Hormone replacement therapy use dramatically increases breast oestrogen receptor expression in obese postmenopausal women

BACKGROUND

It is known that use of hormone replacement therapy (HRT) by postmenopausal women increases the risk of breast cancer.

METHOD

In this study, oestrogen receptor (ER)-alpha expression is examined using standard immunoperoxidase technique.

RESULTS

Normal breast samples of 11 Australian postmenopausal women have been included in the ER-alpha study; the result showed a strong correlation (r(2) = 0.80) between ER-alpha expression in normal breast epithelial cells and body mass index (BMI) in normal women who currently use HRT.

CONCLUSION

This finding confirms that the possibility of increased risk of breast cancer associated with increased ER-alpha expression in normal breast epithelial cells, in turn associated with high BMI and the use of HRT.

Characteristics of responders and nonresponders to brief-pulse right unilateral ECT in a controlled clinical trial

In a double-blind, randomized controlled study of electroconvulsive therapy (ECT) in patients with major depression, 7 of the 17 patients allocated to the right unilateral group failed to respond to treatment. The nonresponders were subsequently openly treated with bitemporal treatment, which produced an acceptable outcome in these cases of right unilateral treatment failure. This paper describes the clinical outcome, electrophysiological characteristics (impedence, estimated seizure threshold, and change in threshold), and the degree to which stimuli exceeded threshold in the responder and nonresponder groups. Responders had lower seizure thresholds and longer seizures than nonresponders. In comparison with nonresponders, responders showed trends toward greater impedance and treatment at a somewhat greater degree above threshold during the first few treatments. Threshold change with treatment was found not to be related to clinical outcome. Early identification of patients likely to respond to low-dose right unilateral ECT, together with the avoidance of benzodiazepine prescription during ECT, may permit many patients to receive low-dose right unilateral ECT successfully and with a minimum of cognitive impairment.

From Bittner to Barr: a viral, diet and hormone breast cancer aetiology hypothesis

It is hypothesized that the human homologue of the mouse mammary tumour virus (HHMMTV) and other viruses, such as human papillomavirus (HPV) and Epstein-Barr virus (EBV), act as cofactors with diet, oestrogens and other hormones in the initiation and promotion of some types of breast cancer in genetically susceptible women. It is further hypothesized that diet influences the risk of breast cancer, through its influence on oestrogen metabolism and that of other hormones, in combination with genetic and infectious agents.

Successful use of propranolol in migraine associated with electroconvulsive therapy

To date, there have been no reports on the use of propranolol in electroconvulsive therapy (ECT)-induced migraine; we describe a 32-year-old woman who was successfully treated with propranolol for this condition. Over a course of ECT, the patient developed increasingly severe migraine which was refractory to treatment with acetaminophen, codeine, and naproxen. Sumatriptan did not relieve the headache and aggravated the nausea. Successful migraine relief was achieved with a combination of propranolol and naproxen, administered before and after ECT. Propranolol reduced blood pressure and decreased the heart rate, measured before and immediately after ECT. Propranolol, possibly in combination with naproxen, may be useful in both acute and prophylactic treatment of post-ECT migraine.

Electrical dose and seizure threshold: relations to clinical outcome and cognitive effects in bifrontal, bitemporal, and right unilateral ECT

In patients allocated blindly and randomly to receive bitemporal, right unilateral, or bifrontal electroconvulsive therapy, seizure length, electrophysiologic characteristics (dynamic impedance, seizure threshold, and changes in threshold), and the degree of suprathreshold stimulation were recorded. The relations of these variables to clinical outcome and cognitive effects were determined. There were no differences in seizure length between groups, and there were no significant correlations between seizure length and any measure of clinical response. There were substantial differences between the groups in mean charge per treatment, with the right unilateral group receiving lower doses than either bilateral group. Convulsion time was inversely related to applied charge and the rate of increase in charge. There were no significant correlations between impedance, charge, energy, or rate of increase in charge on the one hand, and clinical improvement on the other. The increase in threshold during the course of treatment was not related to clinical change. Cognitive impairment was related to electrical dose only in the bifrontal group, which showed the least degree of treatment-induced intellectual dysfunction. Compared with bitemporal or right unilateral treatment, bifrontal electroconvulsive therapy yields the best ratio of benefits to side effects and should be given at threshold level to minimize cognitive loss.

