Failure of blue-tinted lenses to change reading scores of dyslexic individuals.

BACKGROUND: This study was designed to address a perceived major flaw in past studies investigating tinted lenses and dyslexia; i.e., the lack of a direct, scientifically validated means of diagnosing the type and severity of dyslexia. METHODS: Sixteen 5th and 8th grade students, found to be dyslexic based on testing via the Dyslexia Determination Test (DDT), were randomly divided into two groups of eight. One group was tested first with blue filters (then, 2 to 5 weeks later, no filters) using the Gates MacGinitie Reading Test for reading comprehension. The other group of eight was tested in the same way, first with no filters, then 2 to 5 weeks later with blue filters. The grade level of the test used for each subject was in accord with the DDT decoding level. RESULTS: There was no significant difference in reading comprehension level or reading speed when the blue filter condition was compared to the no filter condition. CONCLUSIONS: Using DDT classification, subjects were found to have mostly dysphoneidetic (mixed pattern) dyslexia. Among this population of dyslexic students, tinted lenses appeared to provide no beneficial effect. We offer an explanation based on neuro-anatomical relationships between the visual system and reading centers in the brain. The hypothesis states that the transient system defect may be an epiphenomenon, which can coincidentally occur in cases of reading disability.

Psychiatric comorbidity in pedophilic sex offenders.

OBJECTIVE: The primary purpose of this research was to assess the rates of axis I and axis II psychiatric disorders, as defined in DSM-IV, in a group of pedophilic sex offenders. METHOD: Forty-five male subjects with pedophilia who were participating in residential or outpatient sex offender treatment programs were recruited to participate. Subjects were interviewed by using the Structured Clinical Interview for DSM-IV. RESULTS: Ninety-three percent of the subjects (N = 42) met the criteria for an axis I disorder other than pedophilia. The lifetime prevalence of mood disorder in this group was 67%. Sixty-four percent of the subjects met the criteria for an anxiety disorder, 60% for psychoactive substance use disorder, 53% for another paraphilia diagnosis, and 24% for a sexual dysfunction diagnosis. CONCLUSIONS: Axis I and II comorbidity rates are high in this population. Untreated comorbid psychiatric disorders may play a role in treatment failure and recidivism.

The use of pharmacologic pain sensitization in the treatment of repetitive hair-pulling.

A significant problem for many individuals who engage in repetitive hair-pulling is the fact that they experience no discomfort associated with their behavior, and can thus carry on with hair-pulling outside of conscious awareness. The present case study was an attempt to address this problem through the use of a commercially available topical cream which enhances pain sensitivity. A 38-yr-old female applied the cream daily to two affected areas on her scalp. The increased pain sensitization, in conjunction with the habit reversal technique, resulted in markedly decreased hair-pulling.

Use of ECT after brain injury.

Electroconvulsive therapy (ECT) was administered to a man with a history of a gunshot wound to the head with persisting skull defect and intracranial metallic foreign bodies. It appears that ECT is a safe and effective treatment for depression in this setting. Electrode placement is selected to avoid the skull defect and anticonvulsant therapy may be continued if the patient was previously receiving it.

The characterization and treatment of trichotillomania.

Trichotillomania is an impulse control disorder characterized by chronic self-directed hair pulling. Trichotillomania has additionally been viewed as one of the obsessive-compulsive spectrum disorders. Any body hair may be targeted, and most patients pull from more than one site. In clinical settings the disorder predominantly affects females. Onset is generally in childhood or adolescence, and a chronic course is typical. Depression and anxiety frequently accompany the disorder. An increased incidence of comorbid obsessive-compulsive disorder (OCD) has been noted. Neurobiological investigations have paralleled etiologic studies of OCD and have demonstrated both similarities and differences between these two disorders. Current treatment options include a variety of medications, particularly the serotonin selective reuptake inhibitors, the behavioral technique of habit reversal, and hypnosis.

Impulse control disorders and attention deficit disorder in pathological gamblers.

Little systematic research has been done on psychiatric comorbidity of pathological gambling, an impulse control disorder. This report describes the occurrence of attention deficit disorder and impulse control disorders in 40 pathological gamblers in treatment for gambling problems and 64 controls. Diagnoses were made by structured interviews which utilized operationalized diagnostic criteria. An impulse control disorder other than pathological gambling was noted in 35% of the pathological gamblers, compared to 3% of the controls (p < .001). Compulsive buying (p < .001) and compulsive sexual behavior (p < .05) were significantly higher in pathological gamblers than controls. A strong association was seen among pathological gambling, attention deficit, and other impulse control disorders. Attention deficit disorder was seen in 20% of the pathological gamblers. Rates of impulse control disorders did not differ by gender. Implications of these high rates of comorbidity are discussed.

