different perspectives from which these results could be interpreted were discussed.

Judgment error in category vs magnitude scales.

The effects of a variety of experimental conditions on the judgments (length of lines) of 16 normal and 16 mentally retarded observers were examined using category and magnitude scaling techniques. Using error and variability of judgment as criteria for measuring response bias, for normal subjects knowledge about the stimulus range, whether learned or provided, had as much to do with resulting judgments as the type of scale used. Judgment error of the retarded group was significantly greater than the normal group and appeared to be related to their limited ability to assign categories or proportions to the simuli used.

Effects of treatment programs on the acquisition of basic skills.

The relative effectiveness of alternative programs in producing changes in ambulation and toilet training among retarded individuals admitted to an institution was evaluated. Little change in ambulation over a 3-year-period was found unless special programming such as sensory-motor training was provided. The impact of such institutional programs was also evident for toilet training. However, about 40 percent of the retarded individuals placed in foster care also improved. In all instances, those individuals in standard care showed the least change. It was concluded that simple answers regarding the "best" placement or program are not available.

Probabilities of the development of ambulation for mobile children with moderate to profound mental retardation.

Development of ambulation was studied among 1,744 children, ages 3 through 10 years, with moderate to profound mental retardation. The sample was limited to children with some degree of mobility at initial testing. Evaluations over 6 years indicated that improvements in basic skills, although not probable, do occur far past the normative age for development of speech and ambulation and across all levels of mental retardation. The probability of improvement declined with age. Degree of mental retardation and severity of motor impairment had the expected negative effects on initial skill level and probability of improvement. Limiting the sample to subjects who were mobile minimized the effect of mortality.

Life-span development of institutionalized and community-based mentally retarded residents.

Life-span development of mentally retarded residents in institution and community settings was examined. Results showed that significant growth in adaptive behavior occurred for all groups of residents regardless of their level of retardation. Furthermore, the shapes of these growth curves were parallel across the different levels of retardation over the age range studies (5 to 50 years). Measures of the quality of the environment were available for institutionalized residents and were found to be unrelated to adaptive behavior growth; however, environmental quality was associated with initial levels of adaptive behavior, suggesting that for institutionalized residents, adaptive behavior competence may determine the type of environment provided.

Life-span development of institutionalized and community-based mentally retarded persons, revisited.

Life-span development of adaptive behavior of 30,749 mentally retarded individuals residing in California and being served by the California Department of Developmental Services was studied. The estimated life-span trends differed somewhat from those reported in an earlier investigation (Eyman & Arndt, 1982.) We used a larger sample and a more appropriate model and found different growth curves in adaptive behavior over levels of retardation, contrary to the Eyman and Arndt findings. Moreover, when cross-sectional vs. semi-longitudinal growth curves were compared, the degree of similarity of the two types of curves was a function of level of retardation. Evidence on the need for large sample life-span studies based on at least 6 to 8 years follow-up was presented.

Maladaptive behavior and community placement of mentally retarded persons.

The prevalence of maladaptive behavior was investigated for retarded individuals residing in institutions, community facilities, or their own home. In addition, the relationship between behavior problems and sex, age, level of retardation, and race was examined. The findings confirmed a much higher prevalence of behavior problems in the institutions as compared to community placements. The data also suggested that the profoundly retarded individuals, unless handicapped by not being able to move around, exhibit more injurious behavior than moderately and mildly retarded persons.

Patterns in mortality over 60 years among persons with mental retardation in a residential facility.

Records of 2,444 decreased institutionalized persons with mental retardation were examined for etiologies, disabilities, causes of death, and life expectancies over 60 years. Participants at most risk tended to have prenatal etiology of brain damage, to be young, and have the lowest IQs, epilepsy, poor mobility and feeding skills, and more medical complications. Most mortality was from respiratory infections. Epilepsy was present in 57.2% but was rare in people with Down syndrome. Sudden death occurred in 22.2% of these deceased residents. Over the years generally more residents had prenatal etiology of mental retardation, lower IQ, epilepsy, and were nonambulatory and older when they died.

Prognosis for survival and improvement in function in children with severe developmental disabilities.

OBJECTIVE: To derive prognostic data for survival and clinical improvement in children with severe developmental disabilities. STUDY DESIGN: A 13-year follow-up study of several cohorts of children initially evaluated before their first birthday. The outcomes studied were survival and improvement in condition. Methods were used to overcome limitations in previously published work on the same California data base. Of the 11,912 children who received services from the California Department of Developmental Services between January 1980 and December 1993, we focused on three cohorts defined according to mobility and need for tube feeding. RESULTS: Children who were tube fed and unable to lift their heads by ages 3 to 12 months were at high risk for early death, with a median remaining life expectancy of 3.2 years. Of those who survived an additional 2 years, the condition of about one third improved. A substantial majority of those who either showed improvement or died had done so by that age. CONCLUSION: By age 5 years, the prognoses for survival and improvement have to a large extent been clarified. For children who survive to age 5 years, even those in the lowest functioning cohort have a 60% chance of surviving an additional 5 years. Detailing the probabilities of various outcomes at various ages should be useful to parents, pediatricians, and others concerned with children with developmental disabilities.