Flexibility in continuous judgments of gender/sex and race

Across six preregistered studies (N = 1,292; recruited from university subject pools and Prolific Academic), we investigate how face perception along the dimensions of gender/sex and race can vary based on immediate contextual information as well as personal experience. In Studies 1a and 1b, we find that when placing stimuli along a continuum from male to female, cisgender participants sort prototypical gender/sex faces in a bimodal fashion and show less consensus and greater error when placing faces of intermediate gender/sex. We replicate and extend these findings to race in Study 2. In Study 3, we test whether sorting patterns can be influenced by preexisting experiences, and find evidence that transgender/nonbinary participants show less error than cisgender heterosexual participants when sorting intermediary faces. Finally, in Studies 4 and 5, we test whether cisgender participants' judgments of intermediary faces along the continuum are influenced by the specific circumstances under which they are asked to sort. Here, we find that changing the sorting framework to include a third category resulted in less error when placing intermediary faces along the continuum than when participants were provided with only two category labels or two categories and a line at the midpoint, suggesting that new perceptual categories introduced with minimal training can be adopted quickly and successfully in a perceptual task. These data suggest that both long-term life experiences and quick experimental interventions can shape how we think about gender/sex and race. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Parent and self-socialization of gender intergroup attitudes, perceptions, and behaviors among ethnically and geographically diverse young children

Previous work has shown the robust nature of gender bias in both children and adults. However, much less attention has been paid toward understanding what factors shape these biases. The current preregistered study used parent surveys and child interviews to test whether parents' conversations with their children about and modeling of gender intergroup relations and/or children's self-guided interests about gender (self-socialization) contribute to the formation of gender attitudes, status perceptions, and gender intergroup behaviors among young 4- to 6-year-old children. Our participant sample also allowed us to explore variation by child gender, ethnicity (Asian-, Black-, Latiné-, and White-American), and U.S. geographical region (Northeast, Pacific Northwest, West, Southeast, and Hawaii). Data suggest that children whose parents reported they were especially active in seeking information about gender tended to allocate more resources to same-gender versus other-gender children and expressed less positive evaluations of other-gender children in comparison to children who were less active. By contrast, we found that parents' conversations with their children about gender intergroup relations and about gender-play stereotypes showed few connections with children's gender attitudes. In terms of demographic differences, boys raised in households with more unequal versus equal division of labor perceived that men had higher status than women, but few differences by ethnicity or geographic region emerged. In sum, our study suggests that both self- and parent socialization processes are at play in shaping early gender attitudes, status perceptions, and gender intergroup behavior, although self-socialization seemed to play a larger role. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Outcomes of WHO-conforming, longer, all-oral multidrug-resistant TB regimens and analysis implications

BACKGROUND: Evidence of the effectiveness of the WHO-recommended design of longer individualized regimens for multidrug- or rifampicin-resistant TB (MDR/RR-TB) is limited.OBJECTIVES: To report end-of-treatment outcomes for MDR/RR-TB patients from a 2015-2018 multi-country cohort that received a regimen consistent with current 2022 WHO updated recommendations and describe the complexities of comparing regimens.METHODS: We analyzed a subset of participants from the endTB Observational Study who initiated a longer MDR/RR-TB regimen that was consistent with subsequent 2022 WHO guidance on regimen design for longer treatments. We excluded individuals who received an injectable agent or who received fewer than four likely effective drugs.RESULTS: Of the 759 participants analyzed, 607 (80.0%, 95% CI 77.0-82.7) experienced successful end-of-treatment outcomes. The frequency of success was high across groups, whether stratified on number of Group A drugs or fluoroquinolone resistance, and ranged from 72.1% to 90.0%. Regimens were highly variable regarding composition and the duration of individual drugs.CONCLUSIONS: Longer, all-oral, individualized regimens that were consistent with 2022 WHO guidance on regimen design had high frequencies of treatment success. Heterogeneous regimen compositions and drug durations precluded meaningful comparisons. Future research should examine which combinations of drugs maximize safety/tolerability and effectiveness.

