Faculty Bibliography

BACKGROUND: It has been assumed that a robust vascular response at the tendon to bone interface during rotator cuff repairs is an integral part to the healing process. There are few studies that have explored this in an in-vivo prospective fashion. PURPOSE: To prospectively characterize vascular and anatomical patterns in repaired rotator cuff tendons using Power Doppler sonography in a double-blinded fashion. STUDY DESIGN: Case control study; Level of evidence, 3. METHODS: Fifty patients undergoing rotator cuff repair were enrolled: 28 mini-open, 14 open, and 8 arthroscopic repairs; 20 patients were controls. Patients underwent Power Doppler sonography at 6 weeks, 3 months, and 6 months postoperatively. Power Doppler sonography analysis examined 6 areas of the rotator cuff repair: discretely marginated intrasubstance, partial-thickness defects, full-thickness defects, focal thinning of repair, presence of bursal or joint fluid, and location of anchors. A subjective scoring system assessed blood flow in each region. RESULTS: There was a predictable, significant decrease in vascular scores after rotator cuff repair over time. The mean vascular score was 11.6 at 6 weeks, 8.3 at 3 months, 7.0 at 6 months, and 2.4 for controls. There was a significant difference (P < .05) in vascular recruitment scores between each time period, with the most robust flow at the peritendinous region. The lowest vascular score was at the anchor site or cancellous trough. Forty-eight percent of the patients had a rotator cuff repair defect postoperatively. These findings did not correlate with functional assessment and outcome at 6 months. There was no significant difference in vascular scores between the defect and no-defect groups. Mean University of California, Los Angeles; L'Insalata; and American Shoulder and Elbow Surgeons scores at 6 months were 28.6, 86.3, and 81.5, respectively. Thirty-three percent of asymptomatic controls had a rotator cuff tear that averaged 7.6 x 7.1 mm. CONCLUSION: The robust vascular response dropped with time, which is not seen in asymptomatic shoulders. Nearly half of the patients demonstrated persistent rotator cuff defects after rotator cuff repair that did not correlate with functional outcome and physical findings at 6 months.

This article reviews current research on emotional and behavioral disorders among children in foster care and summarizes findings regarding utilization of mental health services in this population. Barriers to needed care are explored, practice and policy implications of lack of care are discussed, and alternative, evidence-based treatment options for foster youth are examined and proposed.

In June 2003, the manufacturer of paroxetine (Paxil) submitted data to the British equivalent of the United States Food and Drug Administration which unexpectedly included the finding that the risk of suicidality was greater in children and adolescents treated with paroxetine than in those given placebo. This event set into motion a cascade of investigations and review of prior studies resulting in the FDA conclusion that the risk of suicidal thinking and behavior (collectively referred to as suicidality) was 4% in children and adolescents treated with antidepressants and 2% in those on placebo. In October 2004, a black-box warning was issued regarding use of all antidepressants in children and adolescents. While this may result in better selection and monitoring of depressed young people, it may also lead to undue reluctance to prescribe antidepressants, resulting in an increase in the morbidity and mortality of a very serious illness. There is a growing literature demonstrating the efficacy of selective serotonin reuptake inhibitors (SSRIs) in the treatment of children and adolescents with depression. Guidelines regarding the safe use of SSRIs and a call to action regarding research are presented. (journal abstract)

AIMS: The current study investigated the efficacy of CB1 receptor-targeted drugs on the development and expression of tolerance to alcohol (EtOH). METHODS: An EtOH-inhalation model was used to induce tolerance, as measured by EtOH-induced sedation and hypothermia after a 24 h withdrawal period. Two drug treatment procedures, (i) co-treatment with EtOH and (ii) acute drug administration following chronic EtOH treatment, were used to test the efficacy of CB1 receptor manipulations on EtOH tolerance. RESULTS: The effects of the CB1 receptor agonist CP-55,940 varied depending on paradigm and behavioural measure. Chronic CP-55,940 co-treatment blocked tolerance to EtOH-induced hypothermia but not to the sedative effect (sleep time) in EtOH-exposed mice. However, chronic CP-55,940 administration alone resulted in tolerance to the sedative effect of a challenge dose of EtOH in control mice. Acute CP-55,940 administration after chronic alcoholization blocked the development of tolerance to EtOH-induced sedation compared to the EtOH alone exposed group, but induced tolerance to the hypothermic effects of EtOH in control mice. Chronic blockade of CB1 receptor function by SR141716A resulted in tolerance to both the sedative and hypothermic effects of EtOH in control mice, but had no effect on EtOH-exposed mice. CONCLUSIONS: The data support a role for the endocannabinoid (EC) system in EtOH tolerance/dependence and suggest that drugs targeted against EC system could be therapeutically useful in treating alcohol-related disorders