Thyroid function and response to 48-hour sleep deprivation in treatment-resistant depressed patients

BACKGROUND

Clinical depression is associated with abnormalities of the hypothalamic-pituitary-thyroid axis. Changes in thyroid function during sleep deprivation may be related to its antidepressant effects.

METHODS

Levels of thyroid-stimulating hormone, tri-iodothyronine, tri-iodothyronine uptake, thyroxine, and free thyroxine were measured before, during, and after a 48-hour sleep deprivation in nine treatment-resistant depressed patients. Clinical state was assessed every 4 hours. A retrospective study of 26 similar patients was added for cross-validation.

RESULTS

Significant increases in thyroid-stimulating hormone and tri-iodothyronine during sleep deprivation were not correlated with clinical improvement. Sleep deprivation responders had lower tri-iodothyronine uptake levels than nonresponders in both the prospective (p <.02) and the retrospective (p <.03) samples.

CONCLUSIONS

The lower tri-iodothyronine uptake values in responders may identify a subgroup of depressed patients who respond to sleep deprivation by virtue of some abnormality of the hypothalamic-pituitary-thyroid axis that is temporarily corrected by sleep deprivation.

Low oestrogen receptor alpha expression in normal breast tissue underlies low breast cancer incidence in Japan

Among white Australians without breast cancer, the median of the percentage of oestrogen receptor alpha positive cells was 12% for women younger than 50 years and 17% for those 50 years or older; among Japanese women who had no breast cancer and are generally at low risk for this disease, the corresponding values were both significantly lower and around 9%.

The link between socioeconomic status and breast cancer--a possible explanation

The aim of this ecological study was to explore possible associations between childhood nutrition and breast cancer. The study compared heights and weights of children of different socioeconomic status and subsequent breast cancer risk in Queensland, Australia. In 1950 12-year-old girls from families of high socioeconomic status were 3 cm taller and 6.6 kg heavier than girls of the same age of lower socioeconomic status. Approximately 35 years later, age standardized mortality rates for breast cancer among all Queensland women were approximately 10% higher for women of high compared with low socioeconomic status. Taking into account the limitations of ecological studies and risk factors other than nutrition, these results are compatible with the hypothesis that there is an association between childhood nutritional experiences and subsequent risk of breast cancer.

The link between socioeconomic status and breast cancer-a possible explanation

The aim of this ecological study was to explore possible associations between childhood nutrition and breast cancer. The study compared heights and weights of children of different socioeconomic status and subsequent breast cancer risk in Queensland, Australia. In 1950 12-year-old girls from families of high socioeconomic status were 3 cm taller and 6.6 kg heavier than girls of the same age of lower socioeconomic status. Approximately 35 years later, age standardized mortality rates for breast cancer among all Queensland women were approximately 10% higher for women of high compared with low socioeconomic status. Taking into account the limitations of ecological studies and risk factors other than nutrition, these results are compatible with the hypothesis that there is an association between childhood nutritional experiences and subsequent risk of breast cancer.

Reading disability subtypes and the test of memory and learning

For Study 1, 24 readers with dysphonetic dyslexia and 21 with dyseidetic dyslexia, classified by Boder criteria, were compared to 90 control group participants (45 matched for age and 45 for reading level) on the Composite Memory Index (CMI) score from the Test of Memory and Learning (TOMAL). CMI scores were significantly lower for children with dyslexia (p <.0001). Plotting average subtest score profiles for all reader groups revealed auditory sequential memory impairments for both types of readers with dyslexia, and multiple strengths for good readers. Dysphonetic and dyseidetic dyslexia profiles were nearly identical. For Study 2, average linkage cluster analysis was performed using principal components derived from subtests of the TOMAL. Homogeneous clusters of normal readers and children with reading disabilities emerged. Results indicated that qualitatively distinct subtypes of readers with dyslexia exist.