Concordance of three approaches for operationalizing outcome definitions for multidrug-resistant TB

BACKGROUND: The WHO provides standardized outcome definitions for rifampicin-resistant (RR) and multidrug-resistant (MDR) TB. However, operationalizing these definitions can be challenging in some clinical settings, and incorrect classification may generate bias in reporting and research. Outcomes calculated by algorithms can increase standardization and be adapted to suit the research question. We evaluated concordance between clinician-assigned treatment outcomes and outcomes calculated based on one of two standardized algorithms, one which identified failure at its earliest possible recurrence (i.e., failure-dominant algorithm), and one which calculated the outcome based on culture results at the end of treatment, regardless of early occurrence of failure (i.e., success-dominant algorithm).METHODS: Among 2,525 patients enrolled in the multi-country endTB observational study, we calculated the frequencies of concordance using cross-tabulations of clinician-assigned and algorithm-assigned outcomes. We summarized the common discrepancies.RESULTS: Treatment success calculated by algorithms had high concordance with treatment success assigned by clinicians (95.8 and 97.7% for failure-dominant and success-dominant algorithms, respectively). The frequency and pattern of the most common discrepancies varied by country.CONCLUSION: High concordance was found between clinician-assigned and algorithm-assigned outcomes. Heterogeneity in discrepancies across settings suggests that using algorithms to calculate outcomes may minimize bias.

Asian Men and Black Women Hold Weaker Race–Gender Associations: Evidence From the United States and China

Prior work finds a consistent association between race and gender: People associate Asian with female and Black with male. We used mouse-tracking to examine whether different U.S. racial/ethnic groups hold this same association (Study 1) and compared Asian-American participants to ethnically Chinese participants in China (Study 2). In Study 1, White and Hispanic participants showed the expected “race is gendered” effect, and the strength of the effect did not differ between men and women. However, participants with a counter-stereotypical racial-gender identity (Black women and Asian men) showed weaker race–gender associations. The same pattern emerged for East Asian participants in Study 2, both among people living in the United States and China. These data provide the first evidence of moderation in Asian-female, Black-male associations and further reveal the importance of considering intersectional identities in social cognition and social perception.

Expectancy Effects Threaten the Inferential Validity of Synchrony-Prosociality Research

Many studies argue that synchronized movement increases prosocial attitudes and behavior. We reviewed meta-analytic evidence that reported effects of synchrony may be driven by experimenter expectancy, leading to experimenter bias; and participant expectancy, otherwise known as placebo effects. We found that a majority of published studies do not adequately control for experimenter bias and that multiple independent replication attempts with added controls have failed to find the original effects. In a preregistered experiment, we measured participant expectancy directly, asking whether participants have a priori expectations about synchrony and prosociality that match the findings in published literature. Expectations about the effects of synchrony on prosocial attitudes directly mirrored previous experimental findings (including both positive and null effects)-despite the participants not actually engaging in synchrony. On the basis of this evidence, we propose an alternative account of the reported bottom-up effects of synchrony on prosociality: the effects of synchrony on prosociality may be explicable as the result of top-down expectations invoked by placebo and experimenter effects.

Infants relax in response to unfamiliar foreign lullabies

Music is characterized by acoustic forms that are predictive of its behavioural functions. For example, adult listeners accurately identify unfamiliar lullabies as infant-directed on the basis of their musical features alone. This property could reflect a function of listeners' experiences, the basic design of the human mind, or both. Here, we show that US infants (N = 144) relax in response to eight unfamiliar foreign lullabies, relative to matched non-lullaby songs from other foreign societies, as indexed by heart rate, pupillometry and electrodermal activity. They do so consistently throughout the first year of life, suggesting that the response is not a function of their musical experiences, which are limited relative to those of adults. The infants' parents overwhelmingly chose lullabies as the songs that they would use to calm their fussy infant, despite their unfamiliarity. Together, these findings suggest that infants may be predisposed to respond to common features of lullabies found in different cultures.

Studying Gender Diversity

Gender identity is a core feature of human experience, yet our understanding of gender identity is shifting with broader societal changes in recognizing and understanding gender diversity. Here we discuss recent trends and upcoming directions for this burgeoning subfield.