This study examined the help-seeking behaviors of depressed, African American adolescents. Qualitative interviews were conducted with 18 urban, African American boys, ages 14 to 18, who were recruited from community-based mental health centers and after-school programs for youths. Interviews covered sociodemographic information, questions regarding depressive symptomotology, and open-ended questions derived from the Network-Episode Model--including knowledge, attitudes and behaviors related to problem recognition, help seeking, and perceptions of mental health services. Most often adolescents discussed their problems with their family and often received divergent messages about problem resolution; absent informal network resolution of their problems, professional help would be sought, and those receiving treatment were more likely to get support from friends but were less likely to tell friends that they were actually receiving care. Implications for social work research and practice are discussed.

The good news is that there are tools to pin down a diagnosis and medications that are effective. A psychiatrist provides practical guidance

This study investigated whether age and ADHD symptoms affected choice preferences in children and adolescents when they chose between (1) small immediate rewards and larger delayed rewards and (2) small certain rewards and larger probabilistic uncertain rewards. A temporal discounting (TD) task and a probabilistic discounting (PD) task were used to measure the degree to which the subjective value of a large reward decreased as one had to wait longer for it (TD), and as the probability of obtaining it decreased (PD). Rewards used were small amounts of money. In the TD task, the large reward (10 cents) was delayed by between 0 and 30s, and the immediate reward varied in magnitude (0-10 cents). In the PD task, receipt of the large reward (10 cents) varied in likelihood, with probabilities of 0, 0.25, 0.5, 0.75, and 1.0 used, and the certain reward varied in magnitude (0-10 cents). Age and diagnostic group did not affect the degree of PD of rewards: All participants made choices so that total gains were maximized. As predicted, young children, aged 6-11 years (n=25) demonstrated steeper TD of rewards than adolescents, aged 12-17 years (n=21). This effect remained significant even when choosing the immediate reward did not shorten overall task duration. This, together with the lack of interaction between TD task version and age, suggests that steeper discounting in young children is driven by reward immediacy and not by delay aversion. Contrary to our predictions, participants with ADHD (n=22) did not demonstrate steeper TD of rewards than controls (n=24). These results raise the possibility that strong preferences for small immediate rewards in ADHD, as found in previous research, depend on factors such as total maximum gain and the use of fixed versus varied delay durations. The decrease in TD as observed in adolescents compared to children may be related to developmental changes in the (dorsolateral) prefrontal cortex. Future research needs to investigate these possibilities

In Sumary, OCD, non-OCD anxiety disorders and mood disorders are common co-morbid psychiatric disorders are common co-morbid psychiatric disorders in clinically referred youth with TS. Emotional disorders such as anxiety and depression may be more problematic to the patient than the tics, with regard to overall illness severity and the potential for adverse outcomes, such as school and social failure. The emotional symptoms and co-morbid mood and anxiety disorders must be comprehensively identified because they will require specific intervention and treatment. Treatment must be tailored to each individual, and should ideally include education, monitoring, and prioritization of symptoms based on distress and impairment. There is growing evidence to support the use of several medications, particularly the selective serotonin reuptake inhibitors, and some cognitive behavioral techniques to treat the psychiatric co-morbid disorders

OBJECTIVE: To determine whether providers' medical history-taking of substance use varies with their patients' race or ethnicity. DESIGN/SETTING/PARTICIPANTS: The medical records of 1083 low-income women who delivered at an urban teaching hospital over a 12-month period were reviewed and data were abstracted. The frequency with which the presence or absence of substance use was documented was compared among Black, Hispanic, and White women. Multivariate models predicting documentation of data on substance use were also built. RESULTS: Information on substance use was more often documented in the medical records of Black and Hispanic women than in those of White women. For example, 74% of Black women, 78% of Hispanic women, and 60% of White women had data on cocaine use documented in their medical records (P= .0001). Multivariate analyses found that, after controlling for other factors, Black (odds ratio [OR] 4.1) and Hispanic (OR 5.3) non-clinic patients were more likely than White non-clinic patients to have documented data on substance use history in their medical records. No racial/ ethnic disparities were found among clinic patients. Among White women, clinic patients were more likely than non-clinic patients to have documented data on substance use. Among other races and ethnicities, no disparities were found between places of care. CONCLUSIONS: The differential collection of information on women's medical histories may be influenced by organizational factors and/or provider factors. The standard implementation of history-taking protocols would reduce the influence of institutional and personal biases on the care provided to pregnant women and enable all patients to receive appropriate referrals to treatment.