The impact of junk food marketing regulations on food sales: an ecological study

OBJECTIVE

To evaluate the impact of junk food broadcast marketing policies on nationwide junk food sales and identify policy characteristics effective in reducing sales.

METHODS

Country policy data (n = 79) were categorized in a thorough literature review and analysed using a repeated measures design against data on food sales per capita. Study conducted in United States, 2017.

RESULTS

Countries with junk food broadcast marketing policies saw a decrease in junk food sales per capita after implementation, while those without said policies saw an increase (p = 0.013). Countries with statutory policies saw a decrease in sales per capita, while those with only self-regulation saw an increase (p = 0.004). Audience restrictions (p = 0.024) and standardized nutrition criteria (p = 0.008) were policy characteristics significantly associated with a decrease in sales per capita.

CONCLUSIONS

Utilizing a novel approach to evaluate junk food broadcast marketing policies, the study demonstrated that countries with statutory policies saw a significant decrease in junk food sales per capita not seen in countries with no or only self-regulatory policies. To effectively reduce exposure to child-targeted junk food marketing, governments should establish strong, comprehensive statutory regulations. Additionally, countries that implement junk food marketing policies can use food sales data to track policy effectiveness.

Clinical, Immune, and Microbiome Traits of Gingivitis and Peri-implant Mucositis

Tissues surrounding dental implants and teeth develop clinical inflammation in response to microbial stimuli. However, the literature suggests that differences exist in the microbial insult and inflammatory responses leading to gingivitis and peri-implant mucositis. In this pilot study, the authors use for the first time a systems biology approach to comprehensively evaluate clinical parameters, selected inflammatory markers, and the microbiome of subject-matched tooth and implant sites during native inflammation and in response to experimental plaque accumulation. Fifteen subjects with 2 posterior implants and corresponding contralateral teeth were examined at enrollment; at day 0, after reinstitution of gingival/mucosal health; at days 7, 14, and 21, during stent-mediated oral hygiene (OH) abstention; and at day 42, after resumption of OH. The subgingival microbiome was evaluated via 16S rRNA gene sequencing and 8 selected inflammatory markers measured in crevicular fluid. Comparison of teeth and implants via general linear models based on orthogonal polynomials showed similar responses in clinical parameters, inflammatory mediators, and proportions of individual microbial taxa during OH abstention. Implants, however, accumulated less plaque and underwent more heterogeneous shifts in microbiome structure. A multilevel, within-group, sparse partial least squares analysis of covariation of microbial, inflammatory, and clinical parameters throughout all study visits found inflammation around teeth and implants positively correlated with IL-1 alpha and IL-1 beta and with the proportions of Selenomonas, Prevotella, and 5 species-level phylotypes. Gingivitis, however, showed a stronger positive correlation with lactoferrin and IL-1ra and a stronger negative correlation with Rothia. Peri-implant mucositis, on the contrary, correlated positively with certain microbial taxa not associated with gingivitis by a previous study or the current one. In summary, differences existed between implants and tooth sites in microbiome evolution during OH abstention and in the correlation of specific inflammatory mediators and microbial taxa with clinical inflammation. Common biological features, however, were also identified for gingivitis and mucositis.

Effects of dehydroepiandrosterone (DHEA) on cardiovascular risk factors in older women with frailty characteristics

OBJECTIVE

this analysis was to investigate the effects of dehydroepiandrosterone (DHEA) on cardiovascular risk factors in older women with frailty characteristics.

DESIGN, SETTING AND PARTICIPANTS

the study was a double-blind, randomised, placebo-controlled trial of 99 women (mean 76.6 +/- 6.0 year) with the low DHEA-S level and frailty.

INTERVENTION

participants received 50 mg/day DHEA or placebo for 6 months; all received calcium (1,000-1,200 mg/day diet) and supplement (combined) and cholecalciferol (1,000 IU/day). Women participated in 90-min twice weekly exercise regimens, either chair aerobics or yoga.

MAIN OUTCOME MEASURES

assessment of outcome variables included hormone levels (DHEA-S, oestradiol, oestrone, testosterone and sex hormone-binding globulin (SHBG)), lipid profiles (total cholesterol, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol and triglycerides), body composition measured by dual energy absorptiometry, glucose levels and blood pressure (BP).

RESULTS

eighty-seven women (88%) completed 6 months of study; 88% were pre-frail demonstrating 1-2 frailty characteristics and 12% were frail with > or =3 characteristics. There were significant changes in all hormone levels including DHEA-S, oestradiol, oestrone and testosterone and a decline in SHBG levels in those taking DHEA supplements. In spite of changes in hormone levels, there were no significant changes in cardiovascular risk factors including lipid profiles, body or abdominal fat, fasting glucose or BP.

CONCLUSION

research to date has not shown consistent effects of DHEA on cardiovascular risk, and this study adds to the literature that short-term therapy with DHEA is safe for older women in relation to cardiovascular risk factors. This study is novel in that we recruited women with evidence of physical frailty.

Spouse caregivers of Alzheimer patients: problem responses to caregiver burden

This paper reports on comparisons of patterns of responses by 199 spouses of Alzheimer disease patients to stresses of functioning as caregivers. Focusing on gender and age of spouses, we examine effects of the total burden of caregiving and perceived patient problems on a set of emotional and social responses of caregivers. We also examine ways in which depressive symptoms and anxiety of spouse caregivers were associated with patterns of their responses to caregiving stresses. Total patient problem burden was most strongly associated positively with caregiver anger-resentment toward the patient, followed by caregiver concerns about personal time restriction and limitation of social life. Among individual areas of patient problems, emotional lability of the patient rather than cognitive impairment appeared strongest by far in affecting caregiver response measures. Negative impact of caregiving on their social life and associations appeared to have particularly marked effects on effects on caregiver depressive symptoms and anxiety scores. Spouse caregivers did not differ by age in clinically significant ways in their patterns of reaction to stresses of caregiving. The study suggests the importance of considering potential spouse caregiver reactions in such areas as anger and aggressive response to patients, the impact of feelings of social deprivation and personal sacrifice, as well as the implications of caregiving stresses for patient care and maintenance of family cohesion and quality of life.