Universality and diversity in human song

What is universal about music, and what varies? We built a corpus of ethnographic text on musical behavior from a representative sample of the world's societies, as well as a discography of audio recordings. The ethnographic corpus reveals that music (including songs with words) appears in every society observed; that music varies along three dimensions (formality, arousal, religiosity), more within societies than across them; and that music is associated with certain behavioral contexts such as infant care, healing, dance, and love. The discography-analyzed through machine summaries, amateur and expert listener ratings, and manual transcriptions-reveals that acoustic features of songs predict their primary behavioral context; that tonality is widespread, perhaps universal; that music varies in rhythmic and melodic complexity; and that elements of melodies and rhythms found worldwide follow power laws.

Toxicological status of children with autism vs. neurotypical children and the association with autism severity

This study investigates both the level of toxic metals in children with autism and the possible association of those toxic metals with autism severity. This study involved 55 children with autism ages 5-16 years compared to 44 controls with similar age and gender. The study included measurements of toxic metals in whole blood, red blood cells (RBC), and urine. The autism group had higher levels of lead in RBC (+41 %, p = 0.002) and higher urinary levels of lead (+74 %, p = 0.02), thallium (+77 %, p = 0.0001), tin (+115 %, p = 0.01), and tungsten (+44 %, p = 0.00005). However, the autism group had slightly lower levels of cadmium in whole blood (-19 %, p = 0.003). A stepwise, multiple linear regression analysis found a strong association of levels of toxic metals with variation in the degree of severity of autism for all the severity scales (adjusted R(2) of 0.38-0.47, p < 0.0003). Cadmium (whole blood) and mercury (whole blood and RBC) were the most consistently significant variables. Overall, children with autism have higher average levels of several toxic metals, and levels of several toxic metals are strongly associated with variations in the severity of autism for all three of the autism severity scales investigated.

Impact of rapid drug susceptibility testing for tuberculosis: program experience in Lima, Peru

SETTING

Programmatic implementation of decentralized rapid drug susceptibility testing (DST) in Lima, Peru.

OBJECTIVE

Pre-post analysis compared time to diagnosis, treatment outcome and survival among patients tested with direct nitrate reductase assay (NRA) vs. indirect conventional methods.

DESIGN

From 2005 to 2009, we prospectively followed all patients referred for DST before (control) and after (intervention) NRA implementation. Among those referred for DST, NRA was used for smear-positive samples of patients with no prior history of multidrug resistance or treatment for multidrug-resistant tuberculosis (TB). Data were abstracted from patient charts and laboratory registers. Endpoints were favorable outcomes, time to result and time to death.

RESULTS

Of those patients who met the criteria for NRA, 740 underwent NRA and 621 underwent conventional DST. NRA yielded test results for 78.4% of cases vs. 68.8% for conventional DST (P < 0.0001); the median time to result was 44 vs. 133 days, respectively (adjusted HR 0.64, 95%CI 0.56-0.73). Among individuals without previous anti-tuberculosis treatment, NRA was associated with a favorable treatment outcome (adjusted OR 1.39, 95%CI 1.01-1.90) and prolonged survival (adjusted HR 0.53, 95%CI 0.31-0.90).

CONCLUSION

Direct NRA significantly shortened time to test result and improved treatment outcomes and survival in certain groups.

Alcohol use and the management of multidrug-resistant tuberculosis in Tomsk, Russian Federation

SETTING

Alcohol use increases the risk of multidrug-resistant tuberculosis (MDR-TB) and poses challenges for successful MDR-TB treatment, including the potential for additional adverse events.

AIM

To investigate the association between alcohol consumption during MDR-TB treatment and adverse events and treatment outcomes in a cohort of patients in Tomsk, Russia.

DESIGN

From 2000 to 2004, retrospective data were collected on 407 MDR-TB patients in Tomsk. Factors associated with treatment outcomes were assessed using logistic regression.

