Hippocampal volume change relates to clinical outcome in childhood-onset schizophrenia.

BACKGROUND: Fixed hippocampal volume reductions and shape abnormalities are established findings in schizophrenia, but the relationship between hippocampal volume change and clinical outcome has been relatively unexplored in schizophrenia and other psychotic disorders. In light of recent findings correlating hippocampal volume change and clinical outcome in first-episode psychotic adults, we hypothesized that fewer decreases in hippocampal volume would be associated with better functional outcome and fewer psychotic symptoms in our rare and chronically ill population of childhood-onset schizophrenia (COS) patients. METHOD: We prospectively obtained 114 structural brain magnetic resonance images (MRIs) from 27 COS subjects, each with three or more scans between the ages of 10 and 30 years. Change in hippocampal volume, measured by fit slope and percentage change, was regressed against clinical ratings (Children's Global Assessment Scale, Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms) at last scan (controlling for sex, time between scans and total intracranial volume). RESULTS: Fewer negative symptoms were associated with less hippocampal volume decrease (fit slope: p = 0.0003, and percentage change: p = 0.005) while positive symptoms were not related to hippocampal change. There was also a relationship between improved clinical global functioning and maintained hippocampal volumes (fit slope: p = 0.025, and percentage change: p = 0.043). CONCLUSIONS: These results suggest that abnormal hippocampal development in schizophrenia can be linked to global functioning and negative symptoms. The hippocampus can be considered a potential treatment target for future therapies.

Methanol addition to dihapto-coordinated rhenium complexes of furan.

The complexes [TpRe(CO)(L)(4,5-eta(2)-furan)], present as diastereomeric mixtures (L = (t)BuNC (1A, 1B), PMe(3) (2A, 2B), pyridine (3A, 3B), or 1-methylimidazole (4A, 4B)), undergo acid-catalyzed methanol addition in CH(2)Cl(2) at -40 degrees C, resulting in the syntheses of dihapto-coordinated 2-methoxy-2,3-dihydrofuran complexes. In all cases, two diastereomers resulted, one in which the oxygen of the dihydrofuran is oriented toward the L ligand (5A, 6A, 7A, and 8A), and one in which the oxygen is oriented away from the L ligand (5B, 6B, 7B, and 8B). In all cases, the methoxy group adds stereoselectively, anti to the metal fragment. In addition, the (t)BuNC complex 1 yields a dihapto-coordinated vinyl ether (5C) that results from ring opening of the protonated furan ligand. In no case does the diastereomeric ratio of products correlate with that of the starting material.

Interfacial and intrafacial linkage isomerizations of rhenium complexes with aromatic molecules.

The mechanisms for the interconversion of facial diastereomers of a variety of TpRe(CO)(L)(eta(2)-L(Ar)) complexes [L = (t)BuNC, pyridine (py), PMe(3), or 1-methylimidazole (MeIm); L(Ar) = benzene, anisole, naphthalene, 1-methylpyrrole, furan, or thiophene; Tp = hydridotris(pyrazolyl)borate] have been investigated by (1)H NMR spin saturation experiments. In addition, the rates and free energies of activation for these processes were calculated from spin saturation experiments and T(1) measurements. The operative mechanisms for interconversion of the pi diastereomers were found to be nondissociative, undergoing either an interfacial or intrafacial linkage isomerization. A comparison of the kinetic parameters for isomerization of related eta(2)-olefin complexes of the [TpRe(CO)(PMe(3))] and [CpRe(NO)(PPh(3))](+) fragments is also presented.

Long-term safety and efficacy of a cholesterol-lowering diet in children with elevated low-density lipoprotein cholesterol: seven-year results of the Dietary Intervention Study in Children (DISC).