Vulnerability of husband and wife caregivers of Alzheimer disease patients to caregiving stressors

This study assessed relationships between problem behaviors in 199 Alzheimer Disease patients and vulnerability factors in the well being and emotional health of their spouse caregivers. Among caregiver wives and the younger caregiver husbands (64 years old and under) the volume of patient problem behavior was significantly negatively associated with total scores on a summary well being measure. The association was not found within the older husband caregiver group. Considering five subdimensions of the summary well being scale (Anxiety, Depressive Symptoms, Positive Well Being, Vitality and General Health), correlational analyses showed that the total patient problems measure appeared to have impact primarily among wife caregivers, particularly those 64 years old and under. Multiple regression analyses showed that one patient problem behavior category, Emotional Lability, was the single strongest predictor of impaired well being of the caregiver among all five subdimensions of the caregiver well being measure. Although Destructive Behavior of the patient was not significant by itself, an Age by Destructive Behavior interaction showed that high levels of patient Destructive Behavior predicted high levels of Depression, Anxiety, and low levels of Positive Well Being more among younger caregivers. Husband caregivers had significantly higher Anxiety scores than wife caregivers. These findings document how particular patient problem behaviors can affect caregivers. They point up as well how both gender and age may help target which caregivers are most vulnerable to the stress of specific Alzheimer patient behavior problems. They also suggest the utility of examining specific dimensions of well being rather than a total score alone for purposes of understanding the relationship of particular patient behavior problems to caregiver emotional and physical health.

Personality and substance use disorders as predictors of criminality

The study objective was to evaluate the relationship between a personality disorder (PD) diagnosis and criminal behavior among drug- and alcohol-dependent patients both retrospectively and prospectively. We examined 1-year pretreatment and 1-year post-treatment crime rates among 370 drug- and/or alcohol-dependent patients. Hierarchical logistic regression was used to examine the predictive value of DSM-III-R PD diagnoses after controlling for demographic features and type and severity of substance dependence. Patients with a diagnosis of antisocial PD (ASPD) were more likely to report having committed a variety of crimes, including violent crimes, during the pretreatment period. Individuals with more PD diagnoses or a diagnosis of borderline PD (BPD) or schizoid PD also reported a greater number of pretreatment violent crimes. In addition, the number of PD diagnoses was correlated with the number of crimes against property. During the pretreatment period, significant interactions were also found between PD measures and substance use in relation to both property crimes and violation of parole or probation. During the posttreatment period, a diagnosis of BPD predicted the commission of violent crimes. In contrast, a cluster A PD predicted a lower frequency of crimes against property. ASPD did not predict criminality during the 1-year follow-up period. In conclusion, a PD diagnosis, particularly ASPD, was associated with a variety of criminal behaviors during the 1-year period preceding substance abuse treatment. Following treatment, PD diagnosis had limited value in the prediction of criminal behavior. Possible explanations for these findings are discussed.

Myers-Briggs type and medical specialty choice: a new look at an old question

BACKGROUND

Career development of health professionals is one of many uses of Myers-Briggs Type Indicator (MBTI), with many studies reported from the 1950s. Since 1977, no large-scale effort to collect data on the medical school population has been reported.

PURPOSE

To determine (a) changes in MBTI profiles of medical students over time, (b) differences between the profiles of men and women and the effects of the increased number of women in medical school, (c) possible associations between type and career choices, and (d) possible type differences of graduates selecting primary care and specialties.

METHOD

Twelve U.S. schools with data on 3,987 students contributed to a database of their graduates' MBTI type and specialty choice at Match.

RESULTS

Compared with data from the 1950s, the type distribution of physicians has remained fairly stable, save for a trend toward more judging types. Women in medicine today are more representative of the general population on the feeling dimension than earlier, when medicine was more male-dominated. Women are more likely than men to choose primary care specialties, as are those with preference for introversion and feeling. Feeling types choose Family Medicine significantly more often than thinking types; male, extraverted, and thinking types choose surgical specialties. Of those selecting nonprimary care, male, extraverted, and thinking types choose surgical specialties significantly more than women, introverted, and feeling types.

CONCLUSION

Type remains useful for understanding how some aspects of personality relate to medical specialty choice.

Brain morphometric analysis in neurofibromatosis 1

RATIONALE AND OBJECTIVES

To investigate the relationships between brain and skull base growth in patients with neurofibromatosis 1 (NF1) compared with healthy control subjects using brain magnetic resonance imaging (MRI) for morphometric analysis.

METHODS

Evaluated patients included children who underwent T1- and T2-weighted or dual-echo proton density axial and T1-weighted sagittal brain MRI from January 1, 1988, to December 31, 1995. Study subjects (n = 27) received a diagnosis of NF1 by accepted National Institutes of Health clinical criteria and were compared with an age- and sex-matched control group (n = 43). Twenty-four predetermined ventricular and brain parenchymal dimensions and area calculations were evaluated. Data were analyzed using 2-tailed t tests, chi2 analysis, analysis of variance, and analysis of covariance adjusted for age and sex. Correlational analyses with respect to subject type and age were performed separately.

RESULTS

There were 27 patients (20 boys, aged 1.0-17.7 years; mean age, 8.8 years) and 43 controls (22 boys, aged 0.1-17.7 years; mean age, 5.9 years). The mean ages between groups (boys, girls, and totals) were not statistically different. Significant differences were appreciated for 6 of 24 measures. Patients with NF1 had a significantly larger bicaudate width (P = .002), biatrial width (P<.001), and biparietal diameter (P = .003), but not hemispheric length. They also had significantly increased iter measures (P = .004), descending sigmoid sinus (P<.001), and an age-specific increase in brainstem height (P = .03) not seen in controls.

CONCLUSIONS

Patients with NF1 experience dynamic changes in brain morphometry, resulting in a predominant lateral volume expansion of the supratentorial compartment and an increasing velocity of brainstem growth as they age. These data underscore brain-region-specific parenchymal overgrowth potential.