RESULTS

Of the 407 patients, 253 (62.2%) consumed alcohol during treatment ('drinkers'), and 367 (90.2%) had at least one documented adverse advent. No significant differences were noted in frequency of adverse events in drinkers vs. non-drinkers. Drinkers had less favourable treatment outcomes (OR 0.28, 95%CI 0.18-0.45). Among drinkers, favourable treatment outcome was associated with adherence to at least 80% of prescribed doses (OR 2.89, 95%CI 1.30-6.43) and the occurrence of an adverse event requiring treatment interruption (OR 2.49, 95%CI 1.11-5.59).

CONCLUSIONS

Alcohol use did not appear to increase the risk of adverse events during MDR-TB treatment; however, alcohol consumption was associated with poor outcome. Our findings suggest that individuals who drink alcohol should receive aggressive attention to optimise treatment adherence and manage adverse events.

Hepatotoxicity during treatment for multidrug-resistant tuberculosis: occurrence, management and outcome

SETTING

Multidrug-resistant tuberculosis (MDR-TB) treatment program in Tomsk, Russia.

OBJECTIVE

To describe the incidence and management of hepatotoxicity during treatment of MDR-TB, and to assess risk factors associated with its development and impact on treatment outcomes.

DESIGN

A retrospective case series performed among 608 patients.

RESULTS

Hepatotoxicity, using American Thoracic Society (2006) definitions, was observed in 91/568 patients (16.5%). The median time to the first hepatotoxic event was 196 days post treatment commencement. Baseline factors associated with hepatotoxicity included elevated alanine aminotransferase/aspartate aminotransferase/bilirubin (OR 53.9, 95%CI 6.30-438.7), and renal insufficiency (OR 19.6, 95%CI 2.71-141.6). High treatment adherence (OR 3.25, 95%CI 2.07-5.09) and starting treatment in prison (OR 1.77, 95%CI 1.04-3.01) were associated with treatment success. Smoking (OR 0.44, 95%CI 0.21-0.92) and bilateral cavitary disease (OR 0.51, 95%CI 0.34-0.77) were associated with worse outcomes. For alcohol users, developing hepatotoxicity was associated with better outcomes (OR 4.40, 95%CI 1.79-10.81) than not (OR 0.42, 95%CI 0.25-0.68). One or more medications were permanently stopped in 10/91 patients, but in no case was treatment entirely discontinued.

CONCLUSION

MDR-TB treatment in the face of hepatotoxicity during therapy did not result in a statistically significant increase in poor outcomes.

Effect of a vitamin/mineral supplement on children and adults with autism

BACKGROUND

Vitamin/mineral supplements are among the most commonly used treatments for autism, but the research on their use for treating autism has been limited.

METHOD

This study is a randomized, double-blind, placebo-controlled three month vitamin/mineral treatment study. The study involved 141 children and adults with autism, and pre and post symptoms of autism were assessed. None of the participants had taken a vitamin/mineral supplement in the two months prior to the start of the study. For a subset of the participants (53 children ages 5-16) pre and post measurements of nutritional and metabolic status were also conducted.

RESULTS

The vitamin/mineral supplement was generally well-tolerated, and individually titrated to optimum benefit. Levels of many vitamins, minerals, and biomarkers improved/increased showing good compliance and absorption. Statistically significant improvements in metabolic status were many including: total sulfate (+17%, p = 0.001), S-adenosylmethionine (SAM; +6%, p = 0.003), reduced glutathione (+17%, p = 0.0008), ratio of oxidized glutathione to reduced glutathione (GSSG:GSH; -27%, p = 0.002), nitrotyrosine (-29%, p = 0.004), ATP (+25%, p = 0.000001), NADH (+28%, p = 0.0002), and NADPH (+30%, p = 0.001). Most of these metabolic biomarkers improved to normal or near-normal levels.The supplement group had significantly greater improvements than the placebo group on the Parental Global Impressions-Revised (PGI-R, Average Change, p = 0.008), and on the subscores for Hyperactivity (p = 0.003), Tantrumming (p = 0.009), Overall (p = 0.02), and Receptive Language (p = 0.03). For the other three assessment tools the difference between treatment group and placebo group was not statistically significant.Regression analysis revealed that the degree of improvement on the Average Change of the PGI-R was strongly associated with several biomarkers (adj. R2 = 0.61, p < 0.0005) with the initial levels of biotin and vitamin K being the most significant (p < 0.05); both biotin and vitamin K are made by beneficial intestinal flora.

