Effects of wortmannin analogs on bone in vitro and in vivo

The possible importance of phosphatidylinositol (PI) 3-kinase activity in bone resorption activity in vitro and in vivo were evaluated with synthetic wortmannin analogs in two in vitro bone resorption assays, two in vitro assays for PI 3-kinase activity and for the first time, in two in vivo rat models. Wortmannin and LY301497 were shown to be potent, dose-dependent inhibitors of the bone resorption activity of differentiating chicken osteoclast-like cells and isolated rat osteoclasts. A similar structure/activity profile and potency relationship was observed for the inhibition of osteoclastic activity and of bovine PI 3-kinase activity with purified enzyme, as well as direct inhibition of the PI 3-kinase activity of chicken osteoclast lysates. These in vitro data identified LY301497 as an inhibitor of bone resorption that is 10-fold more potent than wortmannin itself, and the most potent inhibitor of PI 3-kinase activity identified thus far. Wortmannin and analogs also lowered the osteoclast-dependent serum calcium levels like salmon calcitonin in a rat model of secondary hyperparathyroidism. More directly, oral administration of wortmannin analogs prevented the estrogen deficiency-induced loss of trabecular bone in the metaphysis of proximal tibiae from ovariectomized rats. Wortmannin, and especially LY301497, compared favorably in potency in vivo to orally administered estrogen. Taken together, these data are strong evidence to show that wortmannin analogs directly block osteoclastic activity in vitro and in vivo, and confirm that PI 3-kinase activity is a necessary step in the regulation of bone resorption. PI 3-kinase activity appears to be an important component of ovariectomy-stimulated bone loss in rats. This mechanism is supported by the finding that wortmannin had little effect on the activity of myosin light chain kinase in intact osteoclasts. The use of LY301497 should prove useful in elucidating specific molecular interactions important in bone resorption and other PI 3-kinase-mediated cell processes. These data also suggest the possible therapeutic utility of wortmannin analogs to treat conditions characterized by excessive bone loss, such as hyperparathyroidism or hypercalcemia of malignency.

An improved training procedure as a precursor to testing young children with the Frisby Stereotest

We describe a modified version of the Frisby Stereopsis Screening Test which enables a light to be flashed behind the stereo target when the child being tested makes an appropriate pointing or reaching response. The light can be flashed to gain the interest of the child during a training phase in which they are familiarised with the test and its requirements. This phase is then followed by a test phase in which the child is encouraged to demonstrate unaided clear pointing responses to the target to gain a light flash while the plate is held in two or three different positions. This device has proved effective in increasing the chances of administering the test successfully to a sample of 30 very young children (age range 7-23 months).

Widespread HIV counseling and testing linked to a community-based tuberculosis control program in a high-risk population

The aim of the work reported here was to evaluate community-wide screening for HIV infection that was linked to a tuberculosis control program in a population at high risk for both infections. Between May 1990 and August 1992, adults in Cité Soleil, Haiti, were recruited by community health workers at their homes and in clinics for individual, clinic-based counseling and testing for HIV and tuberculosis. All of the screened subjects were offered post-test HIV counseling. Those with active tuberculosis received treatment, while those with latent tuberculosis and HIV infection were offered an opportunity to participate in a trial of antituberculosis chemoprophylaxis. The 10,611 individuals screened for HIV represented 10.0% of the adult population in Cité Soleil. HIV infection was detected in 1,629 (15.4%) and active tuberculosis in 242 (2.3%). Latent M. tuberculosis infection was found in 4,800 (67.5%) of 7,309 community residents who completed tuberculosis screening, 781 (16.3%) of whom were coinfected with HIV. The high prevalence of HIV infection found in this screened population, as compared to other groups undergoing HIV screening in the same community, suggests that people at high risk for HIV infection selectively sought or accepted tuberculosis clinic screening. Also, many people with active tuberculosis were identified earlier in the course of their disease than they would have been in the absence of a screening program. Overall, the results indicate that community-based screening for HIV infection within a tuberculosis control program can result in effective targeting of screening for both infections.

Young children's cardiovascular stress responses predict resting cardiovascular functioning 2 1/2 years later

BACKGROUND

Since the pathogenesis of coronary heart disease (CHD) has its origins in childhood, researchers have increasingly evaluated CHD risk factors in youth. In this study we examined the hypothesized behavioral risk factor of cardiovascular responsivity as a predictor of very young children's resting cardiovascular functioning 2 1/2 years later.

SUBJECTS AND METHODS

During an initial visit to the laboratory, 97 children (30 blacks and 67 whites, 45 boys and 52 girls) aged 6-7 years completed three laboratory stressor tests (forehead cold pressor, postural change, and treadmill exercise). A comprehensive cardiovascular assessment was conducted during the tests. Resting cardiovascular activity (baseline values) was also assessed. Follow-up resting cardiovascular parameters were measured in the laboratory 2 1/2 years later.

RESULTS

Cardiovascular stress responses were predictive of cardiovascular follow-up resting levels 2 1/2 years later. Multiple regression was used to evaluate the independent predictive power of stress responses after controlling for traditional risk factors. Follow-up resting systolic blood pressure (SBP) was predicted by the SBP response to postural change and treadmill exercise. Follow-up resting diastolic blood pressure (DBP) was predicted by the DBP response during treadmill exercise, particularly for blacks. The follow-up resting heart rate was predicted by the heart rate response to the forehead cold pressor and treadmill exercise.

CONCLUSION

These results show that in very young children, stress responses are predictive of resting cardiovascular functioning 2 1/2 years later. Further developmental and longitudinal investigations will determine whether such responses are predictive of later preclinical manifestations of cardiovascular disease. If so, incorporation of stress testing in a standardized risk identification protocol might aid the design and practice of cardiovascular preventive medicine.