Psychotherapies for adolescent substance abusers: 15-month follow-up of a pilot study

In order to test the hypothesis that adolescent substance abusers could be matched to effective treatments on the basis of their comorbid psychopathology, 32 dually diagnosed adolescents were randomized into two short-term outpatient group psychotherapies: cognitive-behavioral treatment (CBT), and interactional treatment (IT). Two follow-up assessments were conducted at 3 and 15 months after planned treatment completion. As reported recently, at the three-month follow-up, no patient-treatment matching effects were identified. However, adolescents assigned to CBT demonstrated a significant reduction in severity of substance abuse compared to those assigned to IT. At 15-month follow-up, there were no differential improvements as a function of therapy type. However, subjects in general maintained significant treatment gains on the substance abuse, family function, and psychiatric status domains of the Teen-Addiction Severity Index (T-ASI), and both CBT and IT were associated with similar long-term gains. Large scale, randomized, controlled treatment studies are further recommended to examine the findings of this small-scale pilot study.

Angiogenesis in normal tissue adjacent to colon cancer

BACKGROUND AND OBJECTIVES

Angiogenesis in malignant neoplasms, as measured by microvessel density, has been shown to correlate with survival or stage in some studies of breast, gastric, and colorectal cancer. We hypothesized that aggressive cancers promote angiogenesis in normal tissue adjacent to the invading neoplasm.

METHODS

To test this hypothesis, 36 specimens of colon adenocarcinoma curatively resected between 1986 and 1990 were sectioned and stained for factor VIII-related antigen, vascular endothelial growth factor (VEGF), and interleukin-8 (IL-8). Microvessel density was measured within the colon cancer and in adjacent, histologically normal tissue. Clinical/pathological variables were examined using multivariate analysis and Student t-test.

RESULTS

Microvessel density was higher in the neoplasms (26.0+/-1.66/ 0.25 mm2) than in the surrounding normal tissue (22.3+/-1.88/0.25 mm2) (P=0.03). The difference was primarily due to smaller neoplasms (T1 and T2) which had vessel counts of 10.6+/-0.74/0.25 mm2 in the adjacent normal tissue compared to vessel counts of 18.9+/-3.02/0.25 mm2 within these tumors (P=0.02). T3 and T4 neoplasms had equivalent amounts of angiogenesis within the lesion (26.9+/-1.81/0.25 mm2) and in the histologically normal margin (24.2+/-1.98/0.25 mm2) (P=0.12). VEGF was present in the tumor microenvironment in 100% and IL-8 in 45% of specimens stained for these angiogenic cytokines. Microvessel density did not correlate with 5-year survival.

CONCLUSIONS

Our data suggest that colon cancers that invade through the muscularis propria may have a greater ability to induce angiogenesis in adjacent normal tissue.

Validity of the Obsessive Compulsive Drinking Scale (OCDS): does craving predict drinking behavior?

OBJECTIVE

The Obsessive Compulsive Drinking Scale (OCDS), a 14-item, self-report questionnaire, was developed to measure alcohol-related craving. The OCDS may provide a measure of the state of illness among alcohol-dependent individuals and may have value in predicting subsequent drinking behavior. The present study was conducted to evaluate the factor structure and the concurrent, construct, and predictive validity of the OCDS.

METHODS

Data on desire to drink and on drinking behavior were obtained from 127 alcohol-dependent subjects who participated in a 12-week outpatient pharmacotherapy trial and a 3-month posttreatment follow-up.

RESULTS

Principal components analysis of the OCDS indicated that three factors best described its structure: obsessions, drinking control and consequences, and alcohol consumption. Data also supported the concurrent and discriminant validity of the OCDS. However, the OCDS total score showed limited validity in predicting drinking during a posttreatment follow-up period. Furthermore, the only empirically derived factor that predicted drinking during this period was the alcohol consumption factor.

CONCLUSIONS

As might be expected, the OCDS questions on drinking behavior predict subsequent drinking behavior. However, the instrument does not appear to provide a general measure of alcohol-related illness. The utility of the OCDS in studies of alcoholism treatment outcome requires clearer definition.

Angiogenesis in normal tissue adjacent to colon cancer

BACKGROUND AND OBJECTIVES

Angiogenesis in malignant neoplasms, as measured by microvessel density, has been shown to correlate with survival or stage in some studies of breast, gastric, and colorectal cancer. We hypothesized that aggressive cancers promote angiogenesis in normal tissue adjacent to the invading neoplasm.

METHODS

To test this hypothesis, 36 specimens of colon adenocarcinoma curatively resected between 1986 and 1990 were sectioned and stained for factor VIII-related antigen, vascular endothelial growth factor (VEGF), and interleukin-8 (IL-8). Microvessel density was measured within the colon cancer and in adjacent, histologically normal tissue. Clinical/pathological variables were examined using multivariate analysis and Student t-test.

RESULTS

Microvessel density was higher in the neoplasms (26.0+/-1.66/ 0.25 mm2) than in the surrounding normal tissue (22.3+/-1.88/0.25 mm2) (P=0.03). The difference was primarily due to smaller neoplasms (T1 and T2) which had vessel counts of 10.6+/-0.74/0.25 mm2 in the adjacent normal tissue compared to vessel counts of 18.9+/-3.02/0.25 mm2 within these tumors (P=0.02). T3 and T4 neoplasms had equivalent amounts of angiogenesis within the lesion (26.9+/-1.81/0.25 mm2) and in the histologically normal margin (24.2+/-1.98/0.25 mm2) (P=0.12). VEGF was present in the tumor microenvironment in 100% and IL-8 in 45% of specimens stained for these angiogenic cytokines. Microvessel density did not correlate with 5-year survival.

CONCLUSIONS

Our data suggest that colon cancers that invade through the muscularis propria may have a greater ability to induce angiogenesis in adjacent normal tissue.

