Processing of grammatical gender in normal and aphasic speakers of Russian.

Sensitivity to grammatical gender was investigated in 22 Russian-speaking aphasic patients, compared with young controls. Experiment 1 used a cued shadowing paradigm to assess gender priming (facilitation and/or inhibition of lexical access by a prenominal modifier with congruent, incongruent or neutral gender). Experiment 2 used a grammaticality judgment paradigm with similar stimuli. Normals showed significant interactions between gender and priming in Experiment 1 (facilitation for feminine and neuter nouns but not for masculines) and Experiment 2 (larger effects of context on feminine and neuter nouns) that we interpret as a Markedness Effect. Patients showed significant priming in Experiment 1 and above-chance accuracy in Experiment 2, but failed to show reduced effects for the least-marked masculine gender (the Markedness Effect) in either experiment. Context effects were not related to specific aphasic symptoms or subtypes in either experiment. However, canonical correlation revealed differential effects of specific aphasic symptoms on judgment accuracy (false alarms vs. misses). We conclude that knowledge of grammatical gender is spared in Russian aphasics, but gender processing is deviant. A possible model to account for these differences is discussed.

Progression into and out of binge drinking among high school students.

The current study examined binge drinking among high school students over an academic year. Adolescent drinkers (N = 621; 58% female) were grouped into 4 trajectories: drinkers (35%), increasers (14%), decreasers (16%), and persistent binge drinkers (35%). Prospective analyses indicated several factors that predicted escalation and de-escalation of binge drinking. Increasers were more likely to regularly use alcohol and cigarettes at a younger age than drinkers. Compared with decreasers, persistent binge drinkers reported regular alcohol and marijuana use at younger ages. Lower levels of perceived student drinking appeared to be a protective factor for onset of binge drinking. The results highlight the need to study precursors to the naturally occurring fluctuations in binge drinking and suggest factors that may accentuate the risk of binge drinking.

Exercise and weight loss reduce blood pressure in men and women with mild hypertension: effects on cardiovascular, metabolic, and hemodynamic functioning.

BACKGROUND: Lifestyle modifications have been recommended as the initial treatment strategy for lowering high blood pressure (BP). However, evidence for the efficacy of exercise and weight loss in the management of high BP remains controversial. METHODS: One hundred thirty-three sedentary, overweight men and women with unmedicated high normal BP or stage 1 to 2 hypertension were randomly assigned to aerobic exercise only; a behavioral weight management program, including exercise; or a waiting list control group. Before and following treatment, systolic and diastolic BPs were measured in the clinic, during daily life, and during exercise and mental stress testing. Hemodynamic measures and metabolic functioning also were assessed. RESULTS: Although participants in both active treatment groups exhibited significant reductions in BP relative to controls, those in the weight management group generally had larger reductions. Weight management was associated with a 7-mm Hg systolic and a 5-mm Hg diastolic clinic BP reduction, compared with a 4-mm Hg systolic and diastolic BP reduction associated with aerobic exercise; the BP for controls did not change. Participants in both treatment groups also displayed reduced peripheral resistance and increased cardiac output compared with controls, with the greatest reductions in peripheral resistance in those in the weight management group. Weight management participants also exhibited significantly lower fasting and postprandial glucose and insulin levels than participants in the other groups. CONCLUSIONS: Although exercise alone was effective in reducing BP, the addition of a behavioral weight loss program enhanced this effect. Aerobic exercise combined with weight loss is recommended for the management of elevated BP in sedentary, overweight individuals.

Effects of exercise training on older patients with major depression.

BACKGROUND: Previous observational and interventional studies have suggested that regular physical exercise may be associated with reduced symptoms of depression. However, the extent to which exercise training may reduce depressive symptoms in older patients with major depressive disorder (MDD) has not been systematically evaluated. OBJECTIVE: To assess the effectiveness of an aerobic exercise program compared with standard medication (ie, antidepressants) for treatment of MDD in older patients, we conducted a 16-week randomized controlled trial. METHODS: One hundred fifty-six men and women with MDD (age, > or = 50 years) were assigned randomly to a program of aerobic exercise, antidepressants (sertraline hydrochloride), or combined exercise and medication. Subjects underwent comprehensive evaluations of depression, including the presence and severity of MDD using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and Hamilton Rating Scale for Depression (HAM-D) and Beck Depression Inventory (BDI) scores before and after treatment. Secondary outcome measures included aerobic capacity, life satisfaction, self-esteem, anxiety, and dysfunctional cognitions. RESULTS: After 16 weeks of treatment, the groups did not differ statistically on HAM-D or BDI scores (P = .67); adjustment for baseline levels of depression yielded an essentially identical result. Growth curve models revealed that all groups exhibited statistically and clinically significant reductions on HAM-D and BDI scores. However, patients receiving medication alone exhibited the fastest initial response; among patients receiving combination therapy, those with less severe depressive symptoms initially showed a more rapid response than those with initially more severe depressive symptoms. CONCLUSIONS: An exercise training program may be considered an alternative to antidepressants for treatment of depression in older persons. Although antidepressants may facilitate a more rapid initial therapeutic response than exercise, after 16 weeks of treatment exercise was equally effective in reducing depression among patients with MDD.

Phased-in comprehensive care: a concept and case report.

A complicated case often requires a multidisciplinary approach. But such an approach makes it difficult for the practitioner to offer the patient a definitive treatment plan. This article outlines the concept of a phased-in comprehensive treatment plan and reports on a case in which such a plan was used successfully.

A comparison of newborns' NBAS reflex responses using total and individual scores. Neonatal Behavioral Assessment Scale.

The purpose of this study was to compare results found using a total summative score of abnormal reflex responses with the results found using individual reflex scores. The 20 reflexes included as part of the Brazelton Neonatal Behavioral Assessment Scale (NBAS) were assessed on 196 neonates on the 1st and 2nd days postnatally. Differences due to of type of delivery, birth weight, whether their mothers were insulin-dependent diabetics or nondiabetics, and day of testing were assessed by using analysis of variance. The key results were that all effects found using the total reflex score were replicated with individual reflex scores and that individual reflex scores also revealed effects not shown using the total score. It was concluded that the individual reflex scores, rather than the total score, should be used when evaluating newborn reflex performance.

Stress management and exercise training in cardiac patