Biomedical subjects

Mary McClain

Publications and source records attributed to Mary McClain.

4 recordsLinked to original sources

PubMed2003

Serotonergic brainstem abnormalities in Northern Plains Indians with the sudden infant death syndrome.

The rate of the sudden infant death syndrome (SIDS) among American Indian infants in the Northern Plains is almost 6 times higher than in U.S. white infants. In a study of infant mortality among Northern Plains Indians, we tested the hypothesis that receptor binding abnormalities to the neurotransmitter serotonin (5-HT) in SIDS cases, compared with autopsied controls, occur in regions of the medulla oblongata that contain 5-HT neurons and that are critical for the regulation of cardiorespiration and central chemosensitivity during sleep, i.e. the medullary 5-HT system. Tritiated-lysergic acid diethylamide binding to 5-HT(1A-D) and 5-HT2 receptors was measured in 19 brainstem nuclei in 23 SIDS and 6 control infants using tissue receptor autoradiography. Binding in the arcuate nucleus, a part of the medullary 5-HT system along the ventral surface, in the SIDS infants (mean age-adjusted binding 7.1 +/- 0.8 fmol/mg tissue, n = 23) was significantly lower than in controls (mean age-adjusted binding 13.1 +/- 1.6 fmol/mg tissue, n = 5) (p = 0.003). Binding also demonstrated significant diagnosis x age interactions (p < 0.04) in 4 other nuclei that are components of the 5-HT system. These data suggest that medullary 5-HT dysfunction can lead to sleep-related, sudden death in affected SIDS infants, and confirm the same binding abnormalities reported by us in a larger dataset of non-American Indian SIDS and control infants. This study also links 5-HT abnormalities in the arcuate nucleus with exposure to adverse prenatal exposures, i.e. cigarette smoking (p = 0.011) and alcohol (p = 0.075), during the periconceptional period or throughout pregnancy. Prenatal exposure to cigarette smoke and/or alcohol may contribute to abnormal fetal medullary 5-HT development in SIDS infants.

Age Factors↗

PubMed2003

Secular changes in sleep position during infancy: 1995-1998.

OBJECTIVE: Prone sleeping among infants has been associated with an increased risk of sudden infant death syndrome. The objective of this study was to compare factors associated with sleep position in 1995-1996 and 1997-1998 and to assess secular trends in use of prone infant sleep position from 1995 through 1998 among families stratified by race and education. METHODS: A prospective cohort study was conducted in eastern Massachusetts and northwest Ohio of 12 029 mothers of infants who weighed > or =2500 g at birth. Descriptive statistics and multivariate odds ratios were used to relate maternal and infant characteristics to prone and supine sleeping. RESULTS: A total of 14 206 mothers (25% of those eligible) were enrolled. A total of 12 029 mothers (85% of enrolled) responded to the 1-month and 11 552 mothers (81% of enrolled) responded to the 3-month follow-up questionnaire. A decline in use of the prone sleep position and increase in use of the supine position was observed during the 4 years of the study. Factors associated with prone and supine sleep position were similar in 1995-1996 and 1997-1998. In 1997-1998, use of prone sleeping at 1 month of age reached the goal of < or =10% only among infants of white and Asian women, married women, women who were older than 25 years, women who were college graduates, and women with incomes >$55 000 per year. At 3 months of age, however, prone sleeping increased to 12% to 17% in these groups. These same groups were most likely to use the supine position; 38% to 45% were supine at 1 month, increasing to 56% to 64% by 3 months of age. However, as of the end of 1998, approximately 27% of infants of non-college-educated black and Hispanic mothers were placed to sleep in the prone position and only 20% to 30% were being placed to sleep in the supine position at 3 months of age. CONCLUSIONS: Recommendations to avoid prone sleep position and especially the recommendation that supine sleep position is preferred have not been effectively delivered to black and Hispanic families and to families of low-income and less than a college education.

Chi-Square Distribution↗

PubMed2002

Risk factors for sudden infant death syndrome among northern plains Indians.