Psychotherapies for adolescent substance abusers: a pilot study

This study tested the hypothesis that dually diagnosed adolescent substance abusers could be matched to effective treatments on the basis of their comorbid psychopathology. Specifically, patients with externalizing disorders would have better outcomes when treated with cognitive-behavioral group treatment (CBT), and subjects with internalizing disorders without comorbid externalizing disorders would fare better in interactional group treatment (IT). Thirty-two dually diagnosed adolescent substance abusers were randomized into two 12-week manual guided outpatient group psychotherapies: CBT and IT. At 3-month follow-up, no patient-treatment matching effects were identified. Adolescents assigned to CBT demonstrated a significant reduction in severity of substance use compared with those assigned to IT. Improvement in severity of family function showed a trend in favor of CBT. School function, peer-social relationships, legal problems, and psychiatric severity all showed a consistent nonsignificant direction in favor of CBT over IT. CBT appears to be a promising short-term psychosocial intervention for adolescents.

Neuropsychologic findings in cocaine-dependent outpatients

1. Nineteen recently abstinent cocaine-dependent males were compared to 16 control subjects on a battery of neuropsychological tests. 2. The performance of cocaine-dependent subjects was inferior to the control group on tasks assessing higher level verbal skills, and on a task requiring logical sequencing of complex visual stimuli. 3. Cocaine users also performed poorly on a delayed visual memory task and on a verbal generation task, but performed better than the control group on a task assessing simple visual-motor speed. 4. Possible reasons for these findings are discussed, as are the treatment implications of these findings.

Bridgeport's Teen Outreach and Primary Services (TOPS) project: a model for raising community awareness about adolescent HIV risk

The Greater Bridgeport Adolescent Pregnancy Program (GBAPP), based on its skills in sex education, pregnancy, and sexually transmitted disease prevention, developed the Teen Outreach and Primary Services (TOPS) project, an innovative teen-focused community outreach model to expand and ensure access to health and support services for primarily underserved minority adolescents and young adults at risk for or living with the human immunodeficiency virus (HIV). TOPS is supported by the Special Projects of National Significance Program, HIV/Acquired Immunodeficiency Syndrome (AIDS) Bureau, Health Resources and Services Administration. The target population for TOPS is inner-city minority youth (ages 15-24 years) at high risk for HIV or HIV positive. Services ranging from outreach to intensive case management were provided to 2173 youth in the project. The number of HIV-positive youth has increased from three in the first year of the project to 17 in 1997. TOPS provides outreach, case management, HIV counseling and testing, risk-reduction activities, and referrals for housing, entitlements, specialty HIV clinics, and substance abuse counseling and treatment. A group of peer educators has been recruited from among the target population and is trained and paired with the staff to provide outreach services, peer counseling, and education, and to assist with recreational opportunities.

The Teen Treatment Services Review (T-TSR)

This report describes the Teen-Treatment Services Review (T-TSR) and its initial testing. This brief interview modified from the adult Treatment Services Review (McLellan et al., 1992) furnishes a quantitative profile of the types and number of in-program and out-program treatment services provided during a treatment episode for substance use disorders (SUD). One-day test-retest interval data were collected from adolescent patients in a partial hospitalization program (PHP, N = 20) and from an outpatient clinic (OPA, N = 24). The clinical utility is supported. The test-retest reliabilities of the T-TSR were variable. The T-TSR may be useful at the programmatic level in describing and comparing programs by the type and number of services delivered to adolescents with SUD. Additionally, it may offer a tool for quality assessment by evaluating actual patient treatment-services matching. Further studies of the psychometric properties of this instrument in various clinical settings for adolescents are recommended.

Measuring treatment process in cognitive-behavioral and interactional group therapies for adolescent substance abusers

The state of the art for treatment efficacy studies now requires manual guided treatments and tests of therapist adherence. This report provides findings regarding adherence assessment of therapists participating in an investigation of treatment matching in adolescent substance abusers. The Group Sessions Rating Scale (GSRS), a group-therapy process measure, was studied to determine its appropriateness for assessing group treatment of adolescents with a) substance use disorders (SUD), b) interrater reliability, c) internal consistency, and d) ability to discriminate the active ingredients of cognitive-behavioral therapy (CBT) from interactional therapy (IT). Interrater reliabilities were moderate to high, with those for CBT generally higher than those for IT. Internal consistency of CBT items was moderate, whereas those of IT were moderately high. Discriminability between the two treatment modalities was high. The frequency of active ingredients was generally therapy-specific: high for the relevant and low for the nonrelevant therapeutic modality items. The GSRS was found to be effective in the measurement of treatment process in adolescents with SUD.

Transforming growth factor-beta expression in otitis media with effusion

OBJECTIVE

To characterize the existence and role of transforming growth factor-beta (TGF-beta) in otitis media with effusion (OME).

STUDY DESIGN

Retrospective.

METHODS

The levels of two major TGF-beta isoforms, TGF-beta1 and TGF-beta2, in the middle ear effusions (MEEs) of 44 children were evaluated using enzyme-linked immunospecific assays (ELISAs). Forty-eight MEEs were separated into three clinically relevant groups (i.e., serous, mucoid, and purulent), and TGF-beta levels were correlated with clinical parameters of disease for these MEEs.

RESULTS

Both TGF-beta1 and TGF-beta2 were present in the samples. Mean levels of TGF-beta1 (920.36 +/- 437.75 pg/mg total protein) were generally 100-fold greater than those of TGF-beta2 (9.65 +/- 11.19 pg/mg total protein). TGF-beta1 levels were elevated in association with a history of previous tympanostomy tube placements (TTPs) (P = .029) and mucoid effusions (P = .042). TGF-beta2 levels were elevated in association with a history of previous TTPs (P = .100) and chronic (i.e., serous or mucoid) effusions (P = .003).

CONCLUSIONS

TGF-beta1 is present in the MEEs of children with OME. Furthermore, TGF-beta1 and TGF-beta2 levels were elevated differentially in the presence of chronic disease indicators in OME, suggesting that these isoforms may have differing roles in the inflammatory processes that characterize OME.

