Reliability of Addenbrooke's Cognitive Examination III in differentiating between dementia, mild cognitive impairment and older adults who have not reported cognitive problems.

Diagnosing dementia can be challenging for clinicians, given the array of factors that contribute to changes in cognitive function. The Addenbrooke's Cognitive Examination III (ACE-III) is commonly used in dementia assessments, covering the domains of attention, memory, fluency, visuospatial and language. This study aims to (1) assess the reliability of ACE-III to differentiate between dementia, mild cognitive impairment (MCI) and controls and (2) establish whether the ACE-III is useful for diagnosing dementia subtypes. Client records from the Northern Health and Social Care Trust (NHSCT) Memory Service (n = 2,331, 2013-2019) were used in the analysis including people diagnosed with Alzheimer's disease (n = 637), vascular dementia (n = 252), mixed dementia (n = 490), MCI (n = 920) and controls (n = 32). There were significant differences in total ACE-III and subdomain scores between people with dementia, MCI and controls (p < 0.05 for all), with little overlap between distribution of total ACE-III scores (< 39%) between groups. The distribution of total ACE-III and subdomain scores across all dementias were similar. There were significant differences in scores for attention, memory and fluency between Alzheimer's disease and mixed dementia, and for visuospatial and language between Alzheimer's disease-vascular dementia (p < 0.05 for all). However, despite the significant differences across these subdomains, there was a high degree of overlap between these scores (> 73%) and thus the differences are not clinically relevant. The results suggest that ACE-III is a useful tool for discriminating between dementia, MCI and controls, but it is not reliable for discriminating between dementia subtypes. Nonetheless, the ACE-III is still a reliable tool for clinicians that can assist in making a dementia diagnosis in combination with other factors at assessment.

Family eating out-of-home: a review of nutrition and health policies.

Childhood obesity is a growing problem worldwide. In recent years, out-of-home (OH) eating has been highlighted as one of the many factors contributing to the obesogenic environment. This review seeks to identify a range of existing guidelines for the provision of healthy food options for families who eat OH frequently. Nationally available nutrition policies were identified using targeted and untargeted searches of the internet to identify established strategies for providing food for children in the family eating out sector in America (US), Australia, Canada and the WHO's European Region (EUR). These were categorised on the basis of eleven pre-defined criteria including: family eating out sector included as stakeholder; inclusion of children's food OH; cost strategies for healthier food choices; provision of nutrition information for customers; nutrition training of catering staff; and monitoring and evaluation structures. Fifty-five policies were reviewed, of which 71% addressed children's food served OH, but principally only for food available in schools. Two voluntary programmes, from Colorado and Slovenia, were identified as possible best practice models as they met a majority of the evaluation criteria. The most frequently used strategy by policies to promote healthier eating OH was the provision of nutrition information on menus, while monitoring and evaluation plans were poorly incorporated into any OH strategies, thus raising issues about their effectiveness. This review has identified a range of initiatives that could be employed to make healthier eating OH more accessible for families. However, to establish best practice guidelines for healthier OH food choices further investigations are required.

Effects of model schematisation, geometry and parameter values on urban flood modelling.

One-dimensional (1D) hydrodynamic models have been used as a standard industry practice for urban flood modelling work for many years. More recently, however, model formulations have included a 1D representation of the main channels and a 2D representation of the floodplains. Since the physical process of describing exchanges of flows with the floodplains can be represented in different ways, the predictive capability of different modelling approaches can also vary. The present paper explores effects of some of the issues that concern urban flood modelling work. Impacts from applying different model schematisation, geometry and parameter values were investigated. The study has mainly focussed on exploring how different Digital Terrain Model (DTM) resolution, presence of different features on DTM such as roads and building structures and different friction coefficients affect the simulation results. Practical implications of these issues are analysed and illustrated in a case study from St Maarten, N.A. The results from this study aim to provide users of numerical models with information that can be used in the analyses of flooding processes in urban areas.

Conduct disorder among Asians and Native Hawaiian/Pacific Islanders in the USA.