CONTEXT: Sudden infant death syndrome (SIDS) is a leading cause of postneonatal mortality among American Indians, a group whose infant death rate is consistently above the US national average. OBJECTIVE: To determine prenatal and postnatal risk factors for SIDS among American Indians. DESIGN, SETTING, AND PARTICIPANTS: Population-based case-control study of 33 SIDS infants and 66 matched living controls among American Indians in South Dakota, North Dakota, Nebraska, and Iowa enrolled from December 1992 to November 1996 and investigated using standardized parental interview, medical record abstraction, autopsy protocol, and infant death review. MAIN OUTCOME MEASURES: Association of SIDS with maternal socioeconomic and behavioral factors, health care utilization, and infant care practices. RESULTS: The proportions of case and control infants who were usually placed prone to sleep (15.2% and 13.6%, respectively), who shared a bed with parents (59.4% and 55.4%), or whose mothers smoked during pregnancy (69.7% and 54.6%) were similar. However, mothers of 72.7% of case infants and 45.5% of control infants engaged in binge drinking during pregnancy. Conditional logistic regression revealed significant associations between SIDS and 2 or more layers of clothing on the infant (adjusted odds ratio [aOR], 6.2; 95% confidence interval [CI], 1.4-26.5), any visits by a public health nurse (aOR, 0.2; 95% CI, 0.1-0.8), periconceptional maternal alcohol use (aOR, 6.2; 95% CI, 1.6-23.3), and maternal first-trimester binge drinking (aOR, 8.2; 95% CI, 1.9-35.3). CONCLUSIONS: Public health nurse visits, maternal alcohol use during the periconceptional period and first trimester, and layers of clothing are important risk factors for SIDS among Northern Plains Indians. Strengthening public health nurse visiting programs and programs to reduce alcohol consumption among women of childbearing age could potentially reduce the high rate of SIDS.

Alcohol Drinking↗

PubMed2002

SIDS education in nursing and medical schools in the United States.

This study suggests there is a need to support the efforts already present to include SIDS in medical and nursing school curricula. Both programs have indicated a need for audiovisual and printed teaching materials. Consideration should be given to teaching materials that are easily updated such as computer-generated materials because of the many rapid changes that take place in SIDS research. Currently, textbooks are the most common source of educational material used by students. Textbooks could be supplemented with information from recent journals and current Web sites. Facilitation of clinical contact with families affected by SIDS is important. The availability of local SIDS resources should be stressed to both medical and nursing programs as well as opportunities for nursing student involvement in the activities of SIDS organizations. While lectures are often the only feasible way to deliver SIDS content to large groups of students, interactive teaching strategies and involvement with bereaved families probably would increase learning beyond the basic level. Nursing schools as well as medical schools, confronted with the realities of decreased faculty time and budgets, face major challenges in developing case-based curricula that prepare students for the next century (Zimmerman et al., 1997). To address these needs, curriculum notes were developed by the Education Working Party of the SIDS Global Strategy Task Force under the direction of Professor John C. Vance and printed in February 1998. The curriculum is divided into seven modules that include content and questions as well as references on a variety of issues. A problem-based learning package is included and is becoming increasingly popular as a teaching strategy (Amos & White, 1998; David & Patel, 1995). There is one case each for medical and nursing students in the curriculum package. This curriculum can be accessed at www. sidsaustralia.org.au. Other useful Web sites include: www.sidsalliance.org. The SIDS Alliance Web site provides support to families and information about SIDS. www.sidscenter.org. The National SIDS Resource Center Web site provides information and technical assistance for parents and professionals on SIDS and related topics. www.aap.org. The American Academy of Pediatrics Web site provides guidelines on sleep position and infant sleeping environment. www.asipl.org. The Association of SIDS and Infant Mortality Programs Web site includes publications and position papers. Finally, many states have SIDS services provided by professional programs and parent organizations. Students have the opportunity to work with these organizations to provide bereavement services and risk-reduction education. The organizations listed above can be contacted for further information.

Curriculum↗