Health Report:

Coronary Artery Disease: CABG vs. Stents?

Swimming Lessons & Drowning Risk in Children

“A critical weekly review of important new research findings for health-conscious readers…”

By, Robert A. Wascher, MD, FACS

Updated:  03/8/2009

The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author.  Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.

CORONARY ARTERY DISEASE: CABG vs. STENTS?

The debate over the optimal treatment of coronary artery diseases continues, even among top heart disease experts.  Much of the clinical research thus far has suggested that coronary artery stents work about as well as the far more invasive coronary artery bypass grafting (CABG) surgery does, at least in the short term, but that the benefits of CABG surgery tend to last longer than coronary artery stents.  Of course, the risks associated with CABG surgery, especially in the early period after surgery, tend to be higher than for stent placement (although patients undergoing CABG surgery also tend to have more advanced coronary artery disease than patients who are typically selected for less invasive coronary artery stent placement procedures).

A new prospective, randomized clinical research trial, just published in the New England Journal of Medicine, further clarifies important differences in outcomes among patients undergoing coronary artery stent placement versus CABG surgery.  In this impressive interventional study, 1,800 patients with coronary artery disease involving either all 3 major coronary arteries or the dominant “left main” coronary artery were randomized to undergo either CABG surgery or coronary artery stent placement (also known as percutaneous coronary intervention, or PCI).  Historically, patients with these patterns of advanced coronary artery disease have been advised to undergo CABG surgery instead of PCI, due to the improved durability of CABG, over time, when compared to PCI.  However, given the minimally invasive nature of coronary artery stent placement, when compared to CABG surgery, both cardiologists and patients have a strong interest in learning whether or not more advanced cases of coronary artery disease can be effectively treat with PCI instead of CABG surgery.

Following CABG or PCI, the 1,800 patient volunteers were observed for an average period of one year, and the incidence of death (from any cause), heart attack, stroke, or the need for additional coronary artery disease interventions, was tracked in both patient groups.

The results of this study largely confirmed earlier clinical studies that have favored CABG surgery over PCI in patients with diseased left main coronary arteries, and in patients with 3-vessel coronary artery disease.  The incidence of major acute coronary artery events was significantly higher in the PCI group when compared to the CABG surgery group (18 percent in the PCI group versus 12 percent in the CABG surgery group).   Much of this observed difference in recurrent coronary artery events between the two patient groups appeared to derive from the two-fold increase in the need for repeat coronary artery interventions in the PCI patient group when compared to the CABG surgery patients.  Nearly 14 percent of the PCI patients required a repeat coronary artery intervention within 12 months of their initial PCI procedure, while only 6 percent of the CABG surgery patients required another coronary artery intervention within a year of their initial surgery.  At the same time, it is important to note that, at 12 months following initial coronary artery intervention, the death rate and the heart attack (myocardial infarction) rate was essentially equivalent between the two patient groups, and the stroke rate was actually higher in the CABG surgery group (2 percent in the CABG surgery group versus 0.6 percent in the PCI group). 

The authors of this study concluded that, after one year of follow-up, CABG surgery was superior to coronary artery stent placement (PCI), as the patients who underwent PCI were twice as likely to require subsequent coronary artery interventions when compared to the patients who had undergone CABG surgery.  However, in my view, the results of this study, as published are somewhat more equivocal, especially from a patient’s perspective.  Although the duration of follow-up in this study (one year) was very brief, this study revealed that the overall death rate was essentially equivalent with either intervention, and many patients in the PCI group were spared the need for major open-heart surgery (and its attendant higher risk of stroke).  Ultimately, it will require longer follow-up of this cohort of patients, in my view, to prove the claimed superiority of CABG surgery over PCI for 3-vessel or left main coronary artery disease.  Based upon previous research studies, one would anticipate that, over a period of 10 to 15 years, the patients who underwent CABG surgery in this study are likely to experience fewer adverse cardiovascular events than the patients who underwent PCI.  As other recent clinical studies have shown, though, the differences in important clinical outcomes during the first few years following either CABG surgery or PCI may be far less than what older studies have suggested, and this narrowing of differences in early outcomes may reflect recent advances in PCI.  For now, in my view, the debate regarding the inherent superiority of CABG over PCI for certain groups of patients with coronary artery disease has not yet been fully resolved by this important new study, and only long-term follow-up of this study’s patient volunteers is likely to definitively decide this ongoing debate.