Do QEEG topographic map data have a multivariate normal distribution? Implications for tests of individual maps

The study was designed to test whether topographic map data expressed in log power units have a multivariate normal (MVN) distribution in a healthy population, and to determine if any deviation from normality poses serious difficulties for the use of standard multivariate statistical tests in assessing the significance of deformations of the map in individual cases. Data on 361 healthy adults using 20 electrodes in the classic 10/20 configuration were recorded in six frequency bands. The log-transformed power data were shown to deviate markedly from MVN. The actual distributions of multivariate tests were computed for the sample using the 'jackknife' method, and shown to deviate markedly from the F-distributions that would be expected for MVN data. These 'jackknife' sampling distributions were then used to demonstrate significant deformations in the topographic maps of a patient who had sustained traumatic head injury.

Severe cervical spinal cord injuries related to rugby union and league football in New South Wales, 1984-1996

OBJECTIVE

To determine the frequency and circumstances of serious cervical cord injuries associated with rugby union and league football in New South Wales.

DESIGN

Retrospective review of patients with rugby football-related cervical spinal cord injuries.

SETTING

The two central spinal units in NSW, from January 1984 to July 1996.

OUTCOME MEASURES

Admission to spinal units; injury resulting in permanent tetraplegia.

RESULTS

During the review period, 115 rugby football players (56 union and 59 league) were admitted to the spinal units because of cervical spinal cord injuries. 49 patients had resultant permanent neurological deficits (complete tetraplegia [quadriplegia])--26 associated with rugby union and 23 with rugby league. Two patients died of injury sequelae within two weeks of admission. There was no significant change in the rate of football-related admissions to spinal units for either code. There was a small decline in the number (from 15 in 1984 to 1987 to 7 in 1992 to 1996) and incidence (from 1.2 to 0.5 per 10,000 participants) of patients with tetraplegia associated with rugby union. When this decline was tested as a trend over the years, it was found to be statistically significant (P = 0.06). No significant trend was found in the tetraplegia data associated with rugby league. Cervical spinal cord injuries leading to complete tetraplegia were most commonly associated with scrum-like plays in union and with tackles in league.

CONCLUSION

Serious cervical spinal injuries associated with both codes of rugby continue to occur in NSW. Rugby football in its various forms is still an inherently dangerous game.

Long-term care: the Australian experience

Mainly because of migration of young people, the Australian population is young in comparison with the population of other economically developed countries. Fragmentation and excessive reliance on institutions of care of handicapped and elderly people have led to efforts at coordination of services, quality assurance, and a balance between institutional and community-based services.

Catastrophic injuries to the eyes and testicles in footballers

OBJECTIVE

To report the occurrence of uncommon but catastrophic eye and testicle injuries to rugby league and rugby union footballers in New South Wales.

METHODS

A retrospective review of players who had permanent football-related injuries and who claimed financial compensation from a voluntary sports injury insurance scheme from 1978-1994.

RESULTS

An average of 100 000 rugby league and rugby union players per year were registered with the insurance scheme in NSW. As a consequence of playing football, 15 players lost 90%-100% vision in one eye, five lost 75% vision in one eye, four lost 50% of vision in one eye and two lost 75% vision in both eyes. Eye injuries were caused by "gouging" with fingers, kicks, or blows from fists, elbows and knees; five cases appeared to be intentional. Fourteen players had testicular injuries: in 11 players this resulted in complete loss of one testicle, and in three partial loss of one or both testicles. The immediate cause of the injuries to the testicles was kicking and kneeing, usually during tackles; at least three of the injuries appeared to be intentional.

RECOMMENDATIONS

Rules relating to tackles, kicks and other assaults to the head or groin should be strengthened and policed. Officials, players, parents and the public should be educated to support this.

Are the renal effects of lithium modified by frequency of administration?

It has been claimed that the unwanted effects and toxicity of lithium can be minimized by changes in the dosing schedules. Twenty consecutive psychiatrically stable patients were investigated in a cross-over study to determine whether renal function and other biochemical tests change significantly with changes from once to twice or multiple doses per day or vice versa. There were no significant differences between the 3 study conditions on the mood rating scales or a side effect scale (UKU). Urine volume, test of renal function and other biochemical and hematological indices were similar in all study conditions. We thus conclude that dosing strategy does not consistently affect renal function in lithium-treated patients.