Effects of naltrexone on cue-elicited craving for alcohol and cocaine

This study examined the effects of naltrexone (50 mg/day) on mood and self-reported desire for alcohol and cocaine in 26 patients with comorbid alcohol and cocaine abuse/dependence. Two laboratory sessions were conducted, separated by 1 week. During the sessions, subjects viewed 5-min films containing either cocaine, alcohol, or neutral cues. The first session occurred prior to random assignment to medication group and the second session was held after 1 week of double-blind treatment with either naltrexone or placebo. The cocaine-related film induced a greater desire to use cocaine than the desire for alcohol that was induced by the alcohol-related film. This finding was observed using both a simple, one-item analog scale administered during the films and more complex craving questionnaires administered immediately after the films. Collectively, the alcohol and cocaine-related films evoked greater levels of self-reported anxiety and elation, and lower levels of concentration, than the neutral film. Naltrexone did not differ from placebo in reducing the desire to use either cocaine or alcohol.

Capnography and ventilatory assessment during ambulatory dentoalveolar surgery

PURPOSE

The purpose of this study was to determine whether capnography is a more sensitive monitor than auscultation of breath sounds in detecting ventilatory changes consistent with hypoventilation, obstruction, or apnea and in detecting ventilatory changes that can be associated with oxygen desaturation.

PATIENTS AND METHODS

Fifty-five patients received intravenous agents and supplemental oxygen to achieve a state of deep sedation or general anesthesia for removal of impacted third molars. The surgeon/anesthetist monitored respiratory status using a pretracheal stethoscope and direct observation. A blinded observer with no access to the patient or anesthetist monitored respiratory status using capnography. A second observer monitored all respiratory parameters to allow for correlation between clinical and electronic monitors.

RESULTS

Ventilatory status was continuously represented by capnogaphy. The Pearson correlation coefficient showed a positive correlation between increased end-tidal CO2 (PETCO2) and decreased oxygen saturation that became stronger with greater positive changes in PETCO2. An additive relationship was found between PETCO2 and respiratory rate (RR), with increased PETCO2 and decreased RR contributing to decreased oxygen saturation.

CONCLUSION

Patients with nasal ventilatory exchange maintain this exchange throughout the anesthesia so that sampling of nasal PETCO2 is an effective way to monitor ventilatory status. Respiratory depression or obstructive ventilatory changes detected by capnography showed a high sensitivity and low positive predictive value in detecting oxygen desaturation. The current technology does not show a clinically satisfactory correlation between PETCO2 and oxygen saturation. However, a combined increase in PETCO2 and decrease in RR suggested a trend of decreasing oxygen saturation.

Utility of the AUDIT for identification of hazardous or harmful drinking in drug-dependent patients

We evaluated the psychometric properties of the alcohol use disorders identification test (AUDIT), a ten-item screening test for identification of hazardous drinkers, in a sample of 82 patients with DSM-III-R drug dependence. AUDIT showed good internal consistency (alpha = 0.94) and a unitary factor structure. Receiver operating characteristics analysis showed the AUDIT to be comparable to the Michigan alcoholism screening test (MAST) in identifying individuals with a current alcohol use disorder and superior to the MAST for those who are hazardous drinkers. In this patient sample, AUDIT performed well at the recommended cut-off score of > or = 8. We recommend use of the AUDIT for identification of hazardous and harmful drinking among individuals with a drug use disorder.

Effectiveness of an endodontic diagnosis computer simulation program

The effectiveness of a recently developed endodontic diagnosis computer simulation program was examined. Third-year dental students (n = 90) in three successive academic classes were given a pre-test in endodontic diagnosis before any endodontic instruction, and then received ten lectures on diagnostic techniques, endodontic pathology, and radiographic interpretation. The students were subsequently divided into three equal groups not differing statistically on their pre-test results. The first group used an endodontic computer simulation program containing fifteen patient simulations for one hour. The second group had a small-group seminar aiming to cover the same material as in the computer program in the same time period. The third group (control) had no further instruction. The three groups then took a post-test to evaluate their diagnostic knowledge in endodontics. The improvement of scores from pre- to post-test in the three groups were statistically different (p = 0.018). The simulation group students improved significantly more than the seminar group (p = 0.05) and the Control Group (p = 0.0024). Difference in improvement between the seminar group and the control group was not statistically significant (p = 0.20). Students were able to cover more cases on average using the simulation program than were covered in the seminar (t-test, p < 0.0001).

Fluoxetine treatment seems to reduce the beneficial effects of cognitive-behavioral therapy in type B alcoholics

OBJECTIVE

The aim of this study was to test the hypothesis that, because of abnormalities in serotonergic neurotransmission that may underlie craving and impulsive behavior, fluoxetine treatment differentially affects drinking among type B alcoholics, who are characterized by high levels of both premorbid vulnerability and alcohol-related problems.

METHODS

Using a k-means clustering procedure, alcohol-dependent subjects from a placebo-controlled trial of fluoxetine were grouped into low-risk/severity (type A: n = 60) and high-risk/ severity (type B: n = 35) groups. Multivariate analysis of covariance (with pretreatment measures as covariates) evaluated the effects of Alcoholic Subtype, Medication Group, Treatment Completion, and their interactions on measures of drinking, both during the 12-week treatment period and a 6-month follow-up period.

RESULTS

Although there were no main effects of Alcoholic Subtype or Medication Group, subjects who completed the treatment trial showed significantly better drinking-related outcomes. There was also an interaction of Alcoholic Subtype by Medication Group during treatment. Among type B subjects, fluoxetine treatment resulted in poorer drinking-related outcomes than placebo treatment. Among type A subjects, there was no effect of Medication Group. This interactive effect did not persist during the 6-month follow-up period.

CONCLUSIONS

Alcoholic subtypes identified by cluster analysis seem to be differentially responsive to the effects of fluoxetine treatment on drinking-related outcomes. Serotonergic abnormalities previously identified among a subgroup of alcoholics who are also characterized by impulsivity and severity of alcohol dependence may help to explain the differential medication effect. Based on these findings, it is recommended that, in the absence of a comorbid mood or anxiety disorder, fluoxetine not be used to maintain abstinence or reduce drinking in high-risk/severity alcoholics.

Validity of psychiatric diagnoses in patients with substance use disorders: is the interview more important than the interviewer?

