Osteoporosis in men: the value of laboratory testing.

UNLABELLED: Evaluation of 234 men referred for osteoporosis found many with undiagnosed secondary causes and multiple unrecognized risk factors. INTRODUCTION: Studies in women with postmenopausal osteoporosis suggest that many have unrecognized disorders affecting bone. Men are considered more likely to have underlying, possibly correctable causes. We studied the prevalence of risk factors, secondary causes, and laboratory abnormalities in men with and without previously known causes for osteoporosis. METHODS: We reviewed the charts of 234 men with osteoporosis diagnosed by bone mineral density testing. In addition to screening chemistries, 25-hydroxyvitamin D, testosterone, luteinizing hormone, follicle-stimulating hormone, thyroid-stimulating hormone, and spot urinary calcium-to-creatinine ratio were measured. RESULTS: The mean age was 70.6 years and mean weight was 76.4 kg. The mean T-score for spine, femoral neck, and forearm was -2.2, -2.4, and -2.3, respectively. Evaluation revealed secondary osteoporosis in 75% overall including hypogonadism, vitamin D deficiency, hypercalciuria, subclinical hyperthyroidism, and hyperparathyroidism. In those men with known secondary osteoporosis at the time of dual energy X-ray absorptiometry testing, additional diagnoses were found in just over half. Vitamin D deficiency and insufficiency were very common, and other common risk factors for osteoporosis included age >65, current smoking, and prior fracture. Half of the subjects had ≥ 4 risk factors. CONCLUSION: Evaluation revealed a specific cause in about half of men thought to have primary osteoporosis. Among men with known secondary osteoporosis, additional risk factors and secondary causes were frequently identified. In conclusion, a relatively modest evaluation of men with osteoporosis will often provide useful information.

Stereotyping among providers and consumers of public mental health services. The role of perceived group variability.

The authors examine stigmatization and mental illness, focusing on the role of perceived group variability in stereotype use. Consumers' and providers' in-group and out-group stereotypes were assessed. Although providers had extensive experience, they judged consumers more stereotypically and just as negatively as did the consumers themselves. Consumers' education and involvement in services were weakly predictive of more stereotypic, less variable, and more negative views of providers, whereas providers' education and involvement in services predicted more stereotypic but also more variable views of both groups. Perceived group stereotypicality predicted more stereotypic judgments of individuals, whereas perceived variability predicted less confidence in judgments. Because providers perceived greater variability, they were less confident in applying the stereotype to individuals. We suggest that increasing perceptions of the variability among consumers may lead to more sensitive use of diagnostic criteria, more individualized treatment, and a decrease in the negative effects of stigmatization.

Intensity and duration of intensive case management services.

OBJECTIVE: Two policy issues related to intensive case management programs were examined: limiting caseload size to ensure that services are intensive and providing intensive services to the same clients in perpetuity. METHOD: The Denver Acuity Scale, which indicates need for services on a 5-point scale, was used for determining the service intensity needed by consumers and for increasing case managers' efficiency when caseload size varied. The acuity ratings of individuals in the Denver intensive case management program were examined to evaluate the effects of service duration on decompensation. Each consumer was rated at every service contact. The percentage of individuals readmitted to the program after they graduated was calculated, and the trajectories of 87 individuals who continued to be served by the program after they attained the highest rating of functioning were examined. RESULTS: Of the 112 individuals who graduated from the program in the 29-month study period, four (4 percent) were readmitted. More than half of the 87 consumers who achieved the highest functioning level did not deviate from that level for the remainder of the study period. Nearly a fifth showed some deterioration shortly after achieving that level but then improved. Slightly more than a fourth continued to deteriorate, but many never reached the lowest levels of functioning. CONCLUSIONS: To increase efficiency and ensure appropriate service levels, service intensity should be based on individual consumers' functioning levels. Most consumers are unlikely to need intensive case management in perpetuity. Providing more intensive services than needed or providing services longer than needed is inefficient and may even impede consumer recovery.