Prevalence of dissociative symptoms and disorders in an adult psychiatric inpatient population in Canada

OBJECTIVE

This study attempted to estimate the prevalence of dissociative symptoms and disorders in a Canadian adult psychiatric inpatient population and also attempted to determine the extent to which dissociative disorders were recognized by the attending clinical staff.

METHOD

All appropriate and consenting adult psychiatric inpatients at the Kingston Psychiatric Hospital in Kingston, Ontario, were given the Dissociative Experiences Scale. Patients scoring 25 or greater were interviewed with the Dissociative Disorders Interview Schedule and the Structured Clinical Interview for DSM-IV Dissociative Disorders. Admission or discharge diagnoses data were used to determine whether or not dissociative disorders were being recognized.

RESULTS

A total of 48 patients completed the Dissociative Experiences Scale and 14 (29%) scored 25 or greater. The prevalence of dissociative disorders in this hospital population was estimated to be 17%. Dissociative identity disorder was found in six percent, dissociative amnesia in eight percent and dissociative disorder not otherwise specified in two percent of the population. These disorders tended to be under-recognized.

CONCLUSION

Research on more extensive populations is required to establish the true prevalence of dissociative symptoms and disorders in psychiatric inpatients.

Education for health services management: a graduate student survey of an Australian program

This article reports the results of a study which was designed to evaluate a revised Master's of Health Administration program in the School of Health Services Management at the University of New South Wales, Australia. The original program was established in 1956; during the 1970s, humanities-based subjects such as sociology and quality assurance were added to the traditional financial and management subjects. During 1987-88, health-oriented subjects such as public health and epidemiology were included as compulsory subjects. To assess the program, a cross-sectional study of 1990 to 1992 graduates was undertaken. The study revealed that students found that the traditional financial and management subjects and the health-related subjects were useful to their jobs. The study also demonstrated significant career advancement for a majority of graduates. Two-thirds of the respondents stated that their initial objectives for enrolling in the course had been met.

A comparison of costs in Australian public teaching, public non-teaching and private hospitals

This paper compares costs for caring for patients according to common diagnosis groups in Australian public teaching, public non-teaching and private hospitals. Generally, the costs for general surgical procedures are highest in public teaching hospitals, followed by public non-teaching hospitals, and are lowest in private hospitals. However, the private sector is more expensive than the public sector for obstetric activities. The reasons for the differences appear to be the much higher 'overheads' in the public sector than in the private sector, and the longer hospital stay for obstetric patients in private hospitals. Managers of individual hospitals should examine the data in detail to determine if alternative approaches are appropriate.

Difficulties in the transition from clinician to manager

Medical clinicians have for many years been managers. However, this management role has most often been in groups of other clinicians and other health personnel. Only recently have increasing numbers of medical clinicians been asked to accept responsibilities for managing hospital and health services divisions that carry financial and administrative responsibility in addition to traditional clinical responsibility. In these circumstances, it is appropriate to seek to gather information about the various issues that surround the transition from clinician to manager in a systematic way and to begin to explore the issue and any actions that might be taken to ameliorate transitional problems. Such a study was undertaken by the School of Health Services Management at the University of New South Wales, Sydney, Australia, and is reported in this article.

Health status differentials in the People's Republic of China

OBJECTIVES

This study sought to demonstrate that health status varies markedly in different parts of China.

METHODS

The main source of data was statistics compiled by the Chinese Ministry for Public Health for 1978 to 1990 regarding causes of death. However, because mortality statistics in China are based on localities that have the capacity to provide data, they are not entirely representative. The international classification of disease categories was also used, together with anatomically based disease descriptions. Rates were calculated using the 1982 and 1990 population censuses.

RESULTS

Death rates differ markedly between urban and rural areas. Deaths due to infectious diseases, respiratory diseases, pregnancy and childbirth, and injuries and poisoning are much higher in rural areas; those due to pertussis, dysentery, typhoid, hepatitis, rabies, and anthrax are much more common in the apparently poorer provinces. Schistosomiasis remains a major problem in some provinces. Goiter and cretinism are still major diseases in many parts of China, especially those areas with iodine deficiency.

