Economic and Social Research Council, Medical Research Council, Department of Health, Jacobs Foundation, Nuffield Foundation.

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BackgroundEarly‐life institutional deprivation is associated with attention‐deficit/hyperactivity disorder (ADHD) later in childhood and adolescence. In this article, we examine, for the first time, the persistence of deprivation‐related ADHD into young adulthood in a sample of individuals adopted as young children by UK families after periods in extremely depriving Romanian orphanages.MethodsWe estimated rates of ADHD at age 15 years and in young adulthood (ages 22–25 years) in individuals at low (LoDep; nondeprived UK adoptees and Romanian adoptees with less than 6‐month institutional exposure) and high deprivation‐related risk (HiDep; Romanian adoptees with more than 6‐month exposure). Estimates were based on parent report using DSM‐5 childhood symptom and impairment criteria. At age 15, data were available for 108 LoDep and 86 HiDep cases, while in young adulthood, the numbers were 83 and 60, respectively. Data on education and employment status, IQ, co‐occurring symptoms of young adult disinhibited social engagement (DSE), autism spectrum disorder (ASD), cognitive impairment, conduct disorder (CD), callous‐unemotional (CU) traits, anxiety, depression and quality of life (QoL) were also collected.ResultsADHD rates in the LoDep group were similar to the general population in adolescence (5.6%) and adulthood (3.8%). HiDep individuals were, respectively, nearly four (19%) and over seven (29.3%) times more likely to meet criteria, than LoDep. Nine ‘onset’ young adult cases emerged, but these had a prior childhood history of elevated ADHD behaviours at ages 6, 11 and 15 years. Young adult ADHD was equally common in males and females, was predominantly inattentive in presentation and co‐occurred with high levels of ASD, DSE and CU features. ADHD was associated with high unemployment and low educational attainment.ConclusionWe provide the first evidence of a strong persistence into adulthood of a distinctively complex and impairing deprivation‐related variant of ADHD. Our results confirm the powerful association of early experience with later development in a way that suggests a role for deep‐seated alterations to brain structure and function.

The assessment of disability in dust diseases of the lung presents a problem of great practical importance.Available evidence indicates that disturbance of the alveolar respiratory component of pulmonary function is of importance in producing disability only in such diseases as pulmonary sarcoidosis and berylliosis (Ferris, Affeldt, Kriete, and Whitten berger, 1951) where there is a lesion of the alveolar epithelium. Much further work remains to be done before the importance of disturbance of the mixing component of pulmonary function in producing disability can be evaluated. Evidence is now available, however, that the principal cause of disability in dust diseases of the lung is disturbance of the ventilatory function (Baldwin, Cournand, and Richards, 1949; Gilson and HughJones, 1953). This is also true of asthma and to a large extent of emphysema.This paper is concerned with the assessment of the maximum ventilatory capacity, and presents a method of measuring this aspect of pulmonary function which has been used during the past three years in an out-patient clinic, and which has been found simple and practical.The oldest objective method for assessing the ventilatory capacity of a subject is the simple vital capacity measurement. This, however, is a static measure of volume and is an imperfect and often misleading index of the ventilatory function (Gilson and Hugh-Jones, 1949). To detect changes in the ventilatory capacity of individual subjects from day to day, and to detect differences between individuals, it is essential to measure the maximum ventilatory capacity. Since the work of f-Hermannsen (1933) It has been suggested (Kennedy, 1950) that a man's maximum voluntary ventilation or his maximum breathing capacity might be predictable from the analysis of his vital capacity tracings recorded on a fast-revolving kymograph. The remainder of this paper summarizes the development of this earlier work. APPARATUSA simple vital-capacity spirometer almost identical with that described by Gilson and Hugh-Jones (1949) has been used for recording the various respiratory tracings. The volume of the spirometer bell is roughly 6.5 litres. In order to minimize resistance to air-flow, a 2-in. diameter tube was used inside the spirometer and for the rubber connexion to the metal mouthpiece. The same electrical integrating device as described by Gilson and Hugh-Jones was used for measuring the volume of air breathed during voluntary hyperventilation. The spirometer bell was counterbalanced by means of a long, thin cylindrical weight which moved up and down within a hollow metal circular container. A small ink recording pen was fixed to this counter-weight so that movements of the spirometer bell could be recorded on a fastrevolving kymograph. Various speeds were tried, and it was found that a kymograph driven by an electric synchronous motor so that its drum periphery revolved at 1.24 cm. per second gave the most satisfactory result. The drum speed was checked by an electric time-marker, and was found to be uniform

(1974). Thorax, 29,[407][408][409][410][411][412][413][414][415][416]. Bronchiectasis: results of surgical and conservative management. A review of 393 cases. A consecutive series of 393 cases of bronchiectasis referred to a thoracic surgical unit has been followed up for one to 15 years. About two-thirds were managed surgically and one-third conservatively. The progress of the patients is analysed and the results of treatment are evaluated. The role of associated bronchitis is considered and indications for surgery are defined. It is our opinion that the current bias towards conservative management is unjustified.

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A B S T R A C THypothalamic-pituitary-adrenal (HPA) axis function is disrupted in institutionally-deprived children -reduced morning cortisol, flattened diurnal slope and blunted reactivity persist even after successful adoption into positive family environments. Here we test whether such effects persist into adulthood. Cortisol release across the day (sampled at awakening, 30 and 45 min later, and at four points across the day) was investigated in young adult adoptees who had lived in severe deprivation for up to 43 months in early childhood in Ceaușescu's Romanian orphanages and a comparison group of non-deprived UK adoptees (Total N = 57; mean age = 24 ± 0.9 years). The mediating role of cortisol levels on adult mental health was examined using data from standardized clinical assessments. Cortisol profiles were disrupted in the Romanian adoptees who experienced more than 6 months deprivation marked by a striking absence of the cortisol awakening response (CAR) and a significantly flatter cortisol curve until 1 h 15 min after awakening. Whereas institutional deprivation was associated with both cortisol secretion and emergence of emotional problems in young adulthood, path analysis revealed no evidence for a mediating role of CAR disruption in the sub-sample studied here. The results are in line with findings of HPA axis hypo-functionality following early adverse experience and provide strong evidence for long-term programming effects of HPA axis function through experience of institutional deprivation.

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