DNA-based immunization against the envelope proteins of the hepatitis B virus

Intramuscular injection in mice of DNA expression vectors encoding the envelope proteins of the hepatitis B virus induced humoral responses specific to several antigenic determinants of the viral envelope. The use of different promoter elements in the plasmid vectors influenced the kinetics and specificity of antibodies produced to the envelope proteins. The first antibodies appeared within 1-2 weeks after injection of DNA and included antibodies of the IgM isotype. Over the following weeks, an IgM-to-IgG class switch occurred, indicating helper T-lymphocyte activity. Peak IgG titers were reached by 4 weeks after a single DNA injection and were maintained for at least 6 months without further DNA injections. The antibodies to the envelope proteins reacted with both group- and subtype-specific antigenic determinants of the HBV surface antigen (HBsAg). The nature of the immune response to the envelope proteins provides indirect evidence that the proteins have adopted a native conformation and have probably been assembled into particles after intramuscular expression from the plasmid vectors. These results indicate that it may be possible to rationally design DNA expression vectors to induce a particular type of immune response for vaccination against hepatitis B or other pathogens.

Data-gathering tools for "real world" clinical settings: a multisite feasibility study

OBJECTIVE

To determine the mental health needs and optimal treatments for children and families in "real world" settings, data-gathering strategies are needed that can be easily implemented across a variety of clinical settings. To address this need, the authors developed and piloted a "clinician-friendly" questionnaire that includes demographic, psychosocial, medical, and family history variables, such as those routinely gathered in standard clinical evaluations.

METHOD

Optical scanning technology was used to encode data from more than 1,900 children, including 1,458 consecutive referrals in four military child psychiatry clinics, 285 consecutive admissions to a civilian psychiatric state hospital, 71 pediatric patients, and a community sample of 113 children.

RESULTS

Despite geographic and logistic obstacles, clinical data were reliably obtained across multiple settings. Data analyses revealed meaningful differences across samples in subjects' presenting complaints, and a range of psychosocial, demographic, and background variables. Data were characterized by an apparently high degree of accuracy and completeness.

CONCLUSIONS

Findings illustrate the importance and feasibility of standardized data-gathering approaches in routine clinical settings and clarify the hazards as well as the opportunities afforded by these research approaches. Such data-gathering tools appear to have significant merit and deserve further implementation and testing across a range of clinical and research settings.

Changes in attitudes of medical students towards psychiatry: an evaluation of a clerkship in psychiatry

The attitudes to psychiatry of medical students before and after their clinical rotation in psychiatry were assessed during the course of the academic year 1989-1990 by a questionnaire administered before and after the clerkship. Analysis of the data indicated that although there was no major shift in attitudes, the clerkship did succeed in improving clinical skills such as the capability for a better understanding of patients and the improvement of doctor-patient relations, as well as giving the student a more realistic approach to the diagnosis, treatment and prognosis of mentally ill patients.

Anti-microbial activity and anti-complement activity of extracts obtained from selected Hawaiian medicinal plants

Selected plants having a history of use in Polynesian traditional medicine for the treatment of infectious disease were investigated for anti-viral, anti-fungal and anti-bacterial activity in vitro. Extracts from Scaevola sericea, Psychotria hawaiiensis, Pipturus albidus and Eugenia malaccensis showed selective anti-viral activity against Herpes Simplex Virus-1 and 2 and Vesicular Stomatitis Virus. Aleurites moluccana extracts showed anti-bacterial activity against Staphylococcus aureus and Pseudomonas aeruginosa, while Pipturus albidus and Eugenia malaccensis extracts showed growth inhibition of Staphylococcus aureus and Streptococcus pyogenes. Psychotria hawaiiensis and Solanum niger inhibited growth of the fungi Microsporum canis, Trichophyton rubrum and Epidermophyton floccosum, while Ipomoea sp., Pipturus albidus, Scaevola sericea, Eugenia malaccensis, Piper methysticum, Barringtonia asiatica and Adansonia digitata extracts showed anti-fungal activity to a lesser extent. Eugenia malaccensis was also found to inhibit the classical pathway of complement suggesting that an immunological basis for its in vivo activity was identified. This study has confirmed some of the ethnobotanical reports of Hawaiian medicinal plants having curative properties against infections using biological assays in vitro.

Control of sexually transmitted diseases in Haiti: results and implications of a baseline study among pregnant women living in Cité Soleil Shantytowns

Women attending Haitian slum-based antenatal clinics were evaluated for sexually transmitted diseases (STDs): 110 (11%) of 996 were syphilis seroreactive, 313 (35%) of 903 had trichomoniasis, 110 (12%) of 897 had gonococcal or chlamydial cervical infection (or both), and 418 (47%) of 891 had at least one STD. Syphilis seroreactivity was associated with illiteracy (P = .007), lower socioeconomic status (P < .001), and a history of spontaneous abortion (P = .02). Of 663 evaluated sera, 56 (8%) had human immunodeficiency virus (HIV) antibodies. In multivariate analysis, positive HIV serostatus was associated with syphilis seroreactivity (P = .006), partner's unemployment (P = .002), and history of a previous sex partner (P = .04). Risk factors for gonococcal or chlamydial cervical infection were evaluated. Clinical assessment of cervical discharge, a World Health Organization algorithm, and a decision model based on local risk factors were 64%, 77%, and 89% sensitive, respectively, and 44%, 38%, and 43% specific, respectively, for predicting cervical infection. Alternative treatment approaches should be validated while waiting for affordable, simple, rapid, and accurate laboratory diagnostic tests for gonococcal and chlamydial cervical infections.

Others

It has been possible for many sadistic leaders to achieve absolute power in their communities in this century. How have they managed to persuade citizens to help them establish a reign of terror? How we perceive others determines our reaction to them, and our perceptions can be manipulated.

Temporal stability of children's cardiovascular (CV) reactivity: role of ethnicity, gender and family history of myocardial infarction

Cardiovascular responses to three laboratory stressors (i.e., postural change, treadmill exercise, forehead cold) were evaluated in 106 children (72 Whites, 34 Blacks) who varied in family history (FH) of early myocardial infarction (53 positive FH, 53 negative FH). Subjects were evaluated on two occasions separated by one year. In general, regardless of ethnicity, gender or FH, stability of resting blood pressures (BP) and heart rates were comparable to existing data. Resting cardiac output (CO) and total peripheral resistance (TPR) stability estimates were comparable or higher than the BP estimates across groups except for the +FH subjects and males who showed poor stability to one or both parameters. Moderate stability was observed for all parameters in response to forehead cold and low to moderate stability was observed in HR, CO, and TPR postural change reactivity. The only consistent pattern of significant differences in stability estimates involved ethnicity. African-Americans exhibited significantly higher coefficients compared to Whites in TPR at rest and during postural change and forehead cold. Reasons for the low to moderate resting and reactivity stability estimates are discussed.

1-Year stability and prediction of cardiovascular functioning at rest and during laboratory stressors in youth with family histories of essential hypertension

Blood pressure (BP). heart rate, cardiac index, and total peripheral resistance index were measured at rest and in response to postural change, forehead cold stimulation, and a video game challenge in a sample of 128 White and 155 African-American normotensive youth with family histories of essential hypertension (EH). These measurements were readministered 1 year later (12.5 +/- 3.2 months). Moderate temporal stability was observed for all resting and absolute stress responses. Reliability estimates for reactivity change scores were lower, although some were within acceptable ranges. African-American youth exhibited greater BP and peripheral resistance index reactivity to forehead cold on both evaluations. After controlling for various anthropometric and demographic parameters and the pertinent previous year's resting cardiovascular (CV) parameter, mean video game systolic blood pressure (SBP) responses were predictive of resting SBP whereas absolute forehead cold and video game diastolic responses predicted resting diastolic blood pressure (DBP) 1 year later. Mean video game DBP responses were also predictive of resting peripheral resistance index after controlling for significant demographic and anthropometric measures. CV reactivity is discussed with regard to possible value in prediction of changes in resting BP and cardiac structure prior lo establishment of EH.

Nutrition counseling--should physicians guide their patients?

This article summarizes the findings of a study initiative under-taken by the U.S. Public Health Service to examine its own role in fostering a more effective education of U.S. physicians in nutrition. The study was completed in response to a congressional request that the federal government examine the need for a more productive government role in this important area. The literature, dating back to the turn of the century, is relatively uniform in its conclusions that U.S. physicians are woefully undertrained in nutrition. The training inadequacy might be dismissed, indeed, has been dismissed by many programs, yet the role of nutrition in promoting health becomes clearer with each passing year. We ask: Will either the government or the medical education community begin to equip our physicians with the knowledge needed to bring nutrition into play as an active therapeutic approach to complement other therapies?

Cluster analysis of MCMI and MCMI-II on chronic PTSD victims

A cluster analysis was used to identify groups of inpatients with confirmed post-traumatic stress disorder (PTSD) due to combat. In Study 1 the MCMI was administered to 256 subjects, in addition to the MMPI, PTSD measures, and background variables. Three clusters resulted: a Traumatic Personality (8-2), Schizoid Influence (8-2-1), and Antisocial Influence (8-6). Comparison on the MCMI symptom scales, MMPI, and PTSD scales showed that the Antisocial Influence cluster was "healthier" on all measures. The Schizoid Influence was most psychopathological. In Study 2 the MCMI-II was administered to 136 new subjects who met the same criteria as in Study 1. Four clusters resulted: Global (1-2-6A-6B-8A-8B), Subclinical (1), Aggressive (6A-6B-8A), and Detached/Self-defeating (1-2-8A-8B).

Self-described weight status of Mexican-American adolescents

PURPOSE

To evaluate Mexican-American adolescents' descriptions of their weight status.

METHODS

Data were from the Hispanic Health and Nutrition Examination Survey, conducted in 1982-1983 among Mexican-Americans in five southwestern states. The current study used data on 429 males and 485 non-pregnant females 12-19 years old. In an interview, participants were asked to describe their weight status (underweight, about the right weight, overweight); in an examination (performed two to four weeks after the interview), weights and heights were measured. Each participant's body-mass index (weight/height2) was calculated, and single year of age-and-sex-specific BMI cutoffs were used to determine each participant's BMI decile.

RESULTS

The overweight description was chosen by 46% of females and 23% of males, and the underweight description by 7% of females and 17% of males. The percentage of adolescents self-described as overweight rose with increasing BMI percentile, the rise starting in the 30-39th percentiles for females and in 60-69th percentiles for males.

CONCLUSIONS

These findings suggest that many Mexican-American adolescents misperceive their weight status.

Fluvoxamine-associated sexual dysfunction

OBJECTIVE

To report two cases of sexual dysfunction induced by fluvoxamine, a selective serotonin reuptake inhibitor (SSRI).

SETTING

University teaching hospital.

PATIENTS

Two depressed patients who developed ejaculation and orgasmic difficulties after initiation of fluvoxamine therapy.

DISCUSSION

The literature concerning sexual dysfunction with serotonergic antidepressants is reviewed, and speculated mechanisms for this untoward effect are discussed.

CONCLUSIONS

Sexual dysfunction associated with antidepressant drugs, including SSRIs, may be underreported. This troublesome adverse effect may significantly affect patient comfort and compliance. Careful evaluation of sexual function is warranted, prior to and during drug treatment, especially as more serotonergic antidepressant agents become available.

Consistency of children's hemodynamic responses to laboratory stressors

Hemodynamic responses to three standard laboratory stressors (i.e., postural change, video game, forehead cold) were evaluated in 341 children (170 males) who had a mean age of 11.2 +/- 2.6 years. Inter-task consistency was evaluated for five physiological parameters for all stressor pairings. Evidence of consistency in systolic and diastolic blood pressure, heart rate, cardiac output, and total peripheral resistance responses to all three stressors was observed. The highest and most consistent correlations across stressors were observed for cardiac output and total peripheral resistance responses. The need for clarification in the categorization of laboratory stressors used to measure reactivity is discussed.

Increasing rates of cervical and lumbar spine surgery in the United States, 1979-1990

STUDY DESIGN

Data from annual national surveys of hospitalizations were used to review trends.

OBJECTIVES

The trends in rates of hospitalizations with cervical and lumbar spine surgery were examined among persons > or = 25 years old.

SUMMARY OF BACKGROUND DATA

Preliminary analysis of national survey data indicated that during 1979 to 1990 the number of spine operations increased markedly.