OBJECTIVE: Diets reduced in fat and cholesterol are recommended for children over 2 years of age, yet long-term safety and efficacy are unknown. This study tests the long-term efficacy and safety of a cholesterol-lowering dietary intervention in children. METHODS: Six hundred sixty-three children 8 to 10 years of age with elevated low-density lipoprotein cholesterol (LDL-C) were randomized to a dietary intervention or usual care group, with a mean of 7.4 years' follow-up. The dietary behavioral intervention promoted adherence to a diet with 28% of energy from total fat, <8% from saturated fat, up to 9% from polyunsaturated fat, and <75 mg/1000 kcal cholesterol per day. Serum LDL-C, height, and serum ferritin were primary efficacy and safety outcomes. RESULTS: Reductions in dietary total fat, saturated fat, and cholesterol were greater in the intervention than in the usual care group throughout the intervention period. At 1 year, 3 years, and at the last visit, the intervention compared with the usual care group had 4.8 mg/dL (.13 mmol/L), 3.3 mg/dL (.09 mmol/L), and 2.0 mg/dL (.05 mmol/L) lower LDL-C, respectively. There were no differences at any data collection point in height or serum ferritin or any differences in an adverse direction in red blood cell folate, serum retinol and zinc, sexual maturation, or body mass index. CONCLUSION: Dietary fat modification can be achieved and safely sustained in actively growing children with elevated LDL-C, and elevated LDL-C levels can be improved significantly up to 3 years. Changes in the usual care group's diet suggest that pediatric practices and societal and environmental forces are having positive public health effects on dietary behavior during adolescence.

Effects of diet and sexual maturation on low-density lipoprotein cholesterol during puberty: the Dietary Intervention Study in Children (DISC).

BACKGROUND: The Dietary Intervention Study in Children (DISC) is a multicenter, randomized, controlled clinical trial designed to examine the efficacy and safety of a dietary intervention to reduce serum LDL cholesterol (LDL-C) in children with elevated LDL-C. METHODS AND RESULTS: The effects of dietary intake of fat and cholesterol and of sexual maturation and body mass index (BMI) on LDL-C were examined in a 3-year longitudinal study of 663 boys and girls (age 8 to 10 years at baseline) with elevated LDL-C levels. Multiple linear regression was used to predict LDL-C at 3 years. For boys, LDL-C decreased by 0.018 mmol/L for each 10 mg/4.2 MJ decrease in dietary cholesterol (P<.05). For girls, no single nutrient was significant in the model, but a treatment group effect was evident (P<.05). In both sexes, BMI at 3 years and LDL-C at baseline were significant and positive predictors of LDL-C levels. In boys, the average LDL-C level was 0.603 mmol/L lower at Tanner stage 4+ than at Tanner stage 1 (P<.01). In girls, the average LDL-C level was 0.274 mmol/L lower at Tanner stage 4+ than at Tanner stage 1 (P<.05). CONCLUSIONS: In pubertal children, sexual maturation, BMI, dietary intervention (in girls), and dietary cholesterol (in boys) were significant in determining LDL-C. Sexual maturation was the factor associated with the greatest difference in LDL-C. Clinicians screening for dyslipidemia or following dyslipidemic children should be aware of the powerful effects of pubertal change on measurements of lipoproteins.

The severity classification system for acquired immunodeficiency syndrome hospitalizations. Association with survival after discharge and inpatient resource use.

The Severity Classification for AIDS Hospitalizations (SCAH) was applied to a longitudinal person-based data set of Maryland adult residents diagnosed with acquired immunodeficiency syndrome (AIDS) between 1983 and 1989 to predict long-term survival. In contrast to other AIDS severity measures, SCAH can be applied to administrative data bases for analyses of large populations. Although SCAH was created to predict inpatient mortality using cross-sectional hospital discharge data, the models used in this study show SCAH stage at first AIDS hospitalization to predict long-term survival in persons with AIDS, even after adjusting for sociodemographic and treatment variables. Additional models in the study show SCAH stage at first hospitalization has a strong association with inpatient length of stay and associated charges, making it useful for health care resource planning.

Nonlinear modeling of alcohol consumption for analysis of beverage type effects and beverage preference effects.

In a previous report (Kimball and Friedman, Am J Epidemiol, 1992;135:1279-86), linear models for relating health outcomes to alcohol consumption were proposed for differentiating between beverage type effects and beverage preference effects. The models were applied to data relating serum high density lipoprotein cholesterol to alcohol consumption. In this report, those models are extended to the nonlinear case and are applied to data from the 1982 Maryland Hypertension Survey relating systolic blood pressure to alcohol consumption.

Alcohol consumption regression models for distinguishing between beverage type effects and beverage preference effects.

In relating health outcomes to alcohol consumption, several investigators have evaluated differences among beverage types, but there is no consistency with respect to models used for this purpose. Furthermore, beverage type effects and beverage preference effects have not been evaluated simultaneously. In this report, the authors propose regression models which permit the simultaneous evaluation of beverage type (congener dose response) effects and beverage preference (sociobehavioral) effects. The presence of sociobehavioral effects can be established even if the variables responsible for them have not been measured or identified. The models are applied to a data set from 589 women who participated in an oral contraceptive study at the Johns Hopkins University (Baltimore, Maryland) in 1988-1989.