CONCLUSIONS

Oral vitamin/mineral supplementation is beneficial in improving the nutritional and metabolic status of children with autism, including improvements in methylation, glutathione, oxidative stress, sulfation, ATP, NADH, and NADPH. The supplement group had significantly greater improvements than did the placebo group on the PGI-R Average Change. This suggests that a vitamin/mineral supplement is a reasonable adjunct therapy to consider for most children and adults with autism.

TRIAL REGISTRATION

CLINICAL TRIAL REGISTRATION NUMBER

NCT01225198.

Effect of a vitamin/mineral supplement on children and adults with autism

BACKGROUND

Vitamin/mineral supplements are among the most commonly used treatments for autism, but the research on their use for treating autism has been limited.

METHOD

This study is a randomized, double-blind, placebo-controlled three month vitamin/mineral treatment study. The study involved 141 children and adults with autism, and pre and post symptoms of autism were assessed. None of the participants had taken a vitamin/mineral supplement in the two months prior to the start of the study. For a subset of the participants (53 children ages 5-16) pre and post measurements of nutritional and metabolic status were also conducted.

RESULTS

The vitamin/mineral supplement was generally well-tolerated, and individually titrated to optimum benefit. Levels of many vitamins, minerals, and biomarkers improved/increased showing good compliance and absorption. Statistically significant improvements in metabolic status were many including: total sulfate (+17%, p = 0.001), S-adenosylmethionine (SAM; +6%, p = 0.003), reduced glutathione (+17%, p = 0.0008), ratio of oxidized glutathione to reduced glutathione (GSSG:GSH; -27%, p = 0.002), nitrotyrosine (-29%, p = 0.004), ATP (+25%, p = 0.000001), NADH (+28%, p = 0.0002), and NADPH (+30%, p = 0.001). Most of these metabolic biomarkers improved to normal or near-normal levels.The supplement group had significantly greater improvements than the placebo group on the Parental Global Impressions-Revised (PGI-R, Average Change, p = 0.008), and on the subscores for Hyperactivity (p = 0.003), Tantrumming (p = 0.009), Overall (p = 0.02), and Receptive Language (p = 0.03). For the other three assessment tools the difference between treatment group and placebo group was not statistically significant.Regression analysis revealed that the degree of improvement on the Average Change of the PGI-R was strongly associated with several biomarkers (adj. R2 = 0.61, p < 0.0005) with the initial levels of biotin and vitamin K being the most significant (p < 0.05); both biotin and vitamin K are made by beneficial intestinal flora.

CONCLUSIONS

Oral vitamin/mineral supplementation is beneficial in improving the nutritional and metabolic status of children with autism, including improvements in methylation, glutathione, oxidative stress, sulfation, ATP, NADH, and NADPH. The supplement group had significantly greater improvements than did the placebo group on the PGI-R Average Change. This suggests that a vitamin/mineral supplement is a reasonable adjunct therapy to consider for most children and adults with autism.

TRIAL REGISTRATION

CLINICAL TRIAL REGISTRATION NUMBER

NCT01225198.

Nutritional and metabolic status of children with autism vs. neurotypical children, and the association with autism severity

Background

The relationship between relative metabolic disturbances and developmental disorders is an emerging research focus. This study compares the nutritional and metabolic status of children with autism with that of neurotypical children and investigates the possible association of autism severity with biomarkers.

Method

Participants were children ages 5-16 years in Arizona with Autistic Spectrum Disorder (n = 55) compared with non-sibling, neurotypical controls (n = 44) of similar age, gender and geographical distribution. Neither group had taken any vitamin/mineral supplements in the two months prior to sample collection. Autism severity was assessed using the Pervasive Development Disorder Behavior Inventory (PDD-BI), Autism Treatment Evaluation Checklist (ATEC), and Severity of Autism Scale (SAS). Study measurements included: vitamins, biomarkers of vitamin status, minerals, plasma amino acids, plasma glutathione, and biomarkers of oxidative stress, methylation, sulfation and energy production.