Development of new group members' in-group and out-group stereotypes: changes in perceived group variability and ethnocentrism.

Changes in new members' in-group and out-group stereotypes were examined, distinguishing among three stereotype components: stereotypicality, dispersion, and ethnocentrism. Pledges in 4 sororities judged their in-group and out-groups 4 times during their 8-month induction. Overall, out-groups were judged more stereotypically than in-groups at every wave. Although out-groups were initially perceived as more dispersed than in-groups, decreased out-group dispersion resulted in a shift toward out-group homogeneity. Ethnocentrism was present at every wave but decreased because of decreased in-group positivity. The authors discuss implications of these results for existing explanations of stereotype development. It is suggested that other aspects of group socialization (R.L. Moreland & J.M. Levine, 1982) are needed to explain fully the development of intergroup perceptions for new group members.

Patterns of services and consumer outcome in an intensive case management program.

This study examined the patterns of services provided to individuals with serious and persistent mental illness during their first year in an intensive case management program. Services in 10 content areas were examined, and patterns for more versus less "successful" individuals were compared. Differences emerged for services focusing on family and housing, suggesting that the need for community support services influences the need for continued intensive case management. Linear reductions in rehabilitation services suggest that such services may indeed be effective early in the treatment process. Finally, differences among case managers in service patterns for 5 of the 10 content areas suggest that case managers play an important role in determining the course of treatment.

Teaching deception skills in a game-play context to three adolescents with autism.

Baron-Cohen (1992) found that students with autism are impaired in their ability to deceive. A multiple-baseline across-subjects design was conceptualized to test the hypothesis that such students could be taught to deceive. Two conditions were presented in baseline and treatment phases. In Condition 1, the student guessed in which hand a small object was hidden when the experimenter presented two closed fists. In Condition 2, the student hid the object and presented two closed fists to the experimenter for a guess. Reinforcement was delivered contingently upon independent guessing during Condition 1 in both baseline and treatment phases. Under Condition 2, reinforcement was delivered noncontingently during the baseline phase and contingently upon successive approximations to the target behavior of deception during the treatment phase. All students displayed the acquisition of at least three of the responses included in the deception response during the baseline phase, and two students showed an erratic acquisition of the total skill during the baseline phase. Results indicate that students with autism can learn to deceive, even without formal intensive training.

Longitudinal changes in consensus as a function of acquaintance and agreement in liking.

By using a round-robin design, groups of freshmen reported their impressions of dormmates at 4 different times during the year. Consensus on W. T. Norman's Big Five (1963) did not increase over the year, even though reported acquaintance did increase. Agreement in liking predicted agreement in the trait ratings, such that groups that agreed in their evaluations of one another were more likely to agree in their trait impressions of one another, and vice versa. These patterns, obtained by using trait ratings, were replicated with open-ended descriptions of the targets. Correlations with self-judgments did not increase with acquaintance. The data suggest that increased acquaintance does not produce increased consensus. Instead, the role of agreement in evaluations is explored as a determining factor in the level of obtained consensus.

Stereotypes and ethnocentrism: diverging interethnic perceptions of African American and white American youth.

Much recent work on stereotyping has dealt with groups that are either artificially created or that do not have an extensive history of conflict. The authors attempted to overcome this limitation by examining issues of perceived variability and ethnocentrism among samples of White American and African American youth. The goals were both to examine theoretical issues in stereotyping and to describe the current state of ethnic interrelations among young people. Four studies are reported. Throughout, the samples of African Americans demonstrate interethnic judgments that are consistent with existing work on stereotyping and ethnocentrism. White American students, however, reported judgements that replicate neither the out-group homogeneity effect nor ethnocentrism. Alternative explanations for this difference are considered, and the discussion focuses on differing views concerning the role of ethnic identity and diversity in our society.

A comparative study of glucose and galactose uptake in pure cultures of human oral bacteria, salivary sediment and dental plaque.

