Effectiveness and clinical response rates of a residential eating disorders facility.

The purpose of this study was to determine the effectiveness of a residential treatment program for adults and adolescents with eating disorders across a wide spectrum of measures. Data on body mass, eating disorder severity, depression, anxiety, and two measures of quality of life were collected on 139 consecutively admitted adolescents and 111 adults at a residential treatment program (N = 250). The same measures were completed at post-treatment. Group level analyses showed that adults and adolescents improved on all measures analyzed. Only 1.7% of adolescents and 2.3% of adults were below a Body Mass Index of 18.5 at discharge. Positive results across diagnoses and ages are reported for three subscales of the Eating Disorder Inventory-3, with clinical response rates reported. Using clinical responder analyses, it was found that for all individuals struggling with secondary issues, 74.7% were responders on the Beck Depression Inventory-II, 41.0% on the Beck Anxiety Inventory, 63.5% on a measure of quality of life, and 95.8% were responders on the physical subscale and 72.6% on the mental subscale of the SF-36-v2. This study suggests that residential treatment for eating disorders is effective at the group level, and it was effective for the majority of individuals within the group.

Drinking and driving: explaining beverage-specific risks.

OBJECTIVE: This study tested whether the association of beer drinking with drinking and driving is due to cultural norms or is an artifact arising from the demographic profile of beer drinkers (young and male), the drinking patterns of this subpopulation (frequent and heavy), and the venues in which they prefer to drink (bars and restaurants). METHOD: Telephone survey data from six U.S. communities were used to establish the demographic characteristics of drinkers, their consumption patterns, beverage preferences, preferred drinking venues and self-reported drinking and driving rates. The survey completion rate was 64.6%. A total sample of 5,231 drinkers was divided into test and validity samples. After deletion of cases with missing data, the test sample included 2,275 drinkers, of whom 985 had driven after drinking. RESULTS: Controlling for a broad set of covariates, the analyses showed that frequent consumers were more likely to drink outside the home, preferred beer and spirits to wine, and were more likely than others to drink and drive. Beverage preferences were not directly associated with drinking and driving. Beer drinkers, however, were from the subpopulation most likely to drink and drive: heavier drinking younger men, who prefer to drink at bars and restaurants. CONCLUSIONS: These results suggest that the association of beer consumption with drinking-driving arises from the circumstances in which the subpopulation of beer drinkers more commonly find themselves (as a result of their efforts to maximize, within economic constraints, the social and amenity value of drinking), as opposed to any culturally induced disposition beer drinkers may have to drink and drive.

Drinking and driving: drinking patterns and drinking problems.

Two perspectives guide examinations of alcohol-related injury; studies of drinking behaviors which characterize the activities in which drinkers participate, and studies of drinking patterns which characterize individuals' likelihoods of intoxication. This paper presents a study of self-reported drinking and driving using both perspectives. A theoretical model of the relationships of drinking patterns and drinking behaviors to drinking and driving is derived. This model is used as the basis for analyses of self-reports of driving after drinking and driving while intoxicated. Using cross-sectional data from a study of alcohol-related injury in the United States, these self-reports were related to measures of respondent socio-demographics, drinking patterns, beverage preferences and routine activities. The results showed: (1) that the drinking pattern measures were significantly related to likelihoods of drinking and driving; (2) these measures were superior to alternate measures of drinking patterns in their ability to explain drinking and driving; (3) the measures of beverage preferences were unrelated to either measure of drinking and driving; and (4) that the utilization of certain venues for drinking (bars and restaurants) was significantly related to both measures of drinking and driving. It is concluded that observed socio-demographic differences in drinking and driving (e.g. related to ethnicity and marital status) are due to related differences in drinking patterns and drinking behaviors.

Suicide rates and alcohol consumption in the United States, 1970-89.

This study investigates the aggregate relationships between suicide rates and beverage specific measures of alcohol consumption for states in the United States over periods of from 14 to 20 years. Time series cross-sectional analyses of these aggregate state level data are presented which control for exogenous differences between states, time trends and covariations over time in nine measures; age composition, male population, non-white population, per capita land area, metropolitanism, income, unemployment, measures of religious preferences and divorce. After correcting for substantial autocorrelations in measurement error, the analyses revealed that suicide rates were specifically associated with spirits sales, age composition of state populations, per capita land area, unemployment and religious preferences over time. While suicide rates increased significantly as a function of increased spirits sales, beer and wine sales were not associated with suicide rates. These findings suggest that it is not the consumption of ethanol per se but rather the consumption of ethanol in the form of spirits that is related to suicides. Rather, it would appear that a population-based preference for the consumption of spirits is associated with suicide events.

Phonetic variation in multisyllable babbling.