Results

Biomarkers of children with autism compared to those of controls using a t-test or Wilcoxon test found the following statistically significant differences (p < 0.001): Low levels of biotin, plasma glutathione, RBC SAM, plasma uridine, plasma ATP, RBC NADH, RBC NADPH, plasma sulfate (free and total), and plasma tryptophan; also high levels of oxidative stress markers and plasma glutamate. Levels of biomarkers for the neurotypical controls were in good agreement with accessed published reference ranges. In the Autism group, mean levels of vitamins, minerals, and most amino acids commonly measured in clinical care were within published reference ranges.

A stepwise, multiple linear regression analysis demonstrated significant associations between several groups of biomarkers with all three autism severity scales, including vitamins (adjusted R² of 0.25-0.57), minerals (adj. R² of 0.22-0.38), and plasma amino acids (adj. R² of 0.22-0.39).

Conclusion

The autism group had many statistically significant differences in their nutritional and metabolic status, including biomarkers indicative of vitamin insufficiency, increased oxidative stress, reduced capacity for energy transport, sulfation and detoxification. Several of the biomarker groups were significantly associated with variations in the severity of autism. These nutritional and metabolic differences are generally in agreement with other published results and are likely amenable to nutritional supplementation. Research investigating treatment and its relationship to the co-morbidities and etiology of autism is warranted.

Adverse reactions among patients being treated for MDR-TB in Tomsk, Russia

BACKGROUND AND SIGNIFICANCE

Treatment of multidrug-resistant tuberculosis (MDR-TB) is challenging because of the toxicity of second-line medications. Little is known about whether adverse events impact treatment outcome.

METHODS

We conducted a retrospective case series of 244 MDR-TB patients enrolled in Tomsk between 10 September 2000 and 10 September 2002. Adverse reactions were determined by laboratory data and/or clinical criteria. A multiple logistic regression model was performed to determine whether the occurrence of adverse reactions was associated with poor treatment outcome.

RESULTS

In this cohort, 76.0% were cured, 6.6% failed, 4.9% died and 11.5% defaulted. Adverse events were observed in 73.3% of patients, occurring in 74.8% of patients who were adherent (taking at least 80% of prescribed doses) and 59.1% of non-adherent individuals (P = 0.11). The impact of adverse events on outcome was modified by non-adherence; among adherent patients, the occurrence of any adverse reaction was associated with treatment cure (adjusted odds ratio 3.24, 95% confidence interval 1.56-6.70).

CONCLUSION

Adverse reactions occurred frequently in MDR-TB patients in Tomsk, Russia, but did not negatively impact treatment outcome. The occurrence of adverse reactions among adherent patients was associated with treatment cure.

Barriers to successful tuberculosis treatment in Tomsk, Russian Federation: non-adherence, default and the acquisition of multidrug resistance

OBJECTIVE

To identify barriers to successful tuberculosis (TB) treatment in Tomsk, Siberia, by analysing individual and programmatic risk factors for non-adherence, default and the acquisition of multidrug resistance in a TB treatment cohort in the Russian Federation.

METHODS

We conducted a retrospective cohort study of consecutively enrolled, newly detected, smear and/or culture-positive adult TB patients initiating therapy in a DOTS programme in Tomsk between 1 January and 31 December 2001.

FINDINGS

Substance abuse was strongly associated with non-adherence [adjusted odds ratio (OR): 7.3; 95% confidence interval (CI): 2.89-18.46] and with default (adjusted OR: 11.2; 95% CI: 2.55-49.17). Although non-adherence was associated with poor treatment outcomes (OR: 2.4; 95% CI: 1.1-5.5), it was not associated with the acquisition of multi-drug resistance during the course of therapy. Patients who began treatment in the hospital setting or who were hospitalized later during their treatment course had a substantially higher risk of developing multidrug-resistant TB than those who were treated as outpatients (adjusted HRs: 6.34; 95% CI: 1.35-29.72 and 6.26; 95% CI: 1.02-38.35 respectively).

