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Older adoptive children have a need for continuity as well as permanency. Traditional closed adoption create an artificial emotional circumstances for older children who are asked to sever ties with meaningful persons. Open adoption may be a more realistic alternative, since older children have demonstrated their resourcefulness in circumventing placement plans that disrupt prior relationships.
Adoption workers who consider one goal of their work the prevention of emotional problems can help adoptive families and adoptees deal with the risks that are inherent in adoption.
The immunoprophylactic and immunotherapeutic effects of LAK cells transferred adoptively on L615-suffering mice were studied. The results showed that adoptive transfer of LAK cells could increase the survival rate of the mice and prolong the mean survival time of mice with advanced L615 leukemia. IL-2 in appropriate concentration was required in the adoptive immunotherapy, and the combined use of LAK cells with 5-FU or IFN-r had no additive immunotherapeutic effects. The results also revealed that the immunotherapeutic activity of the transferred LAK cells maintained a relatively long period of time in the host body.
Immunotherapy by adoptive transfer of lymphocytes was attempted in identical twins, one who was virus-free and the other who was infected with human immunodeficiency virus-1 (HIV-1), at the stage of acquired immunodeficiency syndrome. The noninfected twin was vaccinated by priming with a recombinant vaccinia virus expressing the envelope glycoprotein of one of his brother's viruses and boosting with the same purified gp160 adsorbed on alum. Vaccination elicited major histocompatibility complex class I-restricted CD8+ cytolytic T lymphocytes specific for HIV-1, but no antibody response. The diseased brother, a 38-year-old homosexual who had developed repeated opportunistic infections since 1990 and had a CD4+ count reduced to practically zero, was treated by infusions of lymphocytes collected from the vaccinated brother by lymphopheresis. After a first transfer of the whole lymphocyte population, no changes were observed in the clinical status and biologic or virologic parameters. A second transfer was then applied with activation of the cells with purified envelope glycoprotein before infusion. The outcome of the treatment was an increase in total lymphocytes, in CD4+ and activated CD8+ DR+ cell counts, and in proliferative responses to HIV antigens. A marked but transient 3-log increase in cellular and plasmatic virus loads was also observed after the second adoptive transfer. These observations will be considered with attention to improve the future adoptive transfer protocols, especially in patients with severe CD4+ depletion.
OBJECTIVE: To assess the neurodevelopment of adopted children who had been exposed in utero to cocaine. DESIGN: A case-control observational study. PARTICIPANTS: Twenty-three children aged 14 months to 6.5 years exposed in utero to cocaine and their adoptive mothers, and 23 age-matched control children not exposed to cocaine and their mothers, matched with the adoptive mothers for IQ and socioeconomic status. SETTING: The Motherisk Programme at The Hospital for Sick Children, Toronto, a consultation service for chemical exposure during pregnancy. MAIN OUTCOME MEASURES: Height, weight and head circumference at birth and at follow-up, and achievement on standard tests of cognitive and language development. RESULTS: Compared with the control group, children exposed in utero to cocaine had an 8-fold increased risk for microcephaly (95% confidence interval 1.5 to 42.3); they also had a lower mean birth weight (p = 0.005) and a lower gestational age (p = 0.002). In follow-up the cocaine-exposed children caught up with the control subjects in weight and stature but not in head circumference (mean 31st percentile v. 63rd percentile) (p = 0.001). Although there were no significant differences between the two groups in global IQ, the cocaine-exposed children had significantly lower scores than the control subjects on the Reynell language test for both verbal comprehension (p = 0.003) and expressive language (p = 0.001). CONCLUSIONS: This is the first study to document that intrauterine exposure to cocaine is associated with measurable and clinically significant toxic neurologic effects, independent of postnatal home and environmental confounders. Because women who use cocaine during pregnancy almost invariably smoke cigarettes and often use alcohol, it is impossible to attribute the measured toxic effects to cocaine alone.
In order to establish a more efficient and less toxic approach than lymphokine activated killer (LAK) cell in adoptive immunotherapy (AIT), tumor infiltrating lymphocytes (TILs) were isolated from operation and biopsy samples of 10 patients with bone metastatic tumor during 1990 approximately 1992. TILs activated and expanded in vitro were adoptively transferred to patients with bone metastatic lesions. Complete response in 1, partial response in 2, minor response in 3 and nonresponse in 4 patients with TILs immunotherapy were observed. The effective rate was 30%, P > 0.01. The results of this preliminary study indicate that adoptive immunotherapy with large number of TILs is an encouraging approach in the treatment of advanced neoplasm with bone metastasis.
This paper shows the psycho-sociological factors which have a serious negative impact on childless families, while stressing the importance of the family as basic environment for the development, education and socialisation of man. It presents numerous disorders which affect parentless children brought up in educational institutions. The solution advocated in this paper is prenatal adoption, which responds to the anguish of both childless families and the mothers of unwanted children. Prenatal adoption is also a significant area of medical activity involving great responsibility of the doctor as the first-contact person, who deals directly with the problems of lone pregnant women and abandoned children. The paper informs of the activities of the Prenatal Adoption Centre in Kraków as well as the idea that led to its formation.
