Adolescents as mothers: An interdisciplinary approach to a complex problem

Pregnancy among adolescents, and especially among low-income adolescents, represents a high-risk situation from multiple points of view. When compared to data for the population at large, obstetrical outcome is worsened, subsequent educational attainment is poor, social prognosis is guarded, and repeat unwanted pregnancies are common. The surviving infants, similarly have relatively high incidences of medical and developmental problems. In recent years, comprehensive interdisciplinary programs have been organized to offer more meaningful help to these individuals. The present report describes the authors' 5-year experience with one early intensive program. Considerable medical, educational, and social successes have been noted. The results are especially striking when contrasted with the authors' current experience with an improving but still more fragmented and less successful program. Findings concerning infant development and the mother-infant interaction are also noted. Finally, issues related to the achievement of successes and the persistence of problems after provision of more adequate comprehensive services are discussed.This study was supported in part by Grant No. 03-H-000-079-03-0, Maternal and Child Health Service, H.S.M.H.A., H.E.W.While on the faculty of the State University of New York, College of Medicine at Syracuse, was a founder and the first medical director of the YMED program.Specialty is Developmental Psychology, and research interests concern infant and early child development and the effects of children on parents. While on the faculty of Cornell University, served as a consultant to the YMED program.Project director of the high-risk program.While on the faculty of the State University of New York, College of Medicine at Syracuse, was obstetrical director of the YMED program.     

Tramadol (Ultram) concentrations in death investigation and impaired driving cases and their significance

We reviewed a series of 66 deaths in Washington State between 1995-2000 in which tramadol (Ultram and Ultracet, Ortho-McNeil) was detected in the decedent's blood, in order to assess the role tramadol was determined to have played. Additionally, we reviewed a series of 83 impaired driving cases in which tramadol was detected in order to establish a non-lethal blood tramadol concentration reference range. In both populations, tramadol was consistently found together with other analgesic, muscle relaxant, and CNS depressant drugs. Death was rarely attributable to tramadol alone. However, tramadol may be a significant contributor to lethal intoxication when taken in excess with other drugs, via the potential interaction with serotonergic antidepressant medications, as well as the potential for increased CNS depression. Although the incidence of tramadol detection has increased consistently over the last eight years, there is no evidence of a corresponding increase in the number of cases in which death was attributed solely to tramadol. Blood drug concentrations in many deaths exceeded the therapeutic serum range of 0.28-0.61 mg/L; however, the concentrations overlapped almost completely with the range identified in living subjects arrested for impaired driving. These findings suggest caution in the interpretation of blood tramadol concentrations outside of the recognized therapeutic range. It also suggests that the drug, even when used in moderate excess, is not a principle cause of death in suicidal or accidental deaths.