CONCLUSION

In this cohort of Russian TB patients, substance abuse was a strong predictor of non-adherence and default. DOTS programmes may benefit from incorporating measures to diagnose and treat alcohol misuse within the medical management of patients undergoing TB therapy. Multidrug-resistant TB occurred among adherent patients who had been hospitalized in the course of their therapy. This raises the possibility that treatment for drug-sensitive disease unmasked a pre-existing population of drug-resistant organisms, or that these patients were reinfected with a drug-resistant strain of TB.

Causes of death during tuberculosis treatment in Tomsk Oblast, Russia

SETTING

Tuberculosis (TB) incidence and mortality in Russia have risen dramatically over the past 15 years.

OBJECTIVE

To identify risk factors and causes of death among TB patients in Russia.

DESIGN

A retrospective study conducted to determine the risk factors and causes of death in patients receiving TB therapy in Tomsk, Siberia.

RESULTS

Of 1916 patients who initiated treatment between 1 January 2002 and 31 December 2003, 183 (9.6%) died during treatment, 38 (21%) in the first week of therapy. Twenty-five per cent of deaths were not directly attributable to TB. Risk factors for death included older age, previous treatment for TB, multidrug resistance and alcoholism.

CONCLUSIONS

The high death rate during TB treatment observed in this cohort likely reflects an increased risk of dying not only from TB, but also from comorbid conditions, such as alcoholism and cardiovascular disease. Overall, alcoholism and late presentation both contributed substantially to the mortality in this cohort.

A rapid assessment of breastfeeding status using current status data

Probit analysis of current status epidemiological data was used to estimate breastfeeding rates using 3428 mother-baby pairs from randomly selected facilities in the city of Ibadan, Nigeria. The children whose ages range from 1 to 548 days were distributed over 13 age groups. The observed proportions of breastfeeding children (exclusive and ever-breastfed) in each group were transformed into probits, and a weighted linear regression of probits (y) on ages (x) was calculated using the maximum likelihood Iterative procedure. Prevalence rate for exclusive breastfeeding for Ibadan was 39.6 percent and over 99 percent of the children were ever-breastfed. Median duration of exclusive breastfeeding was 61 days, when half of the exclusively breast fed in the study population would have discontinued exclusive breastfeeding. Mean duration was 64.8 +/- 44.4 days. Nationwide efforts to promote exclusive breastfeeding started in 1992, but there remains a lot more that can be done to promote, support and protect the practice of exclusive breastfeeding in this community. Using this simple procedure, current status data, easily obtained from mothers can be used to rapidly assess breastfeeding practices in the community. This will go along way towards improving documentation of rates, thereby making planning easier.

Cardiovascular and respiratory effects of isoproterenol before and after artificial heart implantation

Quantitation of peripheral vascular versus direct cardiac effects of isoproterenol (0.002 mg/kg) was attempted in a new pharmacologic animal model, the unanesthetized calf, before and after replacement of its natural heart with a pneumatically driven artificial heart (AH). Isoproterenol significantly increased (rho less then 0.01) cardiac output and pulmonary shunt and decreased aortic blood pressure before and after AH replacment. Elevation of cardiac output and pulmonary shunt was greater (rho less than 0.05) and depression of aortic pressure less (rho less than 0.05) before AH replacement than after. Isoproterenol did not change pulmonary artery (PA) or right atrial (RA) blood pressures before AH implantation but did reduce (rho less than 0.05) PA diastolic and mean pressures and increase mean RA pressures after. Systemic vascular resistance was significantly (rho less than 0.01) reduced by isoproterenol before and after AH implantation. Heart rate, 02 uptake, respiratory rate, tidal volume, and minute volume were all markedly increased before AH implantation but unchanged after. These findings demonstrate that approximately half the increase in output and pulmonary shunt and all changes in 02 uptake and respiratory dynamics after administration of isoproterenol are related to cardiac effects of the drug. Our data also suggest that the unanesthetized bovine before and after AH replacement is a unique model for study of the differential pharmacology of drugs with respiratory, cardiac, and peripheral vascular effects.