SWIMMING LESSONS & DROWNING RISK IN CHILDREN

My wife, it can be revealed, never learned to swim, despite spending most of her life living in beach communities.  As a form of parental compensation for my wife’s lack of comfort in an aquatic environment, our two young children have been charged with learning to swim from a very early age.  Of course, this makes perfect sense to me as well, given that we continue to live near the beach.  However, due to the not very infrequent tragic stories of young children drowning in family pools, I have sometimes worried that increasing our young children’s comfort levels in the water could expose them to an increased risk of a pool-related accidents, due to overconfidence on their part.  I was, therefore, quite relieved to find a newly published research study on this very topic, which appears in the current volume of the Archives of Pediatric and Adolescent Medicine. 

In this retrospective case-control study, the authors reviewed cases of drowning deaths occurring in children and adolescents between the ages of 1 and 19 years in the states of Maryland, North Carolina, Florida, California, Texas, and New York.  The researchers then interviewed a sample of 88 families of children and teens, from these same states, who had died in drowning accidents.  A control group of 213 families who had not experienced the tragic loss of a child was also interviewed.  The results and conclusions of this innovative clinical study were rather striking (and personally reassuring to me).

Of the 61 families who lost a child between the ages of 1 and 4 years to drowning, only 3 percent had enrolled their lost child in swimming lessons, while 26 percent of the control group families with children in this same age range had enrolled their toddlers in formal swimming lessons.  Among the 27 families that had lost children between the ages of 5 and 19 years to drowning accidents, 27 percent had enrolled their deceased children in formal swimming lessons, compared with 53 percent of the same-aged children in the 79 control group families.  (While these results suggest that formal swimming instruction in children aged 5 years or older decreases the risk of accidental drowning, the results in this age group were not statistically significant, unlike the results observed for the younger children.)  At the same time, when the researchers looked at unstructured or otherwise informal swimming instruction as a risk factor for accidental drowning, they found absolutely no association between informal instruction and drowning rates in children and adolescents.

The results of this retrospective case-control study identified a whopping 88 percent reduction in the risk of accidental drowning among 1 to 4 year-old children who had undergone formal swimming instruction, when compared to same-age toddlers who had either never undergone formal instruction or who had undergone only informal, unstructured swimming instruction.  While the retrospective case-control methodology used for this study is not as powerful as would be observed in a prospective clinical research trial, this study’s findings do reassure me that there is most likely some significant benefit associated with formal swimming lessons in younger children.  Selection biases, as well as other potential sources of bias, are difficult to eliminate in these types of clinical studies, and so the absolute benefit of swimming lessons is likely to be less than the 88 percent level reported by this retrospective study.  However, when one is considering even potentially modest reductions in the risk of losing one’s child to accidental drowning, there is no such thing as a trivial level of risk reduction, in my view.  So, our young children will definitely be continuing with their swimming lessons at our friendly neighborhood YMCA.

Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, a professor of surgery, a widely published author, and a Surgical Oncologist at the Kaiser Permanente healthcare system in Orange County, California

Send your feedback to Dr. Wascher at:  rwascher@doctorwascher.net

Dr. Wascher’s Biography

Links to Other Health & Wellness Sites

http://doctorwascher.com

Copyright 2009

Robert A. Wascher, MD, FACS

All rights reserved

Dr. Wascher’s Archives:

3-1-2009:  Aspirin & Colorectal Cancer Prevention; Fish Oil & Respiratory Infections in Children

2-22-2009:  Health Differences Between Americans & Europeans; Lycopene & Prostate Cancer

2-15-2009:  Statin Drugs & Death Rates; Physical Activity, Breast Cancer & Sex Hormones

2-8-2009:  Hormone Replacement Therapy (HRT) & Breast Cancer; Stool DNA Testing & Cancer of the Colon & Rectum

2-1-2009:   Obesity and the Complications of Diverticulosis (Diverticulitis & Bleeding); Obesity, Weight Loss & Urinary Incontinence

1-25-2009:  Prostate Cancer, Fatigue & Exercise; Does your Surgeon “Warm-up” Before Surgery?

1-18-2009:  Cancer and Vitamins; Teenagers, MySpace and Risky Behaviors

1-11-2009:  Exercise Reverses Some Effects of Fatty Meals; Vitamin C and Blood Pressure

1-4-2009:  Secondhand Smoke & Heart Attack Risk; Poor Physical Fitness During Childhood & Heart Disease Risk During Adulthood

12-28-2008:  Stress & Your Risk of Heart Attack; Vitamin D & the Prevention of Colon & Rectal Polyps

12-21-2008:  Breast Cancer Incidence & Hormone Replacement Therapy; Circumcision & the Risk of HPV & HIV Infection

12-14-2008:  Vitamin E, Vitamin C and Selenium Do Not Prevent Cancer;  Postscript: A Possible Cure for Down’s Syndrome

12-7-2008:  Generic vs. Brand-Name Drugs, Stress & Breast Cancer Survival

11-30-2008:    A Possible Cure for Down’s Syndrome?; Smoking & Cognitive Decline; Calcium & Vitamin D & Breast Cancer Risk

11-23-2008:  Breast Cancer & Fish Oil; Lymphedema after Breast Cancer Treatment; Vasectomy & Prostate Cancer Risk

11-16-2008:  Vitamin E & Vitamin C: No Impact on Cardiovascular Disease Risk; Does Lack of Sleep Increase Stroke & Heart Attack Risk in Hypertensive Patients?

11-9-2008:  Statins Cut Heart Attack Risk Even with Normal Cholesterol Levels; Statins & PSA Level

11-2-2008:  Radiation Treatment of Prostate Cancer & Second Cancers; Sexual Content on TV & Teen Pregnancy Risk

10-26-2008:  Smoking & Quality of Life

10-19-2008:  Agent Orange & Prostate Cancer

10-12-2008:  Pomegranate Juice & Prostate Cancer

10-5-2008:  Central Obesity & Dementia; Diet, Vitamin D, Calcium, & Colon Cancer

9-28-2008:  Publication & Citation Bias in Favor of Industry-Funded Research?

9-21-2008:  Does Tylenol® (Acetaminophen) Cause Asthma?

9-14-208:   Arthroscopic Knee Surgery- No Better than Placebo?; A Healthy Lifestyle Prevents Stroke

8-23-2008:  Alcohol Abuse Before & After Military Deployment; Running & Age; Running & Your Testicles

8-12-2008:  Green Tea & Diabetes; Breastfeeding & Adult Cholesterol Levels; Fish Oil & Senile Macular Degeneration

8-3-2008:   Exercise & Weight Loss; Green Tea, Folic Acid & Breast Cancer Risk; Foreign Language Interpreters & ICU Patients

7-26-2008:  Viagra & Sexual Function in Women; Patient-Reported Adverse Hospital Events; Curcumin & Pancreatic Cancer

7-13-2008:  Erectile Dysfunction & Frequency of Sex; Muscle Strength & Mortality in Men; Cryoablation for Prostate Cancer

7-6-2008:  Sleep, Melatonin & Breast Cancer Risk; Mediterranean Diet & Cancer Risk; New Treatment for Varicose Veins