Although structured diagnostic interviews are increasingly being used in substance abuse treatment settings, there has been limited systematic evaluation of their ability to enhance reliability and validity of psychiatric diagnoses. The present report provides data on the concurrent, discriminant, and predictive validity of current substance use disorders and common comorbid diagnoses in a sample of 100 substance abuse patients. Diagnoses formulated primarily by master's-level clinicians in the usual course of their duties were compared with diagnoses formulated by research technicians using a semistructured interview. Results indicated that the validity of clinician diagnoses was good for substance use disorders, moderate for personality disorders, and poor for anxiety disorders and major depression. Greater validity was observed for substance abuse diagnoses formulated by research technicians using the semistructured interview. Based on these findings, we conclude that psychiatric diagnosis in substance abuse patients may be improved by adding elements of structured interviews to the clinician's usual assessment.

Placebo-controlled trial of fluoxetine as an adjunct to relapse prevention in alcoholics

OBJECTIVE

The authors tested the hypothesis that fluoxetine, when used in combination with relapse prevention psychotherapy, directly reduces relapse frequency and severity for alcoholics.

METHOD

The authors conducted a randomized, placebo-controlled trial of fluoxetine (up to a maximum of 60 mg/day) for 12 weeks in combination with weekly psychotherapy for 101 alcohol-dependent subjects who were not selected on the basis of comorbid major depression. Outcomes were measured at the end of treatment and 6 months after treatment.

RESULTS

Placebo-treated subjects were more complaint with the medication regimen and remained in the study longer than fluoxetine-treated subjects. There was significantly less alcohol consumption in both groups during treatment than before treatment. These effects persisted during the posttreatment period. Although fluoxetine treatment had no significant effects on alcohol consumption, it reduced Hamilton Depression Rating Scale scores more than placebo treatment among subjects with current major depression.

CONCLUSIONS

Fluoxetine at a dose of 60 mg/day is probably not of use for relapse prevention in alcoholics with mild to moderate alcohol dependence and no comorbid depression. In alcoholics with major depression, the drug may reduce depressive symptoms. Subsequent studies with fluoxetine should probably focus on more severely alcohol-dependent subjects or those with comorbid depression.

Brain morphometric analysis in achondroplasia

RATIONALE AND OBJECTIVES

We undertook an MRI brain morphometric analysis to investigate the relationships between brain and skull base growth and clinical function in patients with achondroplasia as compared to normal controls.

METHODS

Patients selected for evaluation included pediatric patients who underwent T1 and T2 or dual-echo, proton-density axial T1- and T2-weighted and T1 sagittal brain MRI during 1988 to 1992. Study subjects (n = 11) were diagnosed with achondroplasia by clinical and radiologic criteria and compared to an age- and gender-matched control group (n = 25). Twenty-four predetermined ventricular and brain parenchymal dimensions and area calculations were evaluated. Data were analyzed using two-tailed t tests, chi-squared analysis, ANOVA, and ANCOVA, adjusting for age and sex. Correlational analyses with respect to subject type and age were done separately.

RESULTS

There were 36 patients (11 subjects with 15 MRI examinations, mean age 2.3 years, and 25 controls with 26 MRI examinations, mean age 3.0 years). Significant differences existed for 11/17 measures. Achondroplasts had a significantly larger bifrontal width (p < 0.0001), bicaudate width (p < 0.0001), frontal horn diagonal length (p < 0.05), biatrial width (p < 0.0001), biparietal diameter (p < 0.05), and iter to incisural line distance (p < 0.0001). Achondroplasts had significantly smaller frontal lobe depths (p < 0.01), optic tract angles (p < 0.0001), foramen magnum diameters (p < 0.0001), and sinojugular transition zones (p < 0.05). There were no differences in brainstem heights or fourth ventricular widths between achondroplasts and controls. Furthermore, with respect to age, frontal lobe depth was smaller when compared to controls and the descending sigmoid sinus area became increasingly larger.

CONCLUSIONS

Achondroplastic subjects experience dynamic changes in brain morphometry resulting in a rostral displacement of the brainstem with gradual compression of the frontal lobes due to enlargement of the supratentorial ventricular spaces commensurate with an increase in venous sinus distension.

Buspirone treatment of anxious alcoholics. A placebo-controlled trial

BACKGROUND

Symptoms of anxiety are common in alcoholics and may contribute to relapse following initiation of abstinence. Buspirone hydrochloride, a serotonin1A partial agonist, has a pharmacologic profile that may be particularly suited to the treatment of anxious alcoholics.

METHODS

We conducted a randomized, 12-week, placebo-controlled trial of buspirone in 61 anxious alcoholics, all of whom also received weekly relapse prevention psychotherapy. Outcomes were measured at the end of treatment and at a 6-month follow-up evaluation.

RESULTS

Buspirone therapy was associated with greater retention in the 12-week treatment trial, reduced anxiety, a slower return to heavy alcohol consumption, and fewer drinking days during the follow-up period.

CONCLUSIONS

Buspirone appears to have a useful role in the treatment of anxious alcoholics. Further research is needed to clarify which patient characteristics and concomitant treatments result in optimal response to buspirone therapy.

