Faculty Bibliography

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.

Over the past 20 years, there has been an increased emphasis on health promotion, including prevention activities related to vision and oral health, for the general population, but not for individuals with intellectual disability (ID). This review explores what is known about the prevalence of vision problems and oral health conditions among individuals with ID, presents a rationale for the increased prevalence of these conditions in the context of service utilization, and examines the limitations of the available research. Available data reveal a wide range of prevalence estimates for vision problems and oral health conditions, but all suggest that these conditions are more prevalent among individuals with ID compared with the general population, and disparities exist in the receipt of preventive and early treatment for these conditions for individuals with ID. Recommendations for health improvement in these areas include better health planning and monitoring through standardized population-based data collection and reporting and increased emphasis on health promotion activities and early treatment in the healthcare system.

Twenty-six college women with a history of repeated childhood sexual abuse were recruited from the community and compared with 19 healthy female collegiate subjects on neurocognitive measures. Abused subjects showed increased response latency variability and diminished inhibitory capacity during a GO/NO-GO/STOP vigilance task. A strong association was found between duration of abuse and memory impairments. Math Scholastic Aptitude Test (SAT) scores were significantly lower in abused subjects when matched against comparison subjects and when compared to their own Verbal SAT scores. Childhood sexual abuse appears to be associated with a constellation of neuropsychological deficiencies even in a group of relatively healthy women

Learning and memory depend on signaling molecules that affect synaptic efficacy. The cytoskeleton has been implicated in regulating synaptic transmission but its role in learning and memory is poorly understood. Fear learning depends on plasticity in the lateral nucleus of the amygdala. We therefore examined whether the cytoskeletal-regulatory protein, myosin light chain kinase, might contribute to fear learning in the rat lateral amygdala. Microinjection of ML-7, a specific inhibitor of myosin light chain kinase, into the lateral nucleus of the amygdala before fear conditioning, but not immediately afterward, enhanced both short-term memory and long-term memory, suggesting that myosin light chain kinase is involved specifically in memory acquisition rather than in posttraining consolidation of memory. Myosin light chain kinase inhibitor had no effect on memory retrieval. Furthermore, ML-7 had no effect on behavior when the training stimuli were presented in a non-associative manner. Anatomical studies showed that myosin light chain kinase is present in cells throughout lateral nucleus of the amygdala and is localized to dendritic shafts and spines that are postsynaptic to the projections from the auditory thalamus to lateral nucleus of the amygdala, a pathway specifically implicated in fear learning. Inhibition of myosin light chain kinase enhanced long-term potentiation, a physiological model of learning, in the auditory thalamic pathway to the lateral nucleus of the amygdala. When ML-7 was applied without associative tetanic stimulation it had no effect on synaptic responses in lateral nucleus of the amygdala. Thus, myosin light chain kinase activity in lateral nucleus of the amygdala appears to normally suppress synaptic plasticity in the circuits underlying fear learning, suggesting that myosin light chain kinase may help prevent the acquisition of irrelevant fears. Impairment of this mechanism could contribute to pathological fear learning

The purpose of this study was to evaluate the factor structure of the Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA). The LSAS-CA was administered to 225 children and adolescents as a component of various clinical studies. In addition, other measures of psychopathology and impairment were administered to a subgroup of the sample. Confirmatory factor analyses of the social interaction and performance subscales for the anxiety and avoidance ratings yielded poor fit indices. Exploratory factor analysis supported a two-factor solution with a higher order factor for the LSAS-CA anxiety and avoidance ratings. Based on item content, factors were named Social and School Performance. The internal consistency of the factors was high and the convergent and divergent validity was supported vis-a-vis correlations with measures of depression and social anxiety, and clinician ratings of impairment and functioning. Findings suggest that the anxiety and avoidance ratings are best explained by a two-factor solution that measures social anxiety and avoidance in social and school performance interactions. This factor structure appears to be a reliable and valid framework for assessing childhood social phobia.