METHODS

Data from the National Hospital Discharge Survey were used to calculate age-adjusted rates of hospitalizations.

RESULTS

From 1979-81 to 1988-90, in each sex, the rate of hospitalizations with cervical spine surgery increased > 45%, with the rates for cervical fusion surgery increasing > 70%. The rate of hospitalizations with lumbar spine surgery increased > 33% in each sex, with the rate for lumbar fusion surgery increasing > 60% in each sex, the rate for lumbar disc surgery increasing 40% among males and 21% among females, and the rate for lumbar exploration/decompression surgery increasing > 65% in each sex.

CONCLUSIONS

Between 1979 and 1990, rates of hospitalizations with cervical and lumbar spine surgery increased markedly among both sexes and for different categories of spine surgery.

Mexican-American mothers' reports of the weights and heights of children 6 months through 11 years old

OBJECTIVE

To determine the accuracy of mothers' reports of their children's weights and heights.

DESIGN AND SETTING

Cross-sectional survey of Mexican Americans in five southwestern states.

SUBJECTS

Interviews were held with mothers of 2,578 children aged 6 months to 11 years old.

MAIN OUTCOME MEASURES

Sensitivity and specificity of categories formed from reported values, and correlation of reported and measured values.

RESULTS

Probability of mothers answering "don't know" was 24% for children's weights and 51% for heights. On the average, mothers overestimated weights at the 15th percentile or lower for age and sex and underestimated weights at the 85th percentile or higher. On the average, they underestimated heights. Categories of low and high weight, height, and body mass index were created by applying absolute-value cutoffs to reported values. All the categories had low sensitivity or specificity. Age-group-specific correlation coefficients between reported and measured values ranged from .79 to .89 for weight and from .32 (for 6- through 23-month-olds) to .70 (for 9- through 11-year-olds) for height.

APPLICATIONS

The use of categories formed by applying absolute-value cutoffs to mother-reported values results in frequent misclassification of individuals. Therefore, such categories should not be used to estimate relative risks associated with weight, height, and body mass index. The good correlation of mother-reported and measured weights indicates that despite their inaccuracies, reported weights well reflect the relative ranking of measured weights. Thus, the use of reported weights as a continuous variable in multivariate analyses might cause only small errors in the coefficient for weight.

The weights and heights of Mexican-American adolescents: the accuracy of self-reports

The accuracy of Mexican-American adolescents' self-reported weights, heights, and body mass indexes was evaluated with data from the Hispanic Health and Nutrition Examination Survey. On average, adolescents with low measured body mass indexes and high measured body mass indexes overestimated and underestimated their weights, respectively. Categories of low and high body mass indexes created by applying cutoffs to reported body mass indexes had low sensitivities. For weight, height, and body mass indexes, measured and reported values were highly correlated. This high correlation suggests that adolescents' reported values can be used as continuous variables in multivariate analyses with only small errors resulting in the coefficients for weight, height, and body mass index.

The pros and cons of vision screening

Following the implementation of the DSE Regulations last year vision screening has become routine for many OHNs. Hazel Davis examines the pros and cons of current equipment and techniques.

The effect of adiposity on children's left ventricular mass and geometry and haemodynamic responses to stress

This study evaluated the relationship between adiposity, left ventricular mass and geometry, and haemodynamic parameters at rest and during laboratory stressors in a sample of 69 normotensive children with positive family histories of essential hypertension. Children were classified as overweight if they were above the 85th percentile of weight-for-height for their age and gender compared to national normative data. Nineteen children (7 whites, 12 blacks) were classified as overweight and the remaining 50 (26 whites, 24 blacks) were not overweight. Overweight children were found to have higher resting systolic and diastolic blood pressures, heart rates (HR), cardiac output (CO) and stroke volumes (SV), and lower resting total peripheral resistance than the non-overweight children. No differences were noted in haemodynamic reactivity to the stressors. Echocardiographic findings indicated that the overweight children had greater left ventricular mass indexed by height2.7, interventricular septal thickness and left ventricular end diastolic diameter (LVEDD) compared to non-overweight children. These findings are the first to indicate that the higher resting pressures of overweight normotensive children are a reflection of increased normotensive children are a reflection of increased preload (i.e. greater HR, SV, CO, LVEDD). These findings point out the early deleterious effects of obesity on the cardiovascular system in the young and highlight the need for effective obesity prevention and intervention programmes.

Fruit and vegetable food frequencies by fourth and fifth grade students: validity and reliability

OBJECTIVE

Due to the increased emphasis on fruit and vegetable (F+V) consumption and a desire to use the simplest dietary assessment method appropriate to determine F+V intake, we assessed the reliability and validity of weekly and monthly fruit and vegetable food frequency questionnaires (F+V FFQ) among fourth and fifth grade students by comparing them to food records previously validated through school lunch observations.

METHODS

The multiethnic sample (primarily African-American and Caucasian) included predominantly lower-middle socioeconomic students from 10 classes at one elementary school. F+V FFQ were printed on optical scanning forms and classroom administered on two occasions. Students completed preprinted food record forms at school and received new forms weekly. To allow comparison between the F+V FFQ and food records, a dietitian abstracted information from the records according to a written protocol and transferred it to F+V FFQ forms covering respective time periods. F+V FFQ were converted to estimated daily servings and aggregated to create five F+V indices plus three summary indices. Statistical analyses included Spearman correlations and paired t-tests.

RESULTS

Students demonstrated acceptable reliability in completing food records as well as weekly and monthly F+V FFQ; however, validity was unacceptable for both F+V FFQ versions due to significant overreporting.

CONCLUSION

Of the two methods studied, the food record procedure is preferred over the FFQ procedure for collecting self-reported F+V consumption data among fourth and fifth grade students.