CONCLUSIONS

Cause-of-death patterns in Chinese cities are similar to those of industrially developed countries such as Australia, Japan, and the United States. Such patterns in the poorer rural areas are much more typical of those of developing countries.

Lessons from the Australian system

International experiences are becoming more relevant as the Clinton Administration searches for answers to America's health care problems. While interest is focused on the Canadian and European experiences, a brief look at far away Australia offers some potentially useful insights.

Socioeconomic status: the prime indicator of premature death in Australia

The link between socioeconomic status and health has long been recognised. This study of deaths among Australian men aged 15-59 years demonstrates that during the 20-year period, 1966-86 the number of premature deaths was dramatically reduced among all socioeconomic groups, primarily as a result of falls in death rates due to heart disease, stroke and trauma. However, the marked differences in death rates according to social class remain, to the extent that if men of all social classes had the same mortality experiences as professional and technical workers the overall death rates for Australian men would be reduced by 60%. Socioeconomic status is the most important indicator of health status among Australians.

Therapeutic advantage of bifrontal electrode placement in ECT

Fifty-nine patients suffering from a major depressive episode, for whom electroconvulsive therapy (ECT) was clinically indicated, were randomly assigned to one of three electrode placement groups for treatment with brief pulse, threshold-level ECT: bitemporal (BT), right unilateral (RU) or bifrontal (BF). Comparison of these groups in terms of number of treatments, duration of treatment, or incidence of treatment failure, showed that the bilateral placements were superior to the unilateral; comparison of Hamilton, Montgomery-Asberg, and visual analogue scale scores showed that the bifrontal placement was superior to both bitemporal and unilateral treatment. Bitemporal treatment showed therapeutic results intermediate between BF and RU. Because BF ECT causes fewer cognitive side effects than either RU or BT, and is independently more effective, it should be considered as the first choice of electrode position in ECT.

Medicare related payments to Australian medical practitioners

This article analyses Medicare payments to doctors, both general practitioners and specialists. Although these payments represented approximately $4.5 billion in 1991-92, there has been little public analysis of the breakdown of these payments to different medical specialties and general practitioners. These payments are just one source of income for many doctors. Information on practice costs is also presented to give an indication of the size of doctors' net incomes. A comparison is also made between doctors' incomes and taxpayers in general.

Lithium treatment: a comparison of once- and twice-daily dosing

The effects of once- and twice-daily dosing with lithium carbonate were compared in a non-blind, cross-over study on 20 consecutive patients with mood disorders. Mental status, side effects and target organ function were examined after a minimum of a 1-month treatment with each regimen. Eighteen patients completed the study and 2 withdrew because of side effects. There were no significant differences between the 2 groups on the Hamilton Rating Scale for Depression, the Bech-Rafaelsen Mania Scale, the UKU Side Effects Scale or in serum lithium, electrocardiogram and urine volumes. Most blood tests showed no significant difference between the 2 treatment schedules except for white blood cells, ionized calcium and phosphate concentration. The once-daily regimen was associated with a higher white cell count, increased serum phosphate and elevated serum ionized calcium. We conclude that patients are able to tolerate once-daily dosing with lithium carbonate as well as twice-daily dosing.

Recreating the village: the development of groups to improve social relationships among mothers of newborn infants in Australia

There is a clear link between social relationships and health in terms of both morbidity and mortality. The study was conducted during 1989 and 1990 among mothers of newborn infants from a middle-ranking socioeconomic status suburb in Sydney (Ryde). Thirty-four per cent of the study group had a moderate level of social isolation and 16 per cent had a high level of social isolation. These mothers strongly valued participation in the groups: virtually all original participants remained with the group both during a five-week formal period with a nursing staff member as the leader and during months and up to five years of continued meetings. The outcomes appear to be favourable in terms of the development and continuation of strong interpersonal relationships among members of the group and by improved confidence and knowledge about infant rearing. The development of groups of mothers adds no cost to the provision of health services and provides a sound and practical way of reducing social isolation and increasing mothercraft skills in an Australian suburb.