Interleukin-8 expression in otitis media

Based on recent studies in the authors' laboratory on the correlation of cytokines and inflammation in otitis media (OM), the authors hypothesized that in chronic otitis media with effusion (COME) interleukin-8 (IL-8) is responsible for 1. the accumulation of leukocytes in the middle ear cleft and 2. in situ leukocyte activation with subsequent tissue damage. Additionally, the authors hypothesized that IL-8 expression is at least in part under the control of interleukin-1 (IL-1) and tumor necrosis factor (TNF). To begin to test this hypothesis, middle ear effusions (MEE) obtained from children ages 2 to 90 months (mean age, 29 months) undergoing tympanostomy tube placement for the presence of these inflammatory cytokines were analyzed. For these studies, IL-8, interleukin-1 beta (IL-1 beta), tumor necrosis factor-alpha (TNF-alpha), and tumor necrosis factor-beta (TNF-beta) were measured in MEE by radioimmunoassay (RIA) or enzyme-linked immunoassay (ELISA). IL-8, IL-1 beta, TNF-alpha, and TNF-beta were present in 92%, 67%, 77%, and 0% of effusions, respectively. The mean (+/- SEM) values for IL-8, IL-1 beta, and TNF-alpha were 4805 (+/- 913) pg/mg, 4076 (+/- 1510) pg/mg, and 163 (+/- 90) pg/mg. Further analysis indicated that levels of IL-8 correlated with IL-1 beta (R2 = .500, P = .000) and TNF-alpha (R2 = .387, P = .023). Thus the authors' studies clearly demonstrate that IL-8 is consistently present in the MEE of children with COME and is strongly correlated with levels of IL-1 beta and TNF-alpha, both known inducers of IL-8 production. These results support the authors' hypothesis that IL-1 beta, TNF-alpha, and IL-8 are intimately involved in the inflammatory cascade in the middle ear and suggest regulation of these cytokines as possible sites of future therapeutic intervention in otitis media with effusion (OME).

The short-term effects of conjugated estrogen on bone turnover in older women

Estrogen replacement therapy (ERT) prevents bone loss and fracture in early postmenopausal women, but its benefit for women over 70 yr of age has not been determined. We have examined the effect of a short course of ERT on biochemical markers of bone turnover in older women. Eleven women (mean age, 77 yr) were given conjugated estrogen (Premarin; 0.625 mg/day) for 6 weeks. Biochemical markers were measured on serum and urine collected at baseline (two samples), after 5 and 6 weeks of ERT, and 5 and 6 weeks post-ERT. Markers of bone formation were osteocalcin, bone alkaline phosphatase, and type I procollagen peptide. Markers of bone resorption were total urinary hydroxyproline, total and free pyridinoline and deoxypyridinoline cross-links, type I collagen cross-linked N-telopeptides, and serum C-terminal cross-linked telopeptide. Data were analyzed by repeated measures multivariate analysis of variance to estimate the overall effect of ERT on the biochemical markers. Markers of bone resorption decreased during ERT and returned to baseline after ERT (P < 0.05). Markers of bone formation declined less during ERT and continued to decline after ERT (P < 0.05). We conclude that ERT reduces bone turnover in older women and that markers of bone turnover may be useful in assessing the response to treatment in this age group.

Cytokines in experimental otitis media with effusion

Studies in the authors' laboratory have recently demonstrated the presence of potent inflammatory cytokines such as interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF alpha) in human middle ear effusions. The clinical significance of this finding has not been fully elucidated because of the limitations of human studies. We hypothesized that the chinchilla model of otitis media may be an appropriate system with which to study the role of cytokines in otitis media with effusion. To begin to investigate this possibility, 30 chinchillas underwent surgical blockage of the eustachian tube (ET) to promote effusion development. After 2 weeks, examination by otoscopy demonstrated 27 ears to have developed an effusion. Next, all middle ear clefts, in random manner, were either injected with heat-killed Streptococcus pneumoniae 1 x 10(6) in 0.1 mL normal saline, injected with 0.1 mL normal saline alone, or received no injection at all. Middle ear effusions were obtained and analyzed for IL-1 beta and TNF alpha by enzyme-linked immunosorbent assay (ELISA). This study demonstrated a significant correlation between IL-1 beta and the presence of an effusion (P < .001). Additionally, increased TNF alpha levels correlated with bacterial component presence (P < .001), i.e., mean TNF alpha level was 108, 10.8, and 0 pg/mL in bacteria, normal saline, and noninjected ears, respectively. These findings would suggest that cytokine expression may relate to specific pathological conditions and that the chinchilla model for otitis media with effusion (OME) could be used to further explore the role of cytokines in OME.

An evaluation of autonomic nervous system function in patients with Prader-Willi syndrome

OBJECTIVE

Prader-Willi syndrome (PWS) is a complex multisystem genetic disorder in which many cardinal features may have a neurologically based pathophysiology involving both the central and peripheral components of the autonomic nervous system. Autonomic nervous system function was studied noninvasively in a group of subjects with PWS and control subjects to determine whether autonomic nervous system dysfunction exists as part of the PWS.

DESIGN/SETTING

This cross-sectional study was performed in the neurophysiology laboratory at a tertiary care facility.

METHODS

Evaluation included anthropometric measurements and calculation of a body mass index (BMI). Simultaneous electrocardiography and serial recordings of pulse rate and systolic/diastolic mean arterial blood pressures during orthostatic maneuvers were taken. Pupillary response to the instillation of dilute pilocarpine and measurements of plasma norepinephrine at rest and after standing were also obtained. Results were analyzed using two-tailed t tests, Fisher exact test, analysis of variance, and analysis of covariance adjusting for age, gender, and BMI.

PATIENTS

There were 14 subjects with PWS (8 female, 6 male; aged 4 to 40 years, mean age 16 years) and 8 control subjects (4 female, 4 male; aged 5 to 37 years, mean age 19 years).

RESULTS

Abnormal findings were obtained only in subjects with PWS. Analysis of covariance adjusting for age, gender, and BMI revealed a trend for subjects with PWS to have lower resting diastolic blood pressure (P < .09) and significantly less change in diastolic blood pressure after standing (P < .02). Subjects with PWS had significantly greater BMI than did control subjects (P < .001), which correlated significantly with all pulse rate measurements where the greater the BMI the higher the pulse rate at rest (r = .25, P < .04) and the lower the pulse rate after arising from lying to standing at both 15 and 30 seconds (r = .17, P < .1; r = .55, P < .08 respectively). Pupillary constriction of 2 mm or more was seen in 7 of 14 subjects with PWS and in no control subjects (P < .004). The 30:15 R-R interval ratio was abnormal in 6 of 14 subjects with PWS and in no control subjects (P < .03).

CONCLUSIONS

These results suggest that patients with PWS have a detectable underlying autonomic dysfunction characterized principally by diminished parasympathetic nervous system activity.