BACKGROUND: Conduct disorder (CD) is a relatively common disorder of childhood and adolescence in the USA with substantial associated morbidity, yet little has been published on CD among Asians and Native Hawaiian/Pacific Islanders (NH/PI) in the USA. METHOD: We used the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) to examine the prevalence and correlates of retrospectively reported CD within Asians and NH/PI (18 years and older). We also completed logistic regressions to explore factors associated with CD within Asians (n=1093) and, separately, NH/PI (n=139) and to explain racial differences in CD prevalence. RESULTS: Asians were about a third as likely [odds ratio (OR) 0.4, 95% confidence interval (CI) 0.22-0.58] whereas NH/PI were about two and half times more likely (OR 2.6, 95% CI 1.31-5.06) to have had CD compared with Caucasian respondents. Within Asians and NH/PI, CD was strongly associated with adult antisocial behavior, substance use and affective disorders. Demographic factors, the age that subjects came to the USA, measures of family environment and family history could not explain the observed differences in prevalence of CD for NH/PI relative to Caucasians. CONCLUSIONS: Asian and NH/PI youth with CD represent a subgroup of Asian youth at very high risk for a number of serious psychiatric disorders. Further investigation is needed to explain the high CD prevalence among NH/PI.

Dynamic least-cost optimisation of wastewater system remedial works requirements.

In recent years, there has been increasing concern for wastewater system failure and identification of optimal set of remedial works requirements. So far, several methodologies have been developed and applied in asset management activities by various water companies worldwide, but often with limited success. In order to fill the gap, there are several research projects that have been undertaken in exploring various algorithms to optimise remedial works requirements, but mostly for drinking water supply systems, and very limited work has been carried out for the wastewater assets. Some of the major deficiencies of commonly used methods can be found in either one or more of the following aspects: inadequate representation of systems complexity, incorporation of a dynamic model into the decision-making loop, the choice of an appropriate optimisation technique and experience in applying that technique. This paper is oriented towards resolving these issues and discusses a new approach for the optimisation of wastewater systems remedial works requirements. It is proposed that the optimal problem search is performed by a global optimisation tool (with various random search algorithms) and the system performance is simulated by the hydrodynamic pipe network model. The work on assembling all required elements and the development of an appropriate interface protocols between the two tools, aimed to decode the potential remedial solutions into the pipe network model and to calculate the corresponding scenario costs, is currently underway.

Twenty-five year mortality of US servicemen deployed in Vietnam: predictive utility of early drug use.

Large numbers of young men were exposed to high-quality opiates for a relatively short time period during military service in Vietnam. This study examined the relationships of opiate and other drug abuse before, during, and shortly after their time of service in Vietnam with the subsequent 25-year mortality among the cohort of 1227 US Army enlisted returnees and their matched civilians previously studied in 1972 and 1974. Composite factor scores of a variety of drug use measures and other individual behavioral measures were selected separately for three time periods around service in Vietnam from over 120 measures associated with mortality. Results of path analytic models applied to selected significant measures showed that both in-Vietnam and post-Vietnam drug use factors were large and significant predictors of mortality, controlling for pre-service drug use, continuity to later drug use, and demographic and other behavioral measures. The magnitude of the direct effect of drug use on mortality was larger than those of the covariates that were entered in the path analyses, except age. Notwithstanding the high remission rate from opiate addiction, drug use in Vietnam had considerable predictive utility for premature death in this cohort. In light of the re-emergence of increased heroin use since the mid-1990s, the findings point to the importance of early intervention of drug use and comorbid problems for today's youth now initiating heroin use.

Remission from drug abuse over a 25-year period: patterns of remission and treatment use.

OBJECTIVES: Using an epidemiologically obtained sample, we examined patterns of illicit drug use, abuse, and remission over a 25-year period and recent treatment use. METHODS: The surviving members of the cohort (n = 841), previously surveyed in 1972 and 1974, comprised 3 subsamples of Vietnam War enlisted men and civilian controls. Retrospectively obtained year-to-year measures from the 1996-1997 survey included use and remission of sedatives, stimulants, marijuana, cocaine, and opiates, as well as substance abuse and psychiatric treatment use. RESULTS: Relatively stable patterns of frequent use in adulthood were found, with the mean duration from initiation to the last remission ranging from 9 to 14 years. A majority attempted to quit; however, most did not use traditional drug treatment in their last attempts. Fewer than 9% of the then-current drug users were treated in inpatient or outpatient settings at the time of data collection. CONCLUSIONS: Most drug abusers who had started using drugs by their early 20s appeared to gradually achieve remission. Spontaneous remission was the rule rather than the exception. Nonetheless, considerable unmet needs existed for those who had continued use into middle age.