The ability to utilize glucose and the weaker sugar acidogen, galactose, was surveyed in salivary sediment, pooled dental plaque, and in pure cultures of the bacteria that numerically comprise most of the bacteria in these mixed microbial systems. Except for a veillonella isolate, which showed no uptake of either sugar, glucose was utilized more rapidly than galactose by the 27 pure cultures tested and by both sediment and plaque. This sugar difference was also seen for two other measures of glycolysis, formation of acid and previously studied ability to produce an acidic pH. Rates of uptake of the two sugars by individual pure cultures varied considerably. Generally, the Gram-positive bacteria utilized glucose and galactose at rates similar to those seen with salivary sediment and dental plaque, whereas the Gram-negative cultures tested showed much slower uptakes. Bacteria previously identified as arginolytic had lower glucose and galactose uptake rates than similar non-arginolytic micro-organisms. This, together with the ability to produce base from arginine, would explain their tendency to produce a less acidic pH. In pure culture mixtures, uptakes were generally predictable and indicated an averaging effect. When the microbial compositions of salivary sediment or dental plaque were altered by mixing with pure cultures of high glucolytic activity, such as many of the Gram-positives, glucose uptake was enhanced. The opposite was observed when the less glucolytic Gram-negative bacteria were similarly incorporated. As well as determining the glucose and galactose uptake rates of the various bacteria that collectively comprise the bulk of the salivary sediment and supragingival plaque microfloras, this study has shown how variation in microbial composition affects sugar uptake rates and has indicated how microbial composition could be manipulated to produce dental plaques with different capacities to ferment sugars and presumably different cariogenicities.

Bacteria in human mouths involved in the production and utilization of hydrogen peroxide.

Earlier studies have demonstrated that pure cultures of oral streptococci produce hydrogen peroxide but none has found any free peroxide in dental plaque or salivary sediment despite streptococci being major components of their mixed bacterial populations. The absence of peroxide in plaque and sediment could be due to the dominance of its destruction over its formation by bacterial constituents. To identify which of the oral bacteria might be involved in such a possibility, pure cultures of 27 different oral bacteria were surveyed (as well as dental plaque and sediment) for their peroxide-forming and peroxide-removing capabilities. Peroxide production was measured for each of the pure cultures by incubation with glucose at low and high substrate concentrations (2.8 and 28.0 mM) for 4 h and with the pH kept at 7.0 by a pH-stat. Removal of hydrogen peroxide was assessed in similar experiments where peroxide at 0, 29.4, 147.2 or 294.4 mM [0, 0.1, 0.5 and 1% (w/v)] replaced the glucose. Hydrogen peroxide formation was seen with only three of the bacteria tested, Streptococcus sanguis I and II (sanguis and oralis), and Strep. mitior (mitis biotype I); levels of hydrogen peroxide between 2.2 and 9.8 mM were produced when these micro-organisms were grown aerobically and 1.1 and 3.9 mM when grown anaerobically. Earlier reports indicate that such levels were usually sufficient to inhibit the growth of many plaque bacteria. The amounts formed were similar at the two glucose levels tested, suggesting that maximum peroxide production is reached at low glucose concentration. None of the three peroxide-producing organisms was able to utilize hydrogen peroxide but five of the other 24 tested, Neisseria sicca, Haemophilus segnis, H. parainfluenzae, Actinomyces viscosus and Staphylococcus epidermidis, could readily do so, as could the mixed bacteria in salivary sediment and dental plaque, both of which contain relatively high numbers of these peroxide-utilizing micro-organisms. The ability of the bacteria in plaque and sediment to degrade hydrogen peroxide was considerable and extremely rapid; peroxide removal and usually complete within the first 15 min of the incubation even when its initial level was as high as 294.4 mM. This almost overwhelming ability to remove peroxide was confirmed when peroxide-producing and -using cultures were mixed and when each of eight salivary sediments was incubated with glucose and with peroxide at concentrations up to 294.4 mM. In the glucose incubations, no hydrogen peroxide was observed, indicating dominance of microbial peroxide removers over hydrogen peroxide producers.(ABSTRACT TRUNCATED AT 400 WORDS)

Accounting for case manager effects in the evaluation of mental health services.