A nationwide Finnish sample of schizophrenics' offspring given up for adoption was compared blindly with matched controls, who were adopted offspring of non-schizophrenic biological parents. The adoptive families were investigated thoroughly using joint and individual interviews and psychological tests. The biological parents were also interviewed and tested. Among the 155 index offspring, the percentage of both psychoses and other severe diagnoses (borderline syndrome and severe personality disorders) was significantly higher than in the 186 matched control adoptees. This supports a genetic hypothesis. However, notable differences between these two groups only emerged in the families which were rated as disturbed. Thus the genetic effect (i.e. the differences between high and low genetic propensity) was only manifested as a psychiatric disorder in the presence of a disturbed family environment. The impact of disturbed family relations was strongest in the presence of the appropriate genotype.
From a systemic viewpoint, communication and structure of adoptive families are analyzed. An isomorphism between the environment interaction with the adoptive family, and the different family subsystems was found out. Within such a conceptualization, the psychological vulnerability of adoptive children is studied.
Adolescent parenthood reduces the opportunities and optimal outcomes for both mother and child, yet pregnant teenagers rarely consider adoption. This paper reports a qualitative study that explored the reasons this option is so rarely examined. Twenty-one unmarried pregnant adolescents and their significant others were interviewed twice to determine the meaning adoption has for them. Four phenomena were found to be pivotal to the their willingness to consider adoption: (1) societal sanctions, (2) low level of knowledge, (3) anticipated psychological discomfort, and (4) lack of support from helping professionals. Information generated should be useful at health and social policy levels as well as to professionals who work with pregnant teenagers.
The increasing availability of donor insemination (DI) gives couples faced with male infertility a choice between DI and adoption, and for many, DI is now the preferred option. The results of a study of 54 couples who gave birth to a child or children by means of DI are presented both quantitatively and qualitatively, and show that most couples who have children by DI have considered adoption. Their reasons for choosing DI range from the practical to the emotional, from perceived negative aspects of adoption to perceived advantages of DI. This article discusses these perceptions and their implications.
Adoptive immunotherapy with immune T cells mediates regression of established tumors in animal models. We previously demonstrated that precursor lymphocytes of sensitized T cells can develop into mature effector cells after in vitro activation with anti-CD3 mAb and IL-2. We demonstrate here that tumor cells genetically modified to secrete IL-2 can enhance the precursor response in the tumor-bearing host and subsequently augment the antitumor efficacy of adoptive immunotherapy. MCA205 and MCA203, weakly immunogenic fibrosarcomas, were transfected in vitro with cDNA encoding for IL-2, IL-4, or IL-6. Lymph nodes (LN) draining these cytokine-producing tumors for 7 days were harvested, activated in vitro with anti-CD3/IL-2, and adoptively transferred into mice bearing established parental MCA205 pulmonary metastases. The effector cells generated from LN draining the IL-2 producing tumor exhibited enhanced antitumor activity compared with cells from LN draining parental, IL-4-producing, or IL-6-producing tumor. Phenotype analysis of cells from LN draining the IL-2-producing tumor revealed selective expansion of V beta 8+ cells. Depletion of V beta 8+ effector cells abrogated the antitumor efficacy indicating that V beta 8+ cells constituted the majority of antitumor reactivity and that secretion of IL-2 from tumor cells promoted the priming of V beta 8+ precursor cells, which can develop into mature effector cells. These results have important clinical implications that the method presented here could be applicable to the treatment of human cancer as more effective immunotherapy.
The adoption of black children by white families continues to garner significant attention from legislatures, the media, and scholars in many disciplines. Still, forensic psychiatrists have said little about this form of transracial adoption, and they seem willing to allow other disciplines to map out singlehandedly the public policy in this area. This policy is expected to affect an estimated 175,000 black children nationally who live in some form of out-of-home placement. Forensic psychiatrists should increase their understanding of and involvement in the debate over this special form of adoption. This article highlights several principles that must be better understood if forensic psychiatrists are to participate in the debate with clarity and understanding.
Previous experimental studies utilizing human recombinant interferon-alpha-2b (IFNalpha-2b) alone or with zidovudine (AZT) to treat established feline leukemia virus (FeLV) infection resulted in a significant reduction in circulating virus throughout a 49-day treatment period. However, the anti-FeLV effect of IFNalpha was limited by the production of IFNalpha-neutralizing antibodies detected 7 weeks after the start of treatment. AZT without IFNalpha had no effect on circulating virus load. To examine the hypothesis that combination chemoimmunotherapy might induce the clearance of FeLV infection, persistently infected cats were infused with activated lymphocytes, IFNalpha, and AZT 12 weeks after infection with FeLV. Recipient cats received weekly infusions of 1.46 x 10(8) lymphocytes activated in vitro with lectin/IL-2 comprised of 98% T cells and an even distribution of CD4+ and CD8+ lymphocytes. FeLV infection was cleared in 4 of 9 cats receiving combined therapy after four adoptive cell transfers. These cats remained negative for circulating virus during a 63-day treatment period (17 adoptive cell transfers) despite the production of anti-IFNalpha-neutralizing antibodies. Sequential development of virus-neutralizing and virus envelope antibody titers were detected in those cats which cleared retroviremia, an antiviral response that was absent in untreated control animals or nonresponders. Three of four responder cata remained negative for FeLV 95 days after treatment was discontinued. Treatment of cats with lymphocytes without chemotherapy failed to influence the course of FeLV infection. These results suggest that combined treatment using IFNalpha and adoptive lymphocyte transfer served to reconstitute antiviral humoral immunity, counteract immunosuppression, and induce the reversal of retroviremia.