Vasopressin in chronic psychiatric patients with primary polydipsia

Twelve chronic in-patients with primary polydipsia were studied, during free drinking and after fasting, by concurrent measurements of plasma AVP, serum sodium and osmolality, and urine volume, AVP, osmolality, and creatinine. A majority of the patients showed inappropriately high levels of AVP: plasma AVP estimations demonstrated that seven had Type I SIADH and two had Type II SIADH. Urinary AVP estimations confirmed inappropriately raised AVP in seven of the subjects tested, and there was a significant agreement between the plasma and urine diagnoses. Although able to concentrate their urine in response to fluid deprivation, the patients showed a decreased renal sensitivity to AVP. Despite the mitigating effect of decreased renal sensitivity to AVP, the SIADH seen in these patients appears to contribute to the development of water intoxication caused by polydipsia.

Electrode placement in ECT: cognitive effects

Forty patients suffering from a major depressive disorder, for whom electroconvulsive therapy (ECT) was clinically indicated, were assigned to one of three electrode placement groups: bitemporal (BT), right unilateral (RU) or bifrontal (BF). Comparisons of these groups in terms of cognitive status showed that the BF placement, which avoided both temporal regions, spared both verbal and nonverbal functions. These differential effects, which were independent of the degree of clinical depression, were not, however, evident three months after the last ECT.

Prophylactic medication for unipolar depressive illness: the place of lithium carbonate in combination with antidepressant medication

A meta-analysis of the controlled clinical trials comparing the efficacy of combined lithium-imipramine therapy with each drug alone in the prevention of relapse in patients with unipolar depressive illness shows the combination to be superior to lithium alone (for any relapse, p less than 0.05; for specifically depressive relapse, p less than 0.025) and imipramine alone (for any relapse, p less than 0.025; for specifically depressive relapse, p less than 0.05). The issue of statistical power in studies of this kind is discussed. A single case of unipolar depressive illness is described, in which combined lithium-tranylcypromine therapy was superior to either drug alone. A combination of lithium and an antidepressant should be considered for any patient suffering from this condition who fails to remain well on either drug alone.

Osteopenia, pathological fractures, and increased urinary calcium excretion in schizophrenic patients with polydipsia

Ten male chronic schizophrenic patients with polydipsia and 10 nonpolydipsic controls, matched for gender, diagnosis, duration of illness, age, and race, were studied by dual- and single-photon absorptiometry to estimate bone density of the lumbar spine and radius and by 24-hr urine collections to estimate urinary electrolyte excretion. Bone density was normal in the control group, but was abnormally low in the polydipsic group, which had a markedly increased incidence of fractures. Electrolyte excretion was normal in the control group and in the polydipsic group when water intake was restricted to normal amounts; increased urinary sodium and calcium excretion occurred in proportion to polydipsia. As polydipsia is associated with a number of physiological changes, the cause of the osteopenia is unclear; we suggest that a negative calcium balance caused by increased urinary calcium excretion induced by extracellular space expansion may play an important role in the causation of the skeletal changes.

Day care: can it prevent readmission to a psychiatric hospital?

This report concerns the readmission rate for patients involved in Day Care programs at Kingston Psychiatric Hospital. Readmissions were counted for a 3 year period, and results compared with groups of patients who did not attend Day Care. Seventy-three percent of the Day Care Group were readmitted within 3 years as compared to 45% of the main Control Group; however, the Day Care Group had the lowest mean number of readmissions, 1.08, as compared to the Control Group, with 1.25. The relative merits of these two ways of measuring admission rates is discussed in relation to the search for valid outcome criteria. The results were interpreted to indicate that Day Care and related support services help ensure that readmission only occurs in the event of a serious exacerbation of the psychiatric state.

Capillary gas chromatography of trihexyphenidyl, procyclidine and cycrimine in biological fluids

A sensitive (50-100 pg/ml) method is described for the analysis of the anticholinergic drugs cycrimine, procyclidine and trihexyphenidyl by capillary gas chromatography with flame thermionic detection. Since these anticholinergic drugs are frequently administered in combination with antipsychotic medication for the treatment of mental illness, the potential interference by antipsychotic drugs in this assay was examined. No interference was observed from a series of antipsychotic drugs in the quantitation of cycrimine, procyclidine or trihexyphenidyl. The use of this technique to study trihexyphenidyl pharmacokinetics in man is described.