Applying artificial neural network models to clinical decision making.

Because psychological assessment typically lacks biological gold standards, it traditionally has relied on clinicians' expert knowledge. A more empirically based approach frequently has applied linear models to data to derive meaningful constructs and appropriate measures. Statistical inferences are then used to assess the generality of the findings. This article introduces artificial neural networks (ANNs), flexible nonlinear modeling techniques that test a model's generality by applying its estimates against "future" data. ANNs have potential for overcoming some shortcomings of linear models. The basics of ANNs and their applications to psychological assessment are reviewed. Two examples of clinical decision making are described in which an ANN is compared with linear models, and the complexity of the network performance is examined. Issues salient to psychological assessment are addressed.

Substance abuse as a predictor of VA medical care utilization among Vietnam veterans.

The primary objective was to determine whether Vietnam veterans who had alcohol or drug use problems prior to, during, or immediately after the war used Veterans Administration (VA) health care services more intensively during the next two decades than Vietnam veterans without these behaviors. The secondary objective was to identify predictors of VA health services utilization among data collected at service discharge. Logistic and ordinary least squares regression were used to model the effect of predisposing, enabling, and need factors on utilization of VA health services (N = 571). Results show that Vietnam veterans who had substance use problems either before or immediately after Vietnam used VA health care services more intensively during the next two decades than Vietnam veterans without these behaviors. Depression and psychiatric care seeking were also important predictors. More research is needed to evaluate the impact of health system characteristics and private sector use on the predictive ability of the models.

Radial scar and carcinoma of the breast: microscopic findings in 32 cases.

We retrospectively reviewed the microscopic findings in 32 histologically confirmed radial scars in 31 women diagnosed in our unit during 1994-1998. The median age at diagnosis was 53 years (range 47-63 years). Thirty-one (97%) of 32 lesions presented as screen detected mammographic abnormalities (28 stellate lesions, 2 microcalcifications and only 1 architectural distortion). One lesion presented as a palpable breast mass. Stereotactic or ultrasound-guided fine needle aspiration cytology (FNAC) was performed in 28 cases. Cytological analysis of FNAs revealed malignant cells (C5) in 8 (29%) cases, highly suspicious cells (C4) in 3 (11%) cases, atypical benign cells (C3) in 7 (25%) cases and benign epithelial cells (C2) in 10 (35%) cases. All non-palpable lesions were surgically excised following wire localization. Histological examination of the breast specimens (mean weight=16 g) demonstrated, in addition to a radial scar, 6 invasive carcinomas (2 infiltrating ductal, 2 tubular, 1 mixed ductal/lobular and 1 secretory carcinoma) and 4 ductal carcinoma in situ lesions (2 high grade, 1 high grade with micro-invasion and 1 low grade) arising in the radial scar. Of the remaining cases the radial scar was associated with atypical epithelial hyperplasia in 2 cases and regular epithelial hyperplasia in 17 cases (4 florid and 13 mild to moderate). In the 10 cases associated with malignancy, 9 had FNAC and was reported as malignant (C5) in 6 (67%) cases, highly suspicious (C4) in 2 (22%) cases and atypical (C3) in 1 (11%). False positive FNAC (C5) occurred in two patients, one of whom presented with pleomorphic microcalcifications suggestive of ductal carcinoma in situ. This patient was treated with a wire guided segmental mastectomy. All invasive tumours were less than 20 mm in size (T1) and of these 4 were grade I and 2 were grade II. Axillary dissection was performed in 4 patients none of whom had axillary node metastases. Our study demonstrates a significant incidence of malignancy associated with radial scars (31%) suggesting that radial scars may be premalignant lesions. This is supported by detecting various stages of mammary carcinogenesis (atypical epithelial hyperplasia, ductal carcinoma in situ, and early invasive malignancy) in these lesions. Fine needle aspiration cytology seems to be unreliable in the diagnosis of radial scar associated malignancy (67% sensitivity and 91% specificity). Stellate lesions, therefore, should be excised to obtain an histological diagnosis regardless of cytological findings. Further studies examining the biology of radial scars are required.

Hot-water bottle induced thermal injury of the skin overlying Becker's mammary prosthesis.