Oral hygiene for dental implant patients.

Effective home care cleaning techniques are described for patients with dental implants. Specific methods are described for the fixed prosthesis, the fixed detachable prosthesis and the removable prosthesis. While dental caries is no longer a problem, peri-implant gingivitis and peri-implant osteitis are concerns for patients who have dental implants. Techniques and the tools available enable dental implant patients to keep their dental implants plaque-free and consequently, free of peri-implant infection. This report will discuss home care for the fixed detachable prosthesis, the removable prosthesis, and the fixed prosthesis.

Coronary heart disease mortality and alcohol consumption in Framingham.

The relationship between ethanol consumption and coronary heart disease was examined in the original Framingham Heart Study cohort (1948) with a 24-year follow-up from exam 2 (2,106 males and 2,639 females). Ethanol consumption shows a strong U-shaped relationship with coronary heart disease mortality for male nonsmokers and heavy smokers both in the raw age-adjusted data and in the Cox regression analyses, where ethanol consumption is modeled quadratically. No ethanol effects were found for female nonsmokers. The age-adjusted data suggest a U-shape curve for female smokers, although this was not confirmed by the Cox analysis. Separate analyses relating alcohol consumption to mortality from all causes showed similar effects except that the reduction in mortality for males was much less. For male coronary heart disease mortality, ethanol consumption was subdivided into beer, wine, and spirits consumption. These beverages were also modeled quadratically in the Cox analyses, and all showed strong U-shaped curves for both nonsmokers and heavy smokers. In nonsmokers, beer and wine show greater reductions in coronary heart disease mortality than spirits.

Data base management systems extend computer use.

A data base management system (DBMS) is a tool that can help the healthcare industry manage more information efficiently. This tool has the capability to store and retrieve data without the need for several programs or files. The DBMS is a sophisticated yet "user friendly" program that does not require any extensive computer training. In the age of microcomputers, the DBMS provides more power, eliminates seemingly unnecessary and repetitive work with data input, and falls within the budget range of most healthcare institutions.

Regression modeling of consumption or exposure variables classified by type.

Consumption or exposure variables, as potential risk factors, are commonly measured and related to health effects. The measurements may be continuous or discrete, may be grouped into categories and may, in addition, be classified by type. Data analyses utilizing regression methods for the assessment of these risk factors present many problems of modeling and interpretation. Various models are proposed and evaluated, and recommendations are made. Use of the models is illustrated with Cox regression analyses of coronary heart disease mortality after 24 years of follow-up of subjects in the Framingham Study, with the focus being on alcohol consumption among these subjects.

Antihypertensive action of bendroflumethiazide: increased prostacyclin production?

A within-patient randomized, double-blind, crossover study was performed to investigate mechanisms of action of bendroflumethiazide in mild essential hypertension. Significant reductions in lying, standing, and postexercise blood pressure were seen after both 3 days and 10 wk treatment with bendroflumethiazide 10 mg daily. Plasma levels of 6-oxo-PGF1 alpha, the chemical hydrolysis product of prostacyclin, were increased by both 3 days and 10 wk therapy with bendroflumethiazide. This raises the possibility that thiazides may reduce peripheral resistance by increasing prostacyclin biosynthesis.

A computer simulation model of hospital mergers.

The results of a study and a computer model designed to predict the costs of a potential merger of three hospitals rely on a statistically based cost-prediction model. This model was adapted to reflect several different merger options, and the future costs of the three unmerged hospitals were simulated using a stochastic simulation model.

Should financial statements disclose the cost of replacing hospital assets?

The health care industry must do more than point fingers to convince outsiders that health care costs are not seriously out of line. Reporting replacement-cost information can help the industry identify the effects of inflation on hospital costs.

The effect of semisynthetic penicillins on the binding of bilirubin by neonatal serum.

1. The effect of ampicillin, cloxacillin, flucloxacillin and sulphafurazole on bilirubin on bilirubin binding by pooled human umbilical cord serum and bovine serum albumin was studied in vitro using Sephadex gel filtration. 2. Sulphafurazole displaced bilirubin from binding; both cloxacillins displaced bilirubin from pooled cord serum but not bovine serum albumin. 4. No displacement of bilirubin by the cloxacillins from pooled cord serum could be detected at therapeutic plasma concentrations of these drugs. 5. Scatchard analysis of the interactions showed that displacement of bilirubin by these drugs occurred principally at the primary, high affinity, low capacity binding site.