Fatal neurotoxic response to neuroleptic medications: case report and review of the literature

Neuroleptic malignant syndrome (NMS) is a diagnosis of exclusion difficult to make due to a lack of pathognomonic features. Diagnosing NMS by postmortem examination becomes increasingly challenging when possible underlying brain pathology is obscured. The diagnosis is based on clinical history and laboratory findings. Autopsy and histologic findings, if any, usually are reflective of hyperthermia or complications (eg, aspiration pneumonia) of NMS. The authors describe a case of a 36-year-old Hispanic woman with a presumptive diagnosis of pseudoseizures, treated with various combinations of neuroleptic medications over a 6-week period prior to her sudden, unexpected, in-hospital death. Neuroleptic malignant syndrome is likely to have contributed to this patient's death. Confounding factors and medicolegal issues of a postmortem diagnosis of NMS are discussed.     

Invited Commentary: Broadening the Evidence for Adolescent Sexual and Reproductive Health and Education in the United States

Scientific research has made major contributions to adolescent health by providing insights into factors that influence it and by defining ways to improve it. However, US adolescent sexual and reproductive health policies—particularly sexuality health education policies and programs—have not benefited from the full scope of scientific understanding. From 1998 to 2009, federal funding for sexuality education focused almost exclusively on ineffective and scientifically inaccurate abstinence-only-until-marriage (AOUM) programs. Since 2010, the largest source of federal funding for sexual health education has been the “tier 1” funding of the Office of Adolescent Health’s Teen Pregnancy Prevention Initiative. To be eligible for such funds, public and private entities must choose from a list of 35 programs that have been designated as “evidence-based” interventions (EBIs), determined based on their effectiveness at preventing teen pregnancies, reducing sexually transmitted infections, or reducing rates of sexual risk behaviors (i.e., sexual activity, contraceptive use, or number of partners). Although the transition from primarily AOUM to EBI is important progress, this definition of evidence is narrow and ignores factors known to play key roles in adolescent sexual and reproductive health. Important bodies of evidence are not treated as part of the essential evidence base, including research on lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth; gender; and economic inequalities and health. These bodies of evidence underscore the need for sexual health education to approach adolescent sexuality holistically, to be inclusive of all youth, and to address and mitigate the impact of structural inequities. We provide recommendations to improve US sexual health education and to strengthen the translation of science into programs and policy.     

Parent and Peer Pathways to Adolescent Delinquency: Variations by Ethnicity and Neighborhood Context

Effects of ethnicity and neighborhood quality often are confounded in research on adolescent delinquent behavior. This study examined the pathways to delinquency among 2,277 African American and 5,973 European American youth residing in high-risk and low-risk neighborhoods. Using data from a national study of youth, a meditational model was tested in which parenting practices (parental control and maternal support) were hypothesized to influence adolescents' participation in delinquent behavior through their affiliation with deviant peers. The relationships of family and neighborhood risk to parenting practices and deviant peer affiliation were also examined. Results of multi-group structural equation models provided support for the core meditational model in both ethnic groups, as well as evidence of a direct effect of maternal support on delinquency. When a similar model was tested within each ethnic group to compare youths residing in high-risk and low-risk neighborhoods, few neighborhood differences were found. The results indicate that, for both African American and European American youth, low parental control influences delinquency indirectly through its effect on deviant peer affiliation, whereas maternal support has both direct and indirect effects. However, the contextual factors influencing parenting practices and deviant peer affiliation appear to vary somewhat across ethnic groups. Overall the present study highlights the need to look at the joint influence of neighborhood context and ethnicity on adolescent problem behavior.     

Maternal Predictors of Noncoital Sexual Behavior: Examining a Nationally Representative Sample of Asian and White American Adolescents Who Have Never had Sex

Current research in adolescent sexuality has largely focused on vaginal-penile intercourse, with less attention to noncoital sexual activity. This study examined how maternal factors influence the transition from virginity to noncoital behavior among White and Asian American youth who have never experienced vaginal intercourse. We conducted logistic regression analyses to examine whether traditional maternal predictors of coital sex were important in understanding noncoital sexual activity of these two populations. Waves 1 and 2 of the National Longitudinal Study of Adolescent Health were utilized. For White Americans (n = 3,926), direct and indirect maternal factors were associated with noncoital sexual involvement: maternal support, control, mother–child communication about sex, and adolescents’ perceptions of maternal approval of sex. In contrast, only maternal support was associated with the onset of noncoital sexual behavior for Asian Americans (n = 611). The study underscores the need to explore culturally specific factors that may influence Asian American adolescent noncoital sexual behaviors.

Pressure-group influence and institutional change: Branch-banking legislation during the Great Depression

Between 1931 and 1935 the change in the state laws governing the organizational structure of banking was significant. Twenty-two states relaxed restrictions over branch banking, even though many had previously prohibited it. We apply a model of pressure-group and rent-seeking behavior to investigate the reasons underlying this remarkable shift in the institutional arrangements for regulating the structure of the banking industry. The findings indicate that the extraordinarily high rate of bank failures tipped the political balance toward the pro-branching forces in many states. However, in a number of states growth in the influence of branch and group bankers and increases in urbanization were largely responsible for the relaxation of restrictions over branch banking.