Pressor reactivity, ethnicity, and 24-hour ambulatory monitoring in children from hypertensive families

We assessed blood pressure responses of a multiethnic (Black and White) sample of 120 children of hypertensive families to orthostasis, video game, forehead cold, and dynamic exercise, and monitored the children's ambulatory pressure 24 hours later. Thirteen children were studied twice (1-year stability). The Black children exhibited higher 24-hour ambulatory systolic and diastolic pressures than the White children. Regardless of ethnicity, peak and mean systolic pressures during each task were generally positively correlated with mean systolic pressure while the children were awake and asleep. Associations between diastolic pressor responses and ambulatory measurements were somewhat dependent upon ethnicity and task. Relatively few reactivity-ambulatory correlations were significant, using pressor reactivity change scores. The children who participated twice exhibited significant 1-year stability for most ambulatory and pressor measurements. Children's pressor responses to laboratory tasks may generalize to the natural environment.

Ethnic differences in the myocardial and vascular reactivity to stress in normotensive girls

Cardiovascular reactivity to stress has been proposed as a mechanism partially responsible for the increased prevalence of essential hypertension in African-Americans compared with whites. However, few studies have examined ethnic differences in cardiovascular reactivity among women. The present study evaluated potential ethnic differences in the cardiovascular reactivity to three laboratory stressors (postural change, video game challenge, forehead cold stimulation). The sample consisted of 171 normotensive girls (74 whites, 97 African-Americans) with a mean age of 11.1 +/- 2.7 years, all with positive family histories of essential hypertension. African-American girls showed higher resting diastolic blood pressures and higher resting total peripheral resistance compared with white girls. African-American girls also exhibited higher peak responses in systolic and diastolic blood pressure and total peripheral resistance and lower cardiac index responses during video game challenge and forehead cold stressor. The findings extend previous observations of ethnic differences in blood pressure reactivity to stress and indicate that concomitant increases in total peripheral resistance appear to account for the greater blood pressure reactivity in African-American girls.

Accuracy of fourth- and fifth-grade students' food records compared with school-lunch observations

Fourth- and fifth-grade students' food records completed by using a labor-intensive approach (with daily monitoring) or a less labor-intensive approach (with weekly monitoring) were compared with school-lunch observations. Records were completed at three elementary schools for 14-23 d by students in 26 classes. Record pages were printed forms with areas for recording items consumed, number of servings, and locations of meals. Students were randomly selected for lunch observation. Kappa coefficients and percent of agreement for interobserver reliability for both approaches combined ranged from 0.43 to 0.91 and 72.6% to 95.5%, respectively, on 24 observations. Pearson correlations for 117 record/observation matches were significant for eight and three of nine meal items for the daily and weekly monitoring approaches, respectively. Thus, students were reasonably accurate in keeping records and more accurate with the more labor-intensive approach. Researchers need to select an approach based on the degree of accuracy desired and available finances.

Evaluation of the Children's Activity Rating Scale (CARS) in young children

We describe the daily activity patterns and the between-day and -year reliabilities of the Children's Activity Rating Scale (CARS) measured in 180 Anglo-, African-, and Mexican-American children aged 3 or 4 yr. Reliabilities were assessed at up to 11 measurement periods over 3 yr. CARS scores were measured by two trained observers (alternating 2-h shifts) up to 12 working hours. There were no significant ethnic or day of week differences in the activity levels. Males had higher mean activity levels than females and higher activity was performed in the summer and fall than the spring or winter. The all-measurements reliability for a mean of 5.34 d of observation over the 3 yr of measurement was 0.57. The reliability across all days and years of measurement was 0.73. The highest level of reliability (0.75) was found for the percent of minutes spent at CARS levels 3, 4, or 5 followed by an intraclass correlation of 0.74 for percent of minutes spent at CARS levels 4 or 5. These data support the utility of using the CARS as a measure of physical activity in younger children from different ethnic groups.

Naturally occurring atriocaval mesotheliomas in rats

Atriocaval mesotheliomas were observed in two control Sprague-Dawley rats out of a total of 2889 rats examined. Both neoplasms were located at the base of the interventricular septum. Microscopically, the neoplasms consisted of varying proportions of glandular structures and a fibrous tissue stroma. Glandular structures were lined by a single layer of cuboidal to low columnar epithelium with cells containing a moderate amount of eosinophilic fibrillar to granular cytoplasm and a pleomorphic vesicular round nucleus with coarsely clumped chromatin and often a single eccentric prominent nucleolus. Epithelial cells were stained with antibodies raised against both vimentin and cytokeratin. Electron microscopical features included the presence of microvilli, terminal bars composed of modified tight junctions and desmosomes at the lateral and apical borders, and numerous tonofilaments associated with desmosomes.

Measuring fruit and vegetable preferences among 4th- and 5th-grade students

BACKGROUND

Achievement of the nation's Year 2000 fruit and vegetable goal of five or more daily servings may relate to children's preferences for fruits and vegetables. There are, however, no easily administered instruments for measuring preferences for fruits and vegetables among children.

METHODS

An initial questionnaire systematically varied preparation methods after focus group discussions had indicated that this had an impact on fruit and vegetable preferences. The three-part questionnaire (fruits, vegetables, fruit and/or vegetable snacks) was classroom administered. Internal consistencies and test-retest reliabilities were acceptable. Principal components analyses, however, revealed food-specific rather than preparation factors; thus, preparation was eliminated from a revised questionnaire.

RESULTS

Repeat classroom administration of the revised questionnaire yielded acceptable internal consistencies and test-retest reliabilities. Preferences were higher for fruits than vegetables. Principal components analyses indicated single fruit and vegetable factors and a two-factor solution for snacks (vegetables, fruits). Pearson correlations between preferences and consumption were significant, but accounted for only a small fraction of the variance. Correlations between fruit exposure and preferences, and between vegetable exposure and preferences were 0.55 and 0.51, respectively.

CONCLUSION

The revised questionnaire provides a reliable, valid, and simple tool for assessing fruit and vegetable preferences of 4th- and 5th-grade students. The relationship between these preferences and actual consumption is weak; however, making fruits and vegetables more available may enhance preferences.