We report a case of a full thickness burn to the breast following the application of a hot-water bottle to the insensate skin overlying a mammary prosthesis.

Phyllodes tumour of the breast: a retrospective analysis of 30 cases.

Phyllodes tumour (PT) is a rare neoplasm of the female breast that resembles fibroadenoma but occurs in an older age group. We retrospectively reviewed the medical records of 30 women who were treated for phyllodes tumour in our centre. Histological examination was performed by an experienced breast pathologist in all cases and tumours were classified as benign, border line malignant or malignant according to standard histological criteria. The mean age at diagnosis was 49 years (range: 19-80 years). Twenty-one (70%) of 30 tumours were benign and 9 (30%) were malignant (n=7) or borderline malignant (n=2). The mean tumour size was 46 mm (range: 20-100 mm). The final microscopic margins contained tumour in 13 (43%) of 30 cases and were free of tumour in 17 (57%) of 30 patients. After a median follow-up period of 6 years (range: 6 months-20 years), the tumour recurred locally in 5 (17%) patients. One patient had six local recurrences over an 18-year period. Local recurrences were more frequently observed in patients with malignant tumours compared with those with benign lesions (33% versus 10%). However, this association failed to reach statistical significance. There was no association between local recurrence, patient age, tumour size or positive microscopic margins. There was one death (3%) associated with a completely excised malignant tumour. The present study suggests that histological type and margins do not accurately predict the clinical course of PT and that there is a need to identify novel biological markers that more accurately predict the behaviour of this rare neoplasm.

Reflecting adult drinking culture: prevalence of alcohol use and drinking situations among Japanese junior high school students in Japan.

OBJECTIVE: To estimate the prevalence of Japanese adolescents' alcohol use in Japan and the situations surrounding their drinking. METHOD: A general population self-administered questionnaire survey was conducted with a sample of 5,240 Japanese junior high school students obtained from 12 representative schools of the Chiba Prefecture in Japan. RESULTS: Almost 80% of the boys and 75% of the girls reported having consumed an alcoholic beverage on at least one occasion. Consumption occurred most frequently on a ceremonial occasion (52.4%), followed by drinking with family (39.0%), with peers (20.6%), after a bath (9.7%) and at ritual parties among friends (9.3%). In this sample, a greater percentage of students in a higher grade reported a drinking occasion after a bath, at parties among friends, or with peers. However, this trend was not observed for drinking on ceremonial occasions or with family in the evening. A gender difference was observed for the prevalence of drinking after a bath. A majority of students agreed with the statement that minors' use of alcohol was "acceptable depending on the situation." This was in sharp contrast with their perception of cigarette smoking and solvent use (16.3% and 3.8%, respectively, endorsing the same statement). CONCLUSIONS: By sometime in their first year of junior high school (when most students are age 12 years), more than 75% of Japanese adolescents have tried alcohol. Prevalence rates and trends across grades are different depending on the occasions of drinking. The findings on situational drinking among adolescents of this age group appear to reflect that assimilation into Japanese drinking culture takes place early on in family or traditional settings.

Cigarette smoking and solvent use among Japanese adolescents.

To examine the relationship between cigarette smoking and solvent use among Japanese adolescents, epidemiologic data from a survey of 4433 junior high school students were analyzed. For both males and females, the frequency of cigarette smoking was positively associated with curiosity about solvent use, the perception of closeness to solvent users and the lifetime and past-year prevalence rates of solvent use. On the other hand, the frequency of smoking was negatively associated with the endorsement of the current Japanese law which maintains the illegality of solvent use. These results are reported for the first time from epidemiologic-based data among early adolescents in Japan. Although correlational, they suggest the role of cigarette smoking for Japanese adolescents in the initiation of other illicit drug use in these age groups.

Subtypes of adult antisocial behavior among drug abusers.

Recent work has shown that a substantial proportion of injecting drug users would have met criteria for antisocial personality disorder (ASPD) if the childhood trajectory of conduct disorder (CD) were ignored. From among 545 St. Louis, Missouri, drug users interviewed in person, we evaluated the clinical homogeneity of the 405 men and women with adult antisocial behaviors who did and did not have conduct disorder. The fully diagnosed ASPD group (those with CD) was distinguishable from the adult antisocial behavior only group without CD on all childhood behaviors, adult impulsive and aggressive behaviors, and measures of severe drug abuse, including earlier age of onset of drug use and drug treatment utilization. Clinical homogeneity of the groups was reflected by the group's similarity on indices such as types of adult antisocial behaviors, consequences of drug use, injection drug use history, and comorbid psychiatric disorders. Implications for a modification in the concept of ASPD are addressed.