Validation of a screening survey to assess local public health performance.

The study seeks to validate an abbreviated protocol for measuring local public health performance. Primary data were collected during 1993 on a series of indicators keyed to defined public health core functions and their associated practices. The data were obtained from responses provided by local health department directors and were reviewed for accuracy by respective state health department personnel. All local public health jurisdictions (370) in six states were surveyed with a screening protocol. A sample of 36 of these jurisdictions was then resurveyed by means of a full-length protocol using 84 different indicators of public health performance. Correlations between scores obtained from the screening survey and those from the reference survey were high for overall public health performance, for each of the three functions, and for some of the ten practices. A group of only four queries was shown to predict reliably the overall scores. Findings support the conclusion that public health practice can be defined, measured, and monitored. A proposed surveillance system is feasible.

Creating and validating practical measures for assessing public health practices in local communities.

Efforts to develop a surveillance system to measure local public health performance were initiated in 1991. The organizing framework for the proposed system consisted of three core functions formulated by the Institute of Medicine and linked with 10 practices previously defined. A surveillance protocol was developed using local public health jurisdictions rather than specific agencies within the jurisdictions, as the units of study. Selection of 84 indicators was assisted by follow-up study of a group of departments analyzed in 1979 and by review of recent public health literature. Each of the 84 performance indicators was linked to one of the 10 practices. Responses to the survey were obtained from local health department directors. Results yielded scores for the surveyed jurisdiction with regard to adequacy of performance for each practice, the proportional contribution to performance by the local health department, and the identification of other providers contributing to the coverage of each practice within the jurisdiction. A shortened version of the protocol (26 indicators) was tested in all local jurisdictions in six states and shown to correlate reliably with scores obtained from the longer protocol for overall public health performance, as well as for performance of each of the three core functions and for some of the 10 practices. A subset of four indicators was shown to predict reliably the overall score. The findings support the proposition that public health practice can be defined, measured, and monitored and that current widely accepted definitions of core functions and practices have utility. Measurement and surveillance tools for these functions and practices are available and tested.

Analysis of the current status of public health practice in local health departments.

This article describes the performance by local health departments of core public health functions. A post hoc analysis based on these essential functions was implemented using the 1994 dataset from a cooperative project with the Centers for Disease Control and Prevention (CDC) and National Association of County and City Health Officials, which involved a survey of the nation's 2,888 local health departments. Applying guidelines for each functional area drafted by the Office of Disease Prevention and Health Promotion/Office of the Assistant Secretary for Health, CDC, and the Public Health Foundation in conjunction with the health officers in five states, a score was created for each core public health function: (1) health-related data collection, surveillance, and outcomes monitoring, (2) protection of environment, housing, food, and water, (3) investigation and control of diseases and injuries, (4) public information and education, (5) accountability and quality assurance, (6) laboratory services, (7) training and education, and (8) leadership, policy development, and administration. The individual and summary scores provide a mechanism to measure and describe the 2,079 local health departments' performance of these core functions and to examine their relationship to several characteristics and practices--planning, administrative units, annual total expenditures, and jurisdiction population size. This article shows that the core performance index is highest for the data function and for local health departments serving a population of 50,000 or more people. In addition, the performance index increases as budget increases and is greater for all eight functions in those local health departments using health planning models such as Assessment Protocol for Excellence in Public Health (APEX-PH), Planned Approach to Community Health (PATCH), Healthy People 2000, or Healthy Communities 2000. These results may be used to facilitate cooperation between local, state, and federal health agencies and the communities they serve; strengthen the core functions at the local, state, and federal levels; and improve public health practice.

Application of core function concepts to local health department occupational safety and health activities.