Determinants of left ventricular mass in normotensive children

Left ventricular hypertrophy has been shown to be an independent predictor of cardiovascular morbidity and mortality. Few studies have examined the determinants of left ventricular mass (LVM) in normotensive children. Eight-four healthy children, blacks and whites, girls and boys, between 6 and 18 years of age, all with positive family histories of essential hypertension, participated in the study. Demographic and anthropometric characteristics, physical activity, and hemodynamic responses at rest and in response to the stress of forehead cold stimulation and a challenging video game were related to M-mode echocardiographic determined LVM indexed by two indices of body habitus. Hierarchical stepwise multiple regression analysis indicated that the significant independent correlates of LVM per body surface area were gender (boys were greater), baseline systolic blood pressure and heart rate, a physical activity index (sweat episodes per week) and peak systolic blood pressure responses to the forehead cold stressor (final model r2 = 0.49). For LVM/height2.7 significant independent correlates were adiposity index (weight z score--height z score), gender (boys were greater), age, resting systolic pressure, and systemic vascular resistance reactivity to forehead cold stimulation (final model r2 = 0.42). These findings with normotensive children corroborate other findings that have typically involved hypertensive children, indicating that resting heart rate and systolic pressure, gender, and adiposity are early determinants of LVM indices in children. In addition, the current findings indicate that hemodynamic responses to stress also appear to play a role in the early development of LVM.(ABSTRACT TRUNCATED AT 250 WORDS)

Ethnicity, gender, family history of myocardial infarction, and hemodynamic responses to laboratory stressors in children

Relationship among ethnicity, gender, grandparents' histories of early myocardial infarction, and hemodynamic responses to forehead cold and treadmill exercise were examined in 87 6-to-8-year-olds (57 White, 30 Black). Boys had greater increases in systemic vascular resistance and decreases in cardiac index to forehead cold. Girls had greater increases and quicker recovery in heart rate to dynamic exercise. Blacks had greater increases and slower recovery in diastolic pressure to exercise and forehead cold. Blacks showed greater increases and slower recovery in systemic vascular resistance to forehead cold. Positive-family-history children had greater increases in diastolic pressure and systemic vascular resistance to forehead cold and greater diastolic pressure increases to exercise. Positive-family-history Blacks had greater increases in systolic pressure to exercise and slower recovery than all other groups.

Reliability and variability of indicators of heart-rate monitoring in children

We describe the daily heart-rate patterns and the between-day and within-day reliabilities of several heart rate indicators measured in 131 Anglo-, African-, and Mexican-American children aged 5-7 yr. Heart rates were measured over 12 waking hours with a Quantum XL Telemetry heart rate monitor. The percent of heart rates 25% above resting heart rate, an index of physical activity heart rate (PAHR-25 index), was found to have the highest within-day (0.92) and between-day (0.81) reliabilities. The Spearman-Brown prophecy formula indicated that only 9.3 h of observation would be needed to maintain a within-day reliability of 0.90. The percentage of heart rates 50% above resting heart rate (PAHR-50) was found to have slightly lower within-day (0.88) and between-day (0.56) reliability. Principal components analysis revealed that the PAHR-25 and PAHR-50 indicies only had one component throughout the day. The PAHR-25 and PAHR-50 indicies were weakly correlated with age, suggesting that they may be good indicators of relative PAHR. Male children had higher (P < or = 0.025) PAHR-25 index scores than females. There were no gender or ethnic differences in the PAHR-50 index.

Relationship between family environment and children's hemodynamic responses to stress: a longitudinal evaluation

Because interpersonal relationships may have an impact on the risk of developing cardiovascular disease, the authors examined the prospective relationship of family functioning upon hemodynamic stress responses in 87 6- to 8-year-old children. The parents completed the cohesion, conflict, expressiveness, and control subscales of the Family Environment Scale; 2 years later, the authors assessed the children's hemodynamic responses to postural change, forehead cold stimulation, and treadmill exercise. Maternal reports of greater cohesion and expressiveness were related to less increases in systolic pressure and systemic vascular resistance in response to the forehead cold. Mothers' reports of expressiveness were related to lower systolic pressure and cardiac index reactivity to postural change. Fathers' reports of greater control were associated with greater diastolic pressure and vascular resistance increases to forehead cold and to greater vascular resistance responses to exercise. Paternal reports of greater conflict were associated with greater systemic vascular resistance increases and with lower cardiac index increases to exercise. Results suggest family functioning may predict later hemodynamic reactivity to stress. The findings are discussed in terms of previous research on parent-child interaction patterns and children's cardiovascular health.

Ethnicity, family history of hypertension and patterns of hemodynamic reactivity in boys

This study compared blood pressure, heart rate, stroke volume, vascular resistance, and cardiac output responses to a video game challenge and forehead cold stressor in 6- to 15-year-old males who varied in ethnicity and family history of essential hypertension. Controlling for age, significant baseline differences were obtained with black boys exhibiting higher systolic and diastolic pressures than their white cohorts. Positive family history children were found to have higher cardiac outputs and stroke volumes indexed by body surface area during baseline. Controlling for baseline hemodynamic responses and age, positive family history children exhibited greater increases in systemic vascular resistance and systolic and diastolic pressure and greater decreases in heart rate to the cold stressor. The positive family history children exhibited greater decreases in cardiac index during both the video game and cold stressor phases. Implications of the findings and directions for future research are discussed.

Ethnicity, gender, family history of myocardial infarction, and hemodynamic responses to laboratory stressors in children

Relationship among ethnicity, gender, grandparents' histories of early myocardial infarction, and hemodynamic responses to forehead cold and treadmill exercise were examined in 87 6-to-8-year-olds (57 White, 30 Black). Boys had greater increases in systemic vascular resistance and decreases in cardiac index to forehead cold. Girls had greater increases and quicker recovery in heart rate to dynamic exercise. Blacks had greater increases and slower recovery in diastolic pressure to exercise and forehead cold. Blacks showed greater increases and slower recovery in systemic vascular resistance to forehead cold. Positive-family-history children had greater increases in diastolic pressure and systemic vascular resistance to forehead cold and greater diastolic pressure increases to exercise. Positive-family-history Blacks had greater increases in systolic pressure to exercise and slower recovery than all other groups.

Case study of language and numerical disability: A sequential processing deficit?