Learning disability in adults: a comparison of two indices of differential cognitive impairment derived from the Wechsler scales

Two indices descriptive of patterns of differential cognitive impairment have been derived from principal component analyses of the normative data of the Wechsler scales for adults (WAIS-R) and children (WISC-R), respectively. The former index is sensitive to the test-specific cognitive effects of unilateral cerebral damage in adults. The latter accurately describes the pattern of subtest scores produced by learning-disabled children. The present study reviews the available WAIS and WAIS-R data from adults with learning disability in order to determine which of these two indices more precisely delineates their pattern of test performance; the index derived from the children's test appears to be the one best able to do so.

Factorial verbal and performance IQs derived from the WISC-R: their psychometric properties

A method is discussed for securing Factorial Verbal and Factorial Performance IQs from the WISC-R by means of an orthogonal rotation of the axes that describe the plane of the first two principal components derived from an analysis of the intercorrelations of the WISC-R subtests. The reliability and validity of these IQs also are described. Sex differences in normal children are found, as well as differences between normal and learning-disabled children.

Research note: a learning disability index (LDI) derived from the WISC-R: age differences in referred children

A learning disability index (LDI) based on a principal components analysis of the WISC-R normative data has been developed to depict verbal or nonverbal deficits on that test. This index was calculated for the individual test performance of a total of 1371 children referred to a school-board psychology service because of educational difficulties. These children, categorised by sex and age, returned mean scores on this index that were reliably different from the scores of the normative population only after the age of 8 years in the case of the boys, and 7 years in the girls. This cross-sectional age effect was confirmed by longitudinal data obtained from the test-retest scores of a subset of these children.

Environmental control systems in chronic care hospitals and nursing homes

Fifteen severely disabled people residing in institutions were provided with a simple environmental control system which performed five different functions. The disabled people used the equipment an average of ten times a day. Two hours of nursing care by nursing staff would have been required to perform these functions. The cost of the equipment was $1.35 a day. Both the residents and the nursing staff reacted favorably to this innovation. The main benefits which resulted were a heightened sense of independence on the part of the disabled people and a reduction of frustration levels of both the residents and the nursing staff. A considerable savings in nursing care was also achieved.

Sexual dysfunction in stroke patients

The impact of cerebrovascular accident (CVA) on sexual behavior in stroke patients was studied in 113 patients (78 men, 35 women). Seventy-five patients were interviewed with their spouses present. The mean age of the men and women patients was 68.6 years and 68.0 years respectively. Significant decline in libido after stroke was reported by both men and women. The men had a significant decrease in ability to achieve erection and to ejaculate in the period after stroke. Similarly, significant problems were reported by the women regarding normal vaginal lubrication and orgasm after CVA. Sixty-six men (84%) and 21 women (60%) enjoyed their sex lives before their stroke as compared to only 23 men (30%) and 11 women (31%) after stroke. Seventy-four men (95%) and 27 women (76%) were satisfied with sexual activity before their stroke as compared to only 20 men (26%) and 13 women (37%) after stroke. Women patients with right-sided lesions had lesser decline in sexual function than women with left-sided lesions or men with either right or left hemispheric lesions. The most common factor identified as causing decline in sexual activity was the fear that having sex might adversely affect blood pressure and cause another stroke. The sexual problems of these patients are of sufficient magnitude and frequency to warrant further investigation of the physiologic effects of sexual activity on blood pressure and cardiac function after stroke.

The cross-cultural validity of the Learning Disability Index: a reanalysis of Mishra's data

This study investigated the nature of a learning disability index (LDI) for the objective assessment of verbal-nonverbal patterns of intellectual deficit on the WISC-R. The Factor II score coefficients derived from an unrotated principal components analysis of the WISC-R normative data, in combination with the individual's (or group's) average scaled scores, are used for this purpose. The mean LDI of various groups of learning disabled children, including Mishra's (1984a; 1984b) Mexican-American and Papago groups, are shown to be reliably different from the mean LDI of the normative population and thus demonstrate its cross-cultural validity.