The old polynesian custom of giving a child persits. One child in three or four is asked for and adopted (Fa'a'amu). It was not officially recognized, which had no disadvantage as it was between Maoris and inside enlarged polynesian families. But quick acculturation and urbanization, social and economical changes of the past ten years have changed all that. The contradiction between french law and tahitian traditional customs exposes these fa'a'amu children, with no legal statute and without judicial protection, to many drawbacks. First in their tahitian families because they get no family allowances. On the other hand some Europeans wishing to adopt children take often advantages, though it is illegal, of the generosity of the prolific tahitian women (no contraception in Tahiti) who seldom refuse giving children to a European, without understanding clearly that complete adoption (european model) cuts every tie with the biological family (Fanau). The illegal appropriation of these children sometimes leave them deprived of statute and legal protection in Europe (or America, or even Japan?). We have here an exemple of what happens when two cultures meet, whose customs and values are totally different.
The observation that schizophrenia is more commonly observed among the relatives of individuals with schizophrenia than in the general population does not indicate the mechanism that produces such familiality occurs. Adoption designs permit evaluation of the role of genetic factors in schizophrenia independently of the influence of family environments. Results from studies of adoptees with schizophrenia and their biological and adoptive relatives indicate that genetic factors play a highly significant role in the risk for schizophrenia. This genetically mediated risk to relatives includes an increased prevalence of both schizophrenia and a nonpsychotic syndrome analogous to schizophrenia, but does not represent a general liability to other forms of psychopathology. Although adoption studies have convincingly demonstrated an important role for genetic factors in schizophrenia, the necessity and specificity of such factors, their precise identity, and their interaction with environmental influences remain unknown.
INTRODUCTION: On-line continuing medical education (CME) provides advantages to physicians and to medical educators. Although practicing physicians increasingly use on-line CME to meet their educational needs, the overall use of on-line CME remains limited. There are few data to describe the physicians who use this new educational medium; yet, they clearly are the innovators and early adopters who will facilitate the growth of this educational technology. It would be useful to instructional designers and CME developers to better understand the characteristics of this influential group. METHODS: We studied the actual use of several different on-line CME programs within three different groups of physicians. The on-line programs were developed as part of research studies funded by the National Institutes of Health, with no relationship to commercial interests. They were presented to physicians using mass mailouts (two physician groups) or personal contact and were accompanied by incentives to reduce resistance to the new technology. We compared the characteristics of physicians who chose to use these on-line programs with demographic data from larger populations representing the groups from which these users originated. RESULTS: We found that physicians who used these on-line CME programs were younger than average and, importantly, more likely to be female than expected. This finding was consistent across different types of physician populations and different types of CME programs. DISCUSSION: Based on data reflecting actual use of on-line CME, younger physicians appear to be adopting on-line CME more rapidly than others, and women physicians appear to be adopting on-line CME at a faster rate than their male counterparts. This latter finding conflicts with the impression provided by some survey-based studies that male physicians are more likely than female physicians to use on-line CME. The data suggest that the growth of on-line CME is most likely occurring in diffusion networks dominated by relatively new medical school graduates and, possibly, women physicians. These results provide valuable insight to those who seek to develop and market on-line CME and those who seek to reach women physicians with CME programs.
Animal models have demonstrated that syngeneic lymphocytes activated ex vivo and infused into animals with experimentally induced tumors can mediate tumor regression. This "adoptive immunotherapy" has been applied to patients with end-stage malignancy refractory to standard therapy. Lymphocytes are collected with the blood cell separator, expanded in culture under the influence of cytokines such as interleukin-2 (IL-2), and reinfused into the patient under conditions similar to those used in the animal models. Studies from several centers using lymphokine-activated killer (LAK) cells, involving more than 300 patients, have shown an overall response rate of greater than 15% and a complete response rate of approximately 10%. Renal cell carcinoma, melanoma, and lymphoma appear to be the cell types that respond best to such therapy. Toxicity in these phase 1 studies has been substantial, related primarily to high doses of intravenous IL-2, and treatment-related deaths have been reported. Adoptive immunotherapy using lymphocytes derived from surgically excised tumors, tumor-infiltrating lymphocytes (TIL), is in the early stages of clinical trials, but this appears to offer a potentially more potent and specific approach than does LAK cell therapy. TIL have been shown to traffic to tumor sites and mediate tumor regression. The mechanisms of adoptive immunotherapy are poorly understood, but blood cell separators and storage technology are playing a critical role in the collection and processing of cells for these research applications.