6-29-2008:  Bone Marrow Stem Cells & Liver Failure; Vitamin D & Colorectal Cancer Survival; Green Tea & Colorectal Cancer

6-22-2008:  Obesity, Lifestyle & Heart Disease; Effects of Lifestyle & Nutrition on Prostate Cancer; Ginkgo Biloba, Ulcerative Colitis & Colorectal Cancer

6-15-2008:  Preventable Deaths after Coronary Artery Bypass Graft (CABG) Surgery; Green Tea & Colorectal Cancer; Attention-Deficit/Hyperactivity Disorder (ADHD) & St. John’s Wort

6-8-2008:  Vitamin D & Prostate Cancer Risk; Radiofrequency Ablation (RFA) of Kidney (Renal) Cancer; Antisense Telomerase & Cancer

6-2-2008:  Acute Coronary Syndrome- Do You Know the Symptoms?; Green Tea & Lung Cancer; Episiotomy & Subsequent Deliveries- An Unkind Cut

5-25-2008:  Early Childhood Screening Predicts Later Behavioral Problems; Psychiatric Disorders Among Parents of Autistic Children; Social & Psychiatric Profiles of Young Adults Born Prematurely

5-18-2008:  Can Statins Reverse Coronary Artery Disease?; Does Breast Ultrasound Improve Breast Cancer Detection?; Preventive Care Services at Veterans Administration (VA) Medical Centers

5-11-2008:  Smoking Cessation & Risk of Death; Childhood Traumas & Adult Suicide Risk; “White Coat Hypertension” & Risk of Cardiovascular Disease

5-4-2008:  Super-Size Me: Fast Food’s Effects on Your Liver; Exercise, Weight & Coronary Artery Disease; Contamination of Surgical Instruments in the Operating Room

4-27-2008:  Stents vs. Bypass Surgery for Coronary Artery Disease; The “DASH” Hypertension Diet & Cardiovascular Disease Prevention; Testosterone Therapy for Women with Decreased Sexual Desire & Function

4-20-2008:  BRCA Breast Cancer Mutations & MRI Scans; Bladder Cancer Prevention with Broccoli?; Diabetes: Risk of Death Due to Heart Attack & Stroke

4-13-2008:  Breast Cancer Recurrence & Hormone Replacement Therapy (HRT); Carotid Artery Disease: Surgery vs. Stents?; Statin Drugs & Cancer Prevention

4-6-2008:  Human Papilloma Virus (HPV), Pap Smear Results & Cervical Cancer; Human Papilloma Virus (HPV) Infection & Oral Cancer; Hormone Replacement Therapy (HRT) & the Risk of Gastroesophageal Reflux Disorder (GERD)

3-30-2008:  Abdominal Obesity & the Risk of Death in Women; Folic Acid Pretreatment & Heart Attacks; Pancreatic Cancer Regression after Injections of Bacteria

3-23-2008:  Age of Transfused Blood & Risk of Complications after Surgery; Obesity, Blood Pressure & Heart Size in Children

3-16-2008:  Benefits of a Full Drug Coverage Plan for Medicare Patients?; Parent-Teen Conversations about Sex; Soy (Genistein) & Prostate Cancer

3-9-2008:  Flat Colorectal Adenomas & Cancer; Health Risks after Stopping Hormone Replacement Therapy (HRT); Television, Children & Obesity 

3-2-2008:  Medication & Risk of Death After Heart Attack; Hormone Replacement Therapy (HRT) & Mammogram Results; Selenium: Cancer, Heart Disease & Death

2-23-2008:  Universal Healthcare Insurance Study; Glucosamine & Arthritis

2-17-2008:  Exceptional Longevity in Men; Testosterone & Risk of Prostate Cancer; Smoking & Pre-malignant Colorectal Polyps

2-10-2008:  Thrombus Aspiration from Coronary Arteries; Intensive Management of Diabetes & Death; Possible Cure for  Down’s Syndrome?

2-3-2008:  Vitamin D & Cardiovascular Health; Vitamin D & Breast Cancer; Green Tea & Colorectal Cancer

1-27-2008:  Colorectal Cancer, Esophageal Cancer & Pancreatic Cancer: Update from the 2008 American Society of Clinical Oncology’s Gastrointestinal Cancers Symposium

1-20-2008:  Testosterone Levels & Risk of Fractures in Elderly Men; Air Pollution & DNA Damage in Sperm; Statins & Trauma Survival in the Elderly

1-12-2008:  Statins, Diabetes & Stroke and Obesity; GERD & Esophageal Cancer

1-7-2008:  Testosterone Supplements in Elderly Men; Colorectal Cancer– Reasons for Poor Compliance with Screening Recommendations

12-31-2007:  Minority Women, Hormone Replacement Therapy & Breast Cancer; Does Health Insurance Improve Health?

12-23-2007:  Is Coffee Safe After a Heart Attack?; Impact of Divorce on the Environment; Hypertension & the Risk of Dementia; Emotional Vitality & the Risk of Heart Disease

12-16-2007:   Honey vs. Dextromethorphan vs. No Treatment for Kids with Night-Time Cough, Acupuncture & Hot Flashes in Women with Breast Cancer, Physical Activity & the Risk of Death, Mediterranean Diet & Mortality 

12-11-2007:  Bias in Medical Research; Carbon Nanotubes & Radiofrequency: A New Weapon Against Cancer?; Childhood Obesity & Risk of Adult Heart Disease

12-2-2007:  Obesity & Risk of Cancer; Testosterone Level & Risk of Death; Drug Company Funding of Research & Results; Smoking & the Risk of Colon & Rectal Cancer 

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EARLY CHILDHOOD SCREENING PREDICTS LATER BEHAVIORAL PROBLEMS

Significant emotional or behavioral problems are often not detected until affected children begin school.  Moreover, even in moderately severe cases, children with emotional and behavioral problems may not receive appropriate screening and intervention until they have been in school for several years.  Researchers from the University of Connecticut and the University of Massachusetts have just published the results of an interesting study, in the journal Pediatrics, in which they screened children for behavioral and psychological problems at a very early age, and then followed them as they subsequently entered elementary school.

A total of 1,004 socio-economically and ethnically diverse children were evaluated in this study.  The children’s parents completed a standardized Brief Infant-Toddler Social and Emotional Assessment survey when their children were between 12 and 36 months of age (the average age of the children participating in this research study was 24 months).  These children were again evaluated once they entered elementary school, at an average age of 6 years.  Both parents and the children’s teachers participated in this latter evaluation of social and behavioral problems in this large group of children. 

Among those infants and toddlers with evidence of social, developmental and emotional problems detected upon their initial evaluation, 49% were reported, when these children subsequently began elementary school, to have significant behavioral and social difficulties in class, based upon their teachers’ evaluations.  The initial Brief Infant-Toddler Social and Emotional Assessment and Evaluation survey also predicted which babies and toddlers would later develop significant criteria for psychiatric disorders.  Among those infants and toddlers who had evidence of developmental or behavioral difficulties on their initial survey, more than two-thirds (68%) were found to meet the criteria listed for specific psychiatric disorders after reaching elementary school.

As a disclaimer, I will mention that the disciplines of Psychiatry and Psychology are rather unique among the clinical sciences in that it is very difficult (if not impossible) to obtain completely objective research data in clinical research studies such as this one.  Human behavior is extremely complex, variable, and unpredictable.  Thus, unlike research studies that randomize different groups of patients to receive different medical therapies, or studies that involve laboratory experiments, clinical psychiatric and psychological research studies cannot completely control all of the experimental factors that might skew either the resulting data, or, for that matter, its interpretation.  Therefore, I generally do not include such studies in my column.  In this case, however, I chose to include this particular study, because I believe that it may be helpful for some parents (and teachers) to know about its findings.