Three methods of accounting for case manager effects in tests of the efficacy of mental health services are explored. These methods include (a) treating the case manager as a fixed factor, (b) treating the case manager as a random factor, and (c) examining service effects within the case manager. They are demonstrated with data from a nationally known case management program serving individuals with serious and persistent mental illness. Specifically, 3 conceptually distinct types of services provided or brokered by case managers are identified: habilitation-rehabilitation, community support, and traditional psychiatric services. The effectiveness of each in improving clients' adjustment is then examined with multiple regression adjustment strategies and each of the 3 methods to account for case manager effects. The results provide strong support for effects attributable to case managers and some support for the efficacy of habilitation-rehabilitation and community support services beyond the effects of traditional psychiatric services.

Pavlovian conditioning of the tickle response of human subjects: temporal and delay conditioning.

Previous studies of the human response to a tickle have demonstrated that subjects will respond to a gesture that signals the onset of a tickle in the same way as to a tickle. Researchers have described this anticipatory response as an "expectation." In the current study, we investigated, from the Pavlovian framework, the response to a verbal stimulus preceding the tickle stimulus. We exposed subjects to experimental phases which included the Neutral Stimulus Alone, 100% Pairing of the Neutral and Unconditioned Stimuli (tickle strokes to the foot), Random Presentation, Partial (75%) Reinforcement, and Temporal Conditioning. Pavlovian conditioning was observed in all phases, suggesting a parsimonious explanation for the expectation effect described by others.

False consensus and out-group homogeneity: a methodological note on their relationship.

Two different lines of research in social psychology ask subjects to generate estimates of the percentage of group members who they think would espouse some position or make some behavioural choice. Research on the false consensus effect has shown that such estimates are influenced by the subject's own choice. Research on out-group homogeneity has shown that such estimates are higher for group stereotypic choices than counterstereotypic ones and that this difference in turn is more pronounced for out-groups than in-groups. In this article we explore the relationship between these two effects, both of which rely on the same dependent measure. We show that out-group homogeneity will be estimated with bias unless the subject's own choice is included as a factor in the analysis, whenever false consensus is present and whenever the two target groups differ in the prevalence of their actual choices. We demonstrate this confounding with both hypothetical and actual data.

Role of meaningful subgroups in explaining differences in perceived variability for in-groups and out-groups.

Five aspects of the complexity of the knowledge representation of business and engineering majors were examined to see whether these differed by group membership and whether these differences were related to differences in perceived variability. Significantly more subgroups were generated when describing the in-group than the out-group; this difference predicted the relative tendency to see the in-group as more variable, and when controlled for statistically, out-group homogeneity effects were eliminated. Familiarity, redundancy, number of attributes used to describe the group, and the deviance of the subgroups from the larger group generally showed differences for in-group and out-group but did not show consistent evidence of mediation. In a 2nd study, Ss who were asked to sort group members into meaningful subgroups perceived greater variability relative to those who did not perform the sorting task.

Accuracy in the judgment of in-group and out-group variability.

The accuracy of in-group and out-group variability judgments was examined by comparing those judgments with the variability of self-ratings provided by random samples of group members. Following Park and Judd (1990), perceptions of both group dispersion and group stereotypicality were examined. Accuracy was examined both by within-subject sensitivity correlations and by simple discrepancies between perceived and actual variability estimates. In-group-out-group differences in sensitivity were shown, particularly for judgments of stereotypicality. These differences were related to differences in the degree to which out-group variability is underestimated relative to in-group variability (i.e., the out-group homogeneity effect). Out-group stereotypicality judgments were overestimated, supporting the view that out-group stereotypes are overgeneralizations. Whether dispersion judgments were over- or underestimated depended on their measurement.