IQ in childhood and the metabolic syndrome in middle age: Extended follow-up of the 1946 British Birth Cohort Study

IQ in early adulthood has been inversely associated with risk of the metabolic syndrome in midlife. We tested this association in the British 1946 birth cohort, which assessed IQ at age eight years and ascertained the metabolic syndrome at age 53 years based on modified (non-fasting blood) ATPIII criteria. Childhood IQ was inversely associated with risk of the metabolic syndrome, but this association was almost entirely mediated by educational attainment and achieved occupational social class. This may be consistent with a pattern where childhood IQ is strongly associated with outcomes that reflect neurological disorder, such as the degenerative dementias, but less so with common chronic physical diseases of ageing.     

Brief cognitive-behavioral internet therapy for irritable bowel syndrome

While cognitive-behavioral therapy for IBS is quite effective, the limited availability of competent therapists and lack of access to treatment remain problematic. This paper reports on a small, randomized, controlled trial of a five week internet based cognitive-behavioral intervention for IBS with limited therapist feedback via e-mail. Fifty-four IBS patients were recruited via the internet and randomly assigned to either immediate treatment or a wait-list control group. Thirty-one subjects completed the post-treatment assessment. 77% of treatment completers also completed a 3-month follow-up assessment. Treatment completers experienced statistically and clinically significant declines in IBS symptoms and improvements in quality of life. Those gains were substantially maintained at follow-up. Treatment efficacy was partially mediated by reductions in the tendency to catastrophize the social and occupational implications of symptoms, suggesting that catastrophizing may be an important target for treatment.     

Chronic glucocorticoid hypersecretion in Cushing’s syndrome exacerbates cognitive aging

Cumulative exposure to glucocorticoid hormones (GC) over the lifespan has been associated with cognitive impairment and may contribute to physical and cognitive degeneration in aging. The objective of the present study was to examine whether the pattern of cognitive deficits in patients with Cushing’s syndrome (CS), a disorder characterized by chronic exposure to elevated levels of glucocorticoids (GC), is similar to that observed in older individuals. Ten subjects with CS were compared to sex-, age-, and education-matched healthy controls and older subjects (age of CS subjects + 15 yr). All participants were administered tests to assess attention, visuospatial processing, learning and memory, reasoning, concept formation and verbal fluency. MANCOVAs with depression scores as covariate and polynomial contrasts revealed that the age-matched control group performed better than the CS and older subject groups in visual target detection, trail making test, stroop task, digit symbol substitution, block design, object assembly, visual reproduction, spatial memory and similarities. The CS and older subjects performed similarly on these tasks. Further, a principal component analysis revealed two significant factors, representing general cognitive function and verbal memory explaining 39.9% and 10.0% of the variance, respectively. Additional MANCOVAs with depression as a covariate revealed that CS and older control subjects showed impaired performance on general cognitive function compared to age-matched controls. These results suggest that hypersecretion of GCs has “aging-like” effects on cognitive performance in individuals with CS.     

Social Information Processing Skills in Children with Histories of Heavy Prenatal Alcohol Exposure

Based on caregiver report, children with prenatal alcohol exposure have difficulty with social functioning, but little is known about their social cognition. The current study assessed the social information processing patterns of school-age children with heavy prenatal alcohol exposure using a paradigm based on Crick and Dodge’s reformulated six-stage model. Fifty-two children (aged 7–11) with and without heavy prenatal alcohol exposure were tested using a structured interview measure of social information processing involving 18 videotaped vignettes of children in group entry and provocation situations. Alcohol-exposed children displayed maladaptive processing patterns on the goal, response generation, and response evaluation steps in group entry situations, and encoding, attribution, response evaluation, and enactment steps during provocation situations. Children with heavy prenatal alcohol exposure also had difficulty on the Test of Problem Solving, and performance correlated with social information processing measures. Such difficulties may lead to problems in social functioning and warrant early intervention.     

持续正压通气治疗睡眠呼吸暂停低通气综合征的接受意向调查

探讨影响持续气道内正压通气(CPAP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的接受性的非技术因素。设计OSAHS认知度和CPAP意向调查表、信赖他人量表,60例OSAHS患者经健康教育后,100例健康志愿者随机填表,结果做统计分析。两组中43.3%和5%基本了解OSAHS(P<0.01);10%和5%表示接受CPAP(P>0.05);85%和90%认为CPAP机价格高(P>0.05)。量表得分:两组得分分布近似,高分比例大,添加题90%和80%选择负性答案。目前公众对OSAHS认知差,对医生的信任度低,而CPAP机价格高,患者对CPAP接受性差。     

ALI/ARDS患者糖皮质激素的治疗效果和时机

急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)是临床各科经常遇到的急症,其发病机制主要是中性粒细胞向炎症部位的移动,释放出大量的炎性介质和细胞因子,引起肺泡毛细血管膜通透性增高,弥漫性肺损伤和蛋白性肺泡水肿液聚集等病理生理改变。临床表现为呼吸困难、呼吸窘迫、顽固的低氧血症,虽然使用机械通气和呼气末正压通气(PEEP)后,其病死率有所下降,但仍然维持在50%左右。就糖皮质激素的作用机制,对不同原因引起的ALI/ARDS治疗效果,使用时机作一综述,期望对ALI/ARDS治疗过程中糖皮质激素的使用予以规范。     

急性肺损伤与急性呼吸窘迫综合征的诊断与治疗策略

急性肺损伤（ALI）和急性呼吸窘迫综合征（ARDS）是多个危险因素直接或间接引起肺部损伤的连续病理过程,以表现低氧血症为特征,ARDS是ALI严重末期的表现。低流量、呼气末正压（PEEP）保护性通气的措施可明显改善氧和,减轻机械通气肺损伤,降低病死率,明显优于传统通气方式。     

证素辨证新体系的内容及科学意义

提取并规范50项辨证要素,构建起证素辨证新体系,是继承基础上的创新.证素的纲领性与组合的复杂性,是科学的认知论,符合中医辨证思维规律.     

Factors of parricide: Allowance of the use of battered child syndrome as a defense

Children who kill a parent may be mentally ill or dangerously antisocial, but most often they are severely abused. However, most abused children do not resort to killing a parent. Children who do commit murder do so out of desperation when family members and friends have failed to help them. This article discusses issues surrounding allowance of the defense of battered child syndrome as a justification for parricide. An argument will be made for the expansion of the self-defense claim to include battered child syndrome.     

Crib death: a biobehavioral phenomenon?

In developed countries, more children under 1 year of age die of crib death (sudden infant death syndrome, SIDS) than of all other causes combined. Researchers and clinicians have proposed many possible causes of SIDS, but the abrupt, unexpected death of some babies remains mysterious and frightening. Although infant behavior may explain some of these deaths, scant attention has addressed behavioral characteristics of babies who die without medical explanation. Any explanation of SIDS must account for the fact that most SIDS deaths occur at 2 to 5 months of age, acknowledging that a protective mechanism appears to spare babies before 2 months but then disappears. The respiratory occlusion reflex serves as an initial defense against smothering and can provide such an explanation. Infantile reflexes wane, after providing opportunities for learned responses to be acquired. During this well-documented neurobehavioral transition from subcortical to cortically mediated responding, some babies, viable for the first 2 months, may become especially vulnerable if they fail to acquire sufficiently strong defensive behaviors needed to prevent occlusion after the waning of the life-preserving reflex. Recent success of back-to-sleep directives, urging that babies sleep on their backs to avoid smothering, supports this hypothesis.