Is antisocial personality disorder associated with increased HIV risk behaviors in cocaine users?

Previous reports have shown antisocial personality disorder (ASPD) to be strongly associated with injection equipment sharing and increased rates of human immunodeficiency virus (HIV) infection in a sample of heroin injectors. Another report has shown ASPD to be associated with injection drug use, needle sharing, sexual promiscuity, and prostitution in a sample of methadone maintenance clients. The current study extends this work by examining the relationship of ASPD and human immunodeficiency virus (HIV) risk behaviors in a sample of cocaine users (48% out of treatment and 52% just entering treatment). Associations were tested for sexually risky behaviors in addition to injection behaviors. The principle finding of this study is that ASPD was shown to be associated with increased rates of injection drug use and sharing syringes, with earlier age of onset of injection drug use, with certain venereal diseases, and with a variety of HIV risk sexual behaviors. When men and women were tested separately, the pattern of association of risky behaviors with ASPD varied considerably. Overall, this work confirms that psychiatric status, especially the presence of ASPD, may have to be considered in evaluating the results of HIV risk-reduction interventions.

Symptoms in the community. Prevalence, classification, and psychiatric comorbidity.

BACKGROUND: While physical symptoms are the leading reason for outpatient visits, a substantial proportion of physical complaints and "minor" illnesses remain poorly understood. The purpose of our study was to determine the prevalence, patient-attributed cause, and psychiatric comorbidity of symptoms in a general population. METHODS: We analyzed data on 13,538 individuals interviewed in the Epidemiologic Catchment Area Program, a multicommunity mental health survey that used the Diagnostic Interview Schedule to determine the prevalence of psychiatric disorders. The Diagnostic Interview Schedule inquires about 38 physical symptoms and includes a probing scheme to classify symptom severity and potential cause. We focused on 26 symptoms most germane to primary care. RESULTS: Of the 26 symptoms, 24 had been problems for more than 10% of persons at some point in their life, with the most common nonmenstrual symptoms being joint pains (36.7%), back pain (31.5%), headaches (24.9%), chest pain (24.6%), arm or leg pain (24.3%), abdominal pain (23.6%), fatigue (23.6%), and dizziness (23.2%). Most symptoms (84%) were at some point considered major in that they interfered with routine activities or had led individuals to take medications or visit a physician. Nearly one third of symptoms were either psychiatric or unexplained, and most symptoms were associated with at least a twofold increased lifetime risk of a common psychiatric disorder. CONCLUSION: Symptoms in the community are prevalent as well as bothersome. Often lacking an apparent physical explanation, such symptoms are associated with an increased likelihood of psychiatric disorders.

Estimating the prevalence of chronic fatigue syndrome and associated symptoms in the community.

Chronic fatigue syndrome is a poorly understood disease characterized by debilitating fatigue and neuromuscular and neuropsychological symptoms. Despite numerous studies on the subject, the epidemiology of the syndrome in the community remains largely unexplored. An estimate of the prevalence in the population is presented, approximating the Centers for Disease Control criteria as well as the prevalence estimates of the fatigue symptom complex that include fatigue, disability, and neuromuscular and neuropsychological symptoms. The study population consisted of a very large, multicenter, stratified, and random sample of a general population health survey known as the Epidemiologic Catchment Area Program. Data used for this study were gathered between 1981 and 1984. The Diagnostic Interview Schedule, a highly structured mental health interview, was used to assess the lifetime prevalence of medical and psychological symptoms. Chronic fatigue was common. A total of 23 percent of the subjects reported having experienced the symptom of persistent fatigue sometime during their lives. Chronic fatigue syndrome, however, as defined by the Centers for Disease Control, appeared to be quite rare in the general population. Only 1 of 13,538 people examined was found to meet a diagnosis of the syndrome with an approximation of the CDC criteria. Fatigue symptom complex was frequently related to medical or psychiatric illness or substance abuse; thus, persons meeting partial criteria of chronic fatigue syndrome were also found to be rare when psychiatric or medical exclusions were applied.