While I absolutely do not advocate performing routine psychiatric testing on children who do not have any evidence of significant behavioral or psychiatric problems, the results of this study suggest that it may be possible to pick up evidence of significant behavioral or/and psychological problems in the majority of “at risk” children long before they begin their school years.  While not every child with “abnormal” scores on the Infant-Toddler evaluation survey ultimately experienced psychiatric illnesses by the time they reached elementary school, in this study, more than two-thirds of such children were, in fact, subsequently diagnosed with a psychiatric disorder after starting elementary school. 

Perhaps, if identified during late infancy or while still a toddler, children who are at high risk of developing significant emotional or psychiatric illnesses might be able to undergo more intensive early screening and, if appropriate, begin therapy before they start attending school.  If effective therapy is available prior to beginning elementary school for any significant emotional or psychiatric illnesses that are identified early, then these children might have a much more positive and successful experience at school in their later years.

 

PSYCHIATRIC DISORDERS AMONG PARENTS OF AUTISTIC CHILDREN

The incidence of autism in the United States has been, inexplicably and dramatically, rising in recent years.  According to the Autism Society of America, autism is currently diagnosed in 1 of every 150 children born, and approximately 1.5 million people in the US are thought to have an autistic disorder.  Currently, the care of autistic patients is thought to cost around $90 billion per year, and some experts predict that this cost will rise to $200 billion dollars, or more, within the next 10 years.  There is also evidence, from the London School of Economics, that the early diagnosis and treatment of autism can reduce the lifetime cost of caring for such patients by as much as two-thirds (in most cases, the difficulties in communication and social interactions that are the hallmarks of autism can usually be detected within the first 3 years of life).

There is a great deal of debate about the potential causes of autistic disorders.  Recent studies have shown that at least some cases of autism do appear to be linked to specific gene mutations, suggesting that some cases of autism are very likely a result of inheritance.  There has also been a tremendous controversy regarding autism and its link, if any, with childhood vaccinations (and the mumps, measles and rubella, or MMR, vaccine, in particular).  However, multiple rigorous clinical research studies have, so far, failed to find any link between the development of autism and vaccinations.  In most cases, autism is diagnosed during the same age range as when children are beginning to receive their immunizations, and many public health experts have suggested that this factor is the most likely explanation for the apparent onset of the symptoms of autism following vaccinations. 

A new Swedish study, also just published in the journal Pediatrics, takes a look at the incidence of psychiatric illnesses in the parents of children who have been diagnosed with an autistic disorder.  As is the case in most of Scandinavia, and in much of Europe, essentially the entire population has access to universal healthcare provided by the federal government and its contractors.  It is for this reason that huge numbers of patients can be followed in clinical research studies in such countries, as a wide range of clinical data is routinely entered into central public health databases, even in countries with relatively small populations. 

This particular study was the result of collaboration between researchers from Sweden’s famed Karolinska Institute, the University of North Carolina at Chapel Hill, and the Mount Sinai School of Medicine here in New York.  Using the Swedish Medical Birth Register and the Swedish Multi-Generation Register, and other centralized public health databases, the researchers identified 1,227 children born between 1977 and 2003 who were subsequently treated for an autistic disorder.  For comparison purposes, more than 30,000 other children born during the same interval, but without any history of autism, were also included in this research study.  The researchers were then able to further assess this public health data to determine the incidence of treatment for psychiatric disorders among the parents of both groups of children born between 1977 and 2003 (editorializing for a moment here, and needless to say, conducting a study like this is never likely to be approved here in the United States).

In this study, the incidence of mental health disorders among the parents of autistic children was found to be significantly greater than what was observed among the parents of the much larger “control” group of parents of non-autistic children.  Specifically, schizophrenia was found to be more common in both mothers and fathers of autistic children, while depression and personality disorders were found to be more common among mothers of autistic kids, only.