To illustrate how core function concepts might be useful in evaluation of specific local health department (LHD) programs, we analyzed preliminary results from a national questionnaire survey of LHD occupational safety and health (OSH) activities during 1992-1993 in categories corresponding to the three core functions: assessment, policy development, and assurance. Overall, 2,079 (71%) LHDs returned completed questionnaires. With regard to the first core function (assessment), the state health department was the most frequent source of data used by the respondent LHDs (47%) to assess worker health and occupational hazards. Concerning the second core function category (policy development), 5% of LHDs had conducted an appraisal in the past three years to summarize the OSH needs of their communities. With regard to the third core function category (assurance), 23% of LHDs directly provided worksite health promotion activities for workers in their communities. We conclude that core function concepts can be a useful adjunct in evaluation of specific LHD programs. Additional research is needed to further refine and improve core function indicators providing insights into specific LHD programs, as well as into overall LHD performance.

Assessing public health practice: application of ten core function measures of community health in six states.

Factor analysis, combined with an evaluation of item difficulty and discrimination, can provide useful insights in questionnaire development. In 1993, as part of a study to develop a questionnaire to assess performance of the core functions of public health at a community level, 370 local health departments (LHDs) in six states completed a 26-item questionnaire (94% response). This study describes factor analysis results after controlling for item difficulty and discrimination. Fifteen items had intermediate difficulty and fair-to-good discrimination. Factor analysis of these 15 items identified four factors. Three of these factors included items from more than one of the core functions. These findings pose an interesting question for future research: are the core functions of public health better conceived as three discrete, distinguishable factors or as three interlocking factors that form a single, seamless unit?

Identification of cues associated with compulsive, bulimic, and hair-pulling symptoms.

Subjects with obsessive compulsive disorder, bulimia nervosa, or trichotillomania selected cues which elicited or worsened their symptoms from a 339 item list. Principal components analysis suggested a four-component solution. Each disorder was significantly associated with one of these components. Diagnostic assignment based on component scores yielded 85% correct classification. The diagnostic groups did not differ on a negative feeling state component. The results indicate that both disorder-specific and generic components exist. This approach has potential for defining clinical subtypes, studying the interaction of feeling states and environmental cues in evoking symptoms, and designing treatment strategies.

Evaluating local public health performance at a community level on a statewide basis.

As part of efforts to develop a surveillance system to evaluate local public health performance, six state health departments surveyed local health departments in their states. Overall, 370 respondents (94 percent) returned completed surveys. Based on responses to 26 indicators, the mean percent community performance of the three core functions of public health was 56 percent of the potential score. Scores were also calculated for perceived adequacy of performance and for each of 10 practices linked to the three core functions. Variations in performance were related to population size, state, and administrative relationship of local jurisdictions to the state. These results suggest local public health performance can be evaluated at a community level on a statewide basis using a relatively small number of indicators.

An information manager for the Assessment Protocol for Excellence in Public Health.

The Assessment Protocol for Excellence in Public Health (APEXPH) is a method for comprehensive public health planning that can be implemented by state and local health departments. Many local health departments have limited resources for the data analysis and synthesis needed for APEXPH. To facilitate the implementation of APEXPH in Michigan, we used the Centers for Disease Control and Prevention (CDC) Epi Info software package to develop an APEXPH information manager (CDC-AIM) for use by the 50 local health departments in that state. This report describes our methods for formatting, compressing, and presenting data. Examples of tables are provided for demographics by age and sex, numbers of deaths, years of potential life lost, crude mortality rates, and perinatal indicators such as low birthweight. Areas where additional work is needed to further improve CDC-AIM are discussed. Our experience in Michigan suggests that CDC-AIM potentially is an extremely helpful tool to assist state and local health departments in working with their communities to establish public health program plans based on mortality, morbidity, and risk-factor data.

Implementing and assessing organizational practices in local health departments.

One of the most difficult forms of public health practice to characterize involves governmental public health agencies, especially at the local level. A lack of consensus within the public health community as to the purpose and content of organizational public health practice inhibits efforts to increase the capability of public health to address effectively its core functions of assessment, policy development, and assurance. Meaningful capacity building efforts must establish both benchmarks and expectations for the organizational practice of public health. Those markers must be established so that the impact of practice on outcomes and health status can be examined. A model identifying 10 organizational practices was established through the work of the Centers for Disease Control and Prevention (CDC) in collaboration with national practice organizations. Early applications of the model to public health capacity building activities have been effective. Among the applications have been approaches to surveillance of health department practice, certification of local health departments using practice guidelines, and development of leadership within the public health enterprise. Although results are promising, use of the model requires additional external examination and validation, as well as acceptance and consensus within the public health community. The development of organizational practice guidelines for public health agencies may be useful in further efforts to characterize and measure public health practice and its impact on the public's health.