Autonomic nervous system function in severe breath-holding spells

This study attempted to determine noninvasively whether a dysregulation of autonomic nervous system reflexes exists in children with severe cyanotic breath-holding spells (BHS). This was a cross-sectional study performed in the neurophysiology laboratory at a tertiary care hospital. Patients, 18 months of age and older taken from a referral population of children with severe cyanotic BHS and normal controls, were studied. Fourteen children with cyanotic BHS and 12 controls were evaluated. Several noninvasive measures of parasympathetic and sympathetic reflex functions were assessed and statistically analyzed using analysis of variance and covariance, and Fisher's exact tests. The cyanotic BHS group had a significantly greater increase in pulse rate at 15 s of standing after rising from the supine position (P < .06), with a trend toward a concomitant higher mean arterial pressure (P < .09). After adjusting for age, sex, and mean supine systolic and diastolic blood pressures, breath-holders had a greater decrease in diastolic blood pressure (P < .02) without an increase in systolic blood pressure after standing from the supine position. Breath-holders also had significantly abnormal 30:15 R-R interval ratios compared with controls (P < .002). These results support the hypothesis that children with cyanotic BHS have underlying autonomic nervous system dysregulation. This dysregulation may contribute to the pathophysiology of severe BHS in these children.

Behavior profile of children with severe breath-holding spells

Thirty-two children with severe breath-holding spells and 42 control children were studied by using the Child Behavior Checklist. No single behavioral profile could identify children with breath-holding spells, and there were no group differences with respect to individual behavior categories, broad-band profiles, or total scores. No correlation was found between frequency of breath-holding spells and profile scores.

Use of logistic regression in comparing multiple limiting dilution analyses of antigen-reactive T cells

Traditionally, statistical analyses of multiple limiting dilution analyses have used linear regression in comparing the fit of each analysis to a single-hit Poisson model. Multiple analyses can, however, result in an inflated type I error leading to spurious rejection of the null hypothesis. Logistic regression was used as an umbrella statistic to analyze eight limiting dilution analyses for antigen-reactive T cells from two mouse strains (SJL/J; B10.S), at two priming doses of antigen, for each of two antigens (porcine myelin basic protein, PMBP; purified protein derivative of M. tuberculosis, PPD) used to induce experimental allergic encephalomyelitis (EAE). This proved superior to traditional methods: six of the eight strain/dose/antigen combinations were consistent with a viable model, whereas only three of eight were consistent with the Poisson single-hit model. Moreover, only three of the resultant 32 standardized residual values (four per group times eight groups) fell outside the 95% confidence interval. Logistic regression, therefore, is recommended when nominal dependent measures can be structured as a function of more than one independent variable.

Characterization of cytokines present in middle ear effusions

Retention of inflammatory mediators and cells in the middle ear cleft during chronic otitis media with effusion (COME), results in ongoing inflammation with the potential for pathologic changes and hearing loss. Cytokines are glycoproteins produced by macrophages and other cells. Activities of cytokines include fever production, osteoclast, fibroblast, phagocyte and cytotoxic cell activation, regulation of antibody formation, and inhibition of cartilage, bone and endothelial cell growth. Using enzyme-linked immunospecific assays we measured levels of six cytokines in middle ear effusions (MEE) from children with COME. Significant levels of four cytokines: interleukin-1-beta (greater than 50 pg/ml), interleukin-2 (greater than 300 pg/ml), tumor necrosis factor-alpha (greater than 40 pg/ml), and gamma-interferon (greater than 6.25 pg/ml) were found in 51%, 54%, 63%, and 19% of MEE, respectively. In contrast, levels of a fifth cytokine, granulocyte-macrophage colony-stimulating factor, and a sixth cytokine, interleukin-4, were undetectable. Age was observed to have a significant effect on the levels of specific cytokines. Interleukin-1 (IL-1) correlated inversely (P less than .02) with age such that the younger the child, the higher the level of IL-1 in MEE. Tumor necrosis factor-alpha (TNF) correlated directly (P less than .005) with age such that the older the child, the higher the level of TNF in MEE. Children undergoing tympanostomy on multiple occasions had average MEE TNF levels (234.2 +/- 109.1 pg/mg total protein) that were nearly 14 times higher (P less than .005) than those from children undergoing their first tympanostomy (16.9 +/- 3.0 pg/mg total protein). Thus IL-1 correlated with the early stages of COME, while TNF correlated with persistence of disease. The presence of these cytokines in MEE may be responsible for the mucosal damage, bone erosion, fibrosis, and resulting hearing loss seen in some cases of COME.

Practicing dentist and smokeless tobacco

During the past 10 years, it has been noted that a number of children and adolescents are using smokeless tobacco in the form of oral snuff and chewing tobacco. The sale of these products has increased dramatically in the last decade, with more than 15 million people in the United States estimated to use snuff or chewing tobacco. This article describes the distribution of smokeless tobacco use, its health consequences, and how and why the dentist is an appropriate health professional to reduce its use.

Effects of decisional control and work orientation on persistence in preventive health behavior

Examined persistence in the daily use of fluoride mouthrinse among adolescents as a function of an induced-choice manipulation concerning self-management strategies and freedom to participate in the program. Seventh-grade boys and girls from urban and suburban schools were randomly assigned to a series of either high- or low-choice decisional control manipulations; their daily, home use of fluoride was monitored over a 20-week period. In order to ameliorate the relatively lower persistence rates found previously among suburban (vs. urban) students, all students were given self-management and action instructions as per previous studies. Although suburban students still declined in persistence relative to urban students, female students who received high choice persisted at a higher rate than girls who received low choice. Boys, for the most part, were unaffected by the manipulation. In addition, students' self-reported work orientation was also positively associated with persistence.

Cigarette and smokeless tobacco use among Connecticut adolescents

Despite data that the rate of boys' cigarette use has declined nationwide, boys' total tobacco use may actually have remained high because of their substantial use of smokeless tobacco. We surveyed anonymously a random sample of entire classes of grade 7-12 boys and girls from 59 Connecticut towns concerning tobacco use. Despite girls' higher daily cigarette use, boys' total daily tobacco use was higher than that of girls in grades 7-9, and only slightly lower in grades 10-12.