While the results of this study, as with previous studies, suggests that at least some cases of autism might be inherited (and might be associated with other psychiatric disorders that are also thought to be heritable), one must be very careful in drawing conclusions from this data.  Certainly, caring for a child with autism, or other serious mental or physical illnesses, is a tremendously taxing and stressful undertaking.  I can easily imagine that parents who are faced with, potentially, the lifelong care of a severely disabled child could rather easily succumb to the stresses of such demands by developing emotional or psychiatric illnesses themselves. 

Unfortunately, this study, which was based solely on confidential public health records in Sweden, cannot tell us very much about the details of mental illness among parents of autistic children.  Also, as I have already mentioned, virtually all clinical studies involving psychiatric testing and evaluation are associated with a significant likelihood of subjectivity and bias, due to the inherent complexity of assessing human behavior and personality.  All of these disclaimers aside, this study still suggests that at least some significant percentage of autism cases may be linked to specific genetic factors which, in turn, may also be associated with other psychiatric illnesses within families.  The recent identification of specific gene mutations associated with at least some cases of autism also suggest that many (but not all) cases of autism are likely to be the result, at least in part, of specific and potentially heritable genetic factors.

 

SOCIAL & PSYCHIATRIC PROFILES OF YOUNG ADULTS BORN PREMATURELY

As neonatal intensive care units have become increasingly sophisticated in caring for extremely premature babies, more and more of these tiny infants are surviving into adulthood.  There have been numerous clinical research studies published about this group of patients, with some studies finding a significant increase in the incidence of lifelong physical and mental health difficulties among those who were very premature at birth.  As is often the case with public health research, there have also been quite a few studies published that have suggested that most people who were born prematurely do just fine if they survive into adulthood.

A new Dutch study in the Journal of Pediatrics, which was part of a larger ongoing study of children and adults born prematurely, evaluated 656 healthy adolescents who were born very prematurely, and compared them with their same-age peers with respect to general lifestyle, risk-taking behaviors, the presence of psychiatric disorders, and social interactions. 

Interestingly, both the teenage boys and teenage girls who had been born prematurely were less likely to smoke than their peers who had been born after a full-term pregnancy.  The teenage boys born prematurely were also less likely to drink alcohol than their full-term counterparts, while the adolescent girls who were born prematurely consumed alcohol as often as the girls who were born at full-term.  Lifetime illicit drug use was also significantly less common among the teens (boys and girls) who were born prematurely, when compared to their full-term birth peers.  With the notable exception of using public transportation without paying the fare… the adolescents born prematurely were far less likely to be involved in criminal activity than the kids who born at full-term.  Although the boys born prematurely appeared to experience greater difficulty in establishing relationships than their full-term peers, on the whole, the incidence of psychiatric disorders did not differ significantly between the two groups of adolescent boys and girls.

Healthy adolescents who were born “very pre-term,” or at a “very low birth-weight,” like those who were included in this study, represent a very select subgroup of young adults who have managed to grow and thrive, and to achieve excellent overall health, despite severe prematurity at birth.  In this particular subgroup of young adults born very prematurely, risk-taking behavior appeared to be less common than was observed in the general population.  At the same time, increased difficulties with initiating new relationships appeared to be more common among the teens who were born prematurely, especially among the boys.  While the explanations for these differences in social behavior between the two groups of teens is not unclear, they are nonetheless intriguing and worthy of further study.

 

Dr. Wascher is an oncologic surgeon, professor of surgery, a widely published author, and the Director of the Division of Surgical Oncology at Newark Beth Israel Medical Center:

http://www.sbhcs.com/hospitals/newark_beth_israel/mservices/oncology/surgical.html

Send your feedback to Dr. Wascher at:  rwascher@doctorwascher.net

http://www.doctorwascher.com

Copyright 2008.  Robert A. Wascher, MD, FACS.  

All rights reserved.

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