We report a case study of Christine, an intelligent 30-year-old woman with a developmental learning disability. Psychometric evaluation and extensive interviews revealed several findings: most notably, evidence of anomia, auditory processing problems, difficulty acquiring reading and spelling skills, and an extremely poor sense of number. In addition, Christine showed all four of the Gerstmann symptoms (left-right confusion, finger agnosia, dysgraphia, and dyscalculia). We suggest that most, if not all, of these impairments may be explained in terms of a sequential processing deficit (e.g., Bakker 1967; Tallal 1980). In Christine's case, difficulty perceiving serial order appears to have resulted in a major conceptual impairment involving number.HD-To me four is a number that comes after three and before five. It means twice two …C-To me four is a picture.

Improving utilization and patient care. A rural hospital reduces length of stay through policy revisions and education

In 1990 Saint Vincent Memorial Hospital, Taylorville, IL, intensified efforts to improve resource utilization. A program of daily case review and medical staff education has helped the hospital reduce average length of stay from between 7 and 8 days to between 5 and 6.8 days. Steps taken to achieve this include: Hiring an outside medical adviser to oversee collection and analysis of data related to length of stay and conduct case reviews Appointing a medical review officer and a physician-specific case manager Establishing a Utilization Management Task Force, which has reformed the policy concerning patients with methicillin-resistant Staphylococcus aureus to ensure discharge in a timely manner; implemented a nonacute-day reporting system; and completed a transitional care study to identify the benefits of transferring medically stable Medicare patients to the Skilled Nursing Facility.

Transitive inference in rats (Rattus norvegicus)

Although Piagetian theory proposes that the ability to make transitive inferences is confined to humans above age 7, recent evidence has suggested that this logical ability may be more broad based. In nonverbal tests, transitive inference has been demonstrated in preschool children and 2 species of nonhuman primates. In these experiments, I demonstrate evidence of transitive inference in rats (Rattus norvegicus). I used an ordered series of 5 olfactory stimuli (A < B < C < D < E) from which correct inferences were made about the novel B versus D pair. Control procedures indicated that performance did not depend on the recency with which the correct answer was rewarded during training and may be disrupted by the addition of logically inconsistent premises (F > E and A > F). The possibility that logical transitivity may reflect a form of spatial paralogic rather than formal deductions from a syllogistic-verbal system is discussed.

Relationship between the Millon Clinical Multiaxial Inventory and the Millon-II: value of scales for Aggressive and Self-defeating personalities in Posttraumatic Stress Disorder

This study addressed two issues, the interrelationship between the Millon Clinical Multiaxial Inventory (MCMI) and the Millon II (MCMI-II) and the value of the new personality scales, Aggressive and Self-defeating, in a sample with diagnoses of combat-related Posttraumatic Stress Disorder. 100 confirmed cases of combat-related Posttraumatic Stress Disorder were given a battery of measures including both Millon inventories and the Minnesota Multiphasic Personality Inventory (basic scales and selected subscales). They were rated on discharge status during a structured treatment program. Basic treatment and background information were also obtained. Analysis showed scores on the MCMI-II scales were higher but generally reflective of MCMI scales and that the Self-defeating personality style tends to be reflective of greater psychopathology, suicidal problems, treatment/disposition difficulties, overreporting of symptoms, and intensity of problems. Discussion encouraged the use of the MCMI-II with special emphasis given to the Self-defeating style in this group with Posttraumatic Stress Disorder.

An encephalomyocarditis virus epizootic in a baboon colony

Approximately 80 baboon deaths were caused by encephalomyocarditis virus (EMCV) infection in a 3060 member research and production colony. The epizootic extended over a 9-month period and occurred in baboons ranging from 1 day to 22 years of age. Acute death was the most common history. When clinical disease was detected, it was characterized by labored respiration associated with acute congestive heart failure. The salient necropsy findings were pulmonary congestion and edema, hydropericardium, hydrothorax, ascites, lymph node and splenic hypertrophy, and pale white-to-tan mottled hearts. The most significant histologic lesion was nonsuppurative necrotizing myocarditis. Placental infection with fetal loss occurred. Diagnosis was confirmed by light microscopy, transmission electron microscopy, virus culture, and serology. Rarely, EMCV-induced antibody persisted in surviving baboons for more than 24 months. EMCV-infected feral rats were the probable source of the virus and their control stopped the epizootic. No EMCV neutralizing antibody was detected in colony support personnel or chimpanzees.

Structural alterations in retinal tissues from rats deficient in vitamin E and selenium and treated with hyperbaric oxygen

Vitamin E and selenium play key roles in preventing in vitro lipid peroxidation and free radical damage to retinal tissues. In this research, we studied the effects of hyperbaric oxygen on retinal structure in rats fed diets deficient in vitamin E and/or selenium. We also correlated any alterations in retinal structure with previously measured alterations in electroretinograms (ERGs). Age-matched rats were fed a basal diet deficient in both vitamin E and selenium (B diet), a basal diet supplemented with vitamin E alone (B+E diet), or selenium alone (B+Se diet), or with both micronutrients (B+E+Se). Half the rats in each group were treated (+HBO) with hyperbaric oxygen (100% O2 at 3 ATA for 1.5 per hr day, 5 days per week) and half were not (-HBO). We previously found that the rats fed the B diet for 6 weeks and treated with HBO for 4 weeks (B+HBO group) had diminished a-wave ERG amplitudes. At this time point all rats in the B group and half of the rats in the B+E+Se group were killed for the structural studies reported here. Surprisingly, we found no evidence of photoreceptor cell necrosis [i.e. a decreased thickness of the outer nuclear layer (ONL)] in retinas from rats in the B+HBO group despite the diminished amplitude of the a-wave which arises from this retinal layer. Quantitative structural analyses of retinas from rats in the B+HBO, B-HBO, B+E+Se-HBO and B+E+Se+HBO groups also failed to reveal any significant differences in the cell height of the retinal pigmented epithelium (nasal, central or temporal regions) or the number of mitochondria, phagosomas or inclusion bodies in the central retinal pigment epithelium (RPE). The inner nuclear layer (INL) thickness was, however, consistently decreased in all retinal regions for the rats in the B+HBO group. Our previous work also showed that only rats fed the B+Se diet for 17 weeks and treated with HBO for 15 weeks (B+Se+HBO group) showed diminished a-wave and b-wave ERG amplitudes. At this time point rats in the B+E+Se, B+E, and B+Se groups were killed for structural studies reported here. Only rats in the B+Se+HBO group showed a significantly decreased (about 20%) thickness of the central ONL. This evidence of photoreceptor cell necrosis correlated very well with our previous observation of diminished a- and b-wave amplitudes only in the B+Se+HBO group (at week 17).(ABSTRACT TRUNCATED AT 400 WORDS)

A survey of home care aides. A personal and professional profile

How can home health agency managers recruit and retain home care aides effectively? This study reveals the factors that influence aides' work choices, valuable information in battling worker shortage and costly turnover.

