A high prevalence of neurodevelopmental disorders was found among low-income predominantly African-American psychiatric patients on Chicago's South Side. If replicated, these findings should bring about substantial changes in medical practice with African-American patients.

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Background: Sudden Cardiac Arrest (SCA) is a leading cause of global mortality. In India, 700,000 people die from SCA annually, many of which are under the age of 50. Immediate bystander CPR improves chances of survival, however, CPR education and training are difficult in a developing country such as India. In collaboration with University of Illinois Global Health Program, the Indian American Medical Association (Illinois), SHARE INDIA, and the American Heart Association we studied native rural Indian populations, hoping to enhance CPR education and skills training. This is the first rural community CPR project in India involving a university residency-training program from the USA. Methods: We conducted hands-only CPR training (based on the latest AHA guidelines) in the Telangana State in India, recruiting 582 participants with the help of local health outreach workers. A pre-training survey was used to assess baseline knowledge and impressions of CPR. This was followed by training in hands-only CPR consisting of an oral presentation followed by interactive CPR manikin training. A post-course survey was conducted after training. Chi square test and McNemar’s test were used for the analysis of data using SAS. Results: Of 582 participants, 65% were males and the mean age was 19.4 + 5.9. Gender was not associated with pre/post-test CPR knowledge, comfort with CPR, or belief in CPR efficacy. However, in paired analysis, there were significant differences (p<0.0001) in all knowledge and perception measures from pre-to-post training. While only 6% knew the correct compression rate pre-training, 96% knew the correct answer post-training (4% vs. 94% in females, 6% vs. 96% in males). Similar results were seen for the compression depth variable. Training also improved comfort level in performing CPR (64% vs. 87% in females and 70% vs. 89% in males) and belief that CPR can save lives (49% vs. 96% in females and 51% vs. 97% in males). Conclusions: The program was successful in enhancing knowledge, comfort, and perceptions of CPR. Given the high prevalence of SCA in India, training the public in hands-only CPR can be a cost-effective care strategy in resource-limited areas. Due to the success of this pilot, we are planning to continue the program.

When we saw the title of the Review and Overview article by O'Donnell and Meaney (1), "Fetal Origins of Mental Health: The Developmental Origins of Health and Disease Hypothesis," published in the April 2017 issue of the Journal, we were overjoyed because we thought this was indication that our field was finally getting a leg up on prevention. Although the thesis of the review was directionally correct (i.e., the quality of fetal growth and development predicting the risk for a range of noncommunicable, chronic illnesses), the review missed one of the most obvious causes of these problems: fetal alcohol exposure. We appreciated the discussion that fetal growth predicts risk for later psychopathology, such as attention deficit hyperactivity disorder (ADHD), but missing was one of the most common causes of low birth weight and prematurity: fetal alcohol exposure.Fetal alcohol exposure is one of the leading causes of intellectual disability and is associated with impairment in executive functioning, learning, memory, mood or behavioral regulation, attention, and impulse control. DSM-5 lists the prevalence of the proposed diagnosis of neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE) as between 2% and 5% in the United States. The problem has been found at even higher rates in other countries. For example, May et al. (2) found rates of ND-PAE of 18.2%225.9% in four rural communities in South Africa, and Fitzpatrick et al. (3) found rates of 12% in a rural Australian community. More disturbingly, we have found rates of 39% in a family medicine center on Chicago's South Side (4), and this research revealed that patients-whose mental health problems had fetal origins-were misdiagnosed as having bipolar disorder, depression, schizophrenia, and ADHD.To the authors' credit, they did briefly mention that children born small were likely to be born to mothers with high-risk lifestyles that include increased alcohol consumption. However, our study revealed that the vast majority of mothers who were caring for adult children with ND-PAE engaged only in social drinking before they realized they were pregnant (4). We hope this letter to the editor will place more emphasis on more common problems in life, such as ND-PAE.