This investigation examined phonetic variation in multisyllable babbling of infants from 0.7 to 0.11. The basis of this investigation was to examine assumptions present in major models of infant vocal development which suggest systematic developmental increases in phonetic variation of these babbles, and posit separate stages of repetitive (multisyllables with non-varied phonetic elements) and non-repetitive (phonetically varied multisyllables) babbling. Eight infants were audiotaperecorded in their homes at ages 0.7, 0.9 and 0.11. The multisyllable vocalizations were categorized based on the presence or absence of phonetic variation, and the source of that variation (place change, manner change or both). Multisyllables were produced with phonetic variation at or near the beginning of multisyllable babbling, which failed to support the existence of distinct stages of repetitive and nonrepetitive babbling.

Barotrauma and air embolism in hyperbaric oxygen therapy.

A 69-year-old woman underwent hyperbaric oxygen therapy because of a nonhealing ulcer of her foot. During decompression, she developed a left-sided hemiplegia and confusion. Recompression resulted in transient neurologic improvement, but she eventually became comatose. Ventricular dysrhythmias developed and she died without regaining consciousness 17 h after onset of symptoms. An autopsy revealed diffuse interstitial pulmonary fibrosis with severe paracicatricial emphysema, chronic interstitial inflammation, and chronic bronchitis with abundant intrabronchial mucus. There was extensive multifocal ischemic injury of the cerebral cortex. The hippocampi, basal ganglia, and cerebellum were spared. Scattered acute myofiber necrosis was present in the heart. Clinical presentation and autopsy findings strongly support the diagnosis of air embolism and illustrate a potential risk of hyperbaric oxygen therapy in patients with preexisting pulmonary disease.

Analyzing ADN competencies.

El Paso Community College District, using the DACUM Process, identified 19 major competency areas with 313 specific competencies for AD Nursing. This article provides an overview of the DACUM Process, a discussion of the application to the ADN program, a summary of the results, and future activities.

Kestenbaum surgical procedure for torticollis secondary to congenital nystagmus.

The records of 48 patients with congenital nystagmus who required surgery for a significant head turn were reviewed to compare the effectiveness of the surgical techniques. Patients were omitted from the study if the last postoperative visit was less than five months following surgery, or if the surgery was for a vertical head posture. The average preoperative head turn of the 38 patients with horizontal nystagmus was 41.3 degrees with an average postoperative head turn of 11.5 degrees. The net change in head turn was 33.4 degrees. The average duration of time from surgery to final examination was four years and six months. The study was divided into six groups of patients. The first group received the Parks modification of the standard Kestenbaum procedure, the 5-6-7-8 millimeter procedure. The second group received the above procedure plus 1 mm additional surgery. The third group received another modification by Parks of 6.5-8-9-10 millimeters. The fourth group received the Calhoun and Harley modification of 40% augmentation of the original Parks recommendation, and the fifth group received 60% modification. The sixth group required more than one procedure on the horizontal recti for the abnormal head posture. The pre- and postoperative measurements are compared for each of these six groups. In some patients followed for many years, there is a tendency for a gradual return toward the preoperative head posture. In four patients in the study, the gaze preference was shifted to the opposite direction postoperatively.

Surgery of bilateral superior oblique palsy.

Following head trauma, because the patient has no overt vertical or horizontal tropia to account for the complaint of diplopia, the symptoms are dismissed, when in fact cyclodiplopia resulting from the excyclotropic feature of bilateral superior oblique palsy is the cause. A prospective study of nine patients with bilateral superior oblique muscle palsy caused by head trauma and managed by an identical surgical regimen are presented. All patients had symptomatic cyclodiplopia that increased in downgaze. Cover testing performed in various gaze positions and in left and right head tilt positions plus the double Maddox rod tests confirmed the diagnosis. The four expected findings are left hypertropia (LHT) in right gaze and right hypertropia (RHT) in left gaze, RHT on right head tilt and LHT in left tilt, V pattern, and excyclodeviation. All patients received symmetrical bilateral superior oblique tendon surgery, using a modified technique originally described by Harada and Ito, which consisted of advancing the anterior tendon half along the equator of the globe toward the superior border of the lateral rectus muscle. Elimination of the cyclodiplopia symptom was achieved in all cases by reducing the quantity of excyclotropia.

Poland-Möbius syndrome.

A patient with stigmata of both the Möbius syndrome and the Poland syndrome is presented. This is now the twelfth well-documented patient with a combination of the two syndromes. The association of the Poland syndrome and the Möbius syndrome occurs with sufficient frequency that the combination probably represents a formal genesis malformation syndrome of unknown aetiology that should be designated the Poland-Möbius syndrome.