Reliability and variability of heart rate monitoring in 3-, 4-, or 5-yr-old children

We describe the daily heart rate patterns and the between day and within day reliabilities of several heart rate variables measured in 159 Anglo-, African-, and Mexican-American children aged 3-5 yr. Heart rates were measured over 12 waking hours with a Quantum XL Telemetry heart rate monitor. There were no significant ethnic, gender, day of week, or season of the year differences in either mean resting heart rate, mean daily heart rate, mean longest duration of the heart rate sustained above 120 bpm for the day, nor percent of minutes of daily heart rate above 120 bpm. The reliabilities for these variables for 2 d of observation separated by 3-6 months ranged from 0.65 to 0.66. At this level of reliability, just over 4 d of recording are necessary to achieve a reliability of 0.80. All within-day across-hour reliabilities were greater than 0.80. However, for mean hourly heart rate and the longest duration of heart rate sustained above 120 bpm each hour, a principal components analysis revealed three distinct time components during the day. This suggests that monitoring heart rate during limited portions of the day will provide a biased estimate of overall heart rate. For the morning component, there were significant ethnic and gender differences in the children's heart rates and younger children had longer durations of heart rate sustained above 120 bpm than older children. Although daily heart rate monitoring is not a perfect indicator of children's physical activity, these data suggest that it may be a reliable measure among younger children from different ethnic and gender groups.

Buspirone effect on tobacco withdrawal symptoms: a randomized placebo-controlled trial

BACKGROUND

Withdrawal symptoms hinder smoking cessation in nicotine-dependent smokers. This prospective, double-blind, placebo-controlled clinical trial was conducted to evaluate buspirone for nicotine withdrawal symptoms.

METHODS

Fifty-four heavy smokers (mean 33.1 cigarettes per day for 24 years) were randomly prescribed 30 mg/d of buspirone or placebo beginning 3 weeks before abrupt smoking cessation. Validated nicotine withdrawal and anxiety scales were administered at baseline and serially for 2 weeks after cessation.

RESULTS

Baseline demographic and nicotine-dependence measures were similar for each group. Three smokers (1 on buspirone, 2 on placebo) dropped out of the protocol prior to the quit date. Both groups had significant withdrawal effects over time (analysis of variance [ANOVA] P = 0.0001). There was a significant buspirone effect on any nicotine withdrawal symptoms (ANOVA, alpha = 0.05). Smokers who relapsed, regardless of group, reported significantly worse craving, irritability, anxiety, and difficulty concentrating than abstainers (P less than 0.05). Relapse rates at follow-up visits were not significantly different between groups. Two-week abstinence rates were 52 percent for placebo and 62 percent for buspirone (chi-square, P = 0.760).

CONCLUSIONS

In these heavy smokers, buspirone offered no relief from nicotine withdrawal symptoms. Regardless of treatment, relapsing smokers experienced more intense nicotine withdrawal.

Hostility: relationship to lifestyle behaviors and physical risk factors

The relationship between hostility and coronary artery disease may be partially mediated by unhealthy lifestyle behaviors. This study examined the relationship between hostility, lifestyle behaviors, and physical risk factors in 138 adult men and women. Subjects completed the Cook and Medley Hostility Scale (Ho scale) and self-reports of their dietary habits, consumption of alcohol and cigarettes, and physical activity. Recent findings indicated that a composite hostility score from three rationally derived subscales of the Ho scale tapping the dimensions of cynicism, hostile affect, and aggressiveness was a better predictor of mortality than the total Ho score. Thus, this composite measure of hostility and the total Ho score were used in data analyses. Measures of resting blood pressure, height, weight, and adiposity were also obtained. In men and women, both measures of hostility were positively associated with cholesterol intake and vigorous physical activity. Among women, both hostility measures were positively related to animal fat intake and negatively related to fiber intake. The composite measure was positively related to their resting systolic pressures. Among men, both hostility measures were positively related to cigarette smoking and sugar intake and negatively associated with systolic blood pressure and calcium intake. Findings are discussed in terms of previous research linking hostility to lifestyle behaviors and CAD.

Counselling and communication in health care Counselling and communication in health care Wiley John £ 15.95 358pp 0-471-92965-4 [Formula: see text]

Counselling and Communication in Health Care is depressing, exciting, and definitely relevant reading for nurses. It gives a sobering review of the research evidence that the levels of competent, knowledgeable communication and counselling required by patients and their families are, generally, not being provided.

Family history of myocardial infarction and hemodynamic responses to exercise in young black boys

The influence of family history of coronary artery disease on children's hemodynamic responses to exercise was examined with 25 black boys aged 7 to 10 years. Blood pressure, heart rate, cardiac output, stroke volume, and total peripheral resistance were evaluated during preexercise, peak exercise, and recovery stages. Children with a family history of CAD exhibited greater systolic blood pressure and total peripheral resistance during preexercise and peak exercise stages than did those without a family history of coronary artery disease. After controlling for preexercise differences, the group with a family history of coronary artery disease exhibited greater increases in systolic blood pressure and less attenuation of total peripheral resistance to peak exercise than the group without a family history of coronary artery disease. Cardiac output indexed by body surface area and stroke volumes were higher at all times in the group without a family history compared with the group with a family history of coronary artery disease. Findings are compared with those of adult studies in terms of influence of family history of coronary artery disease on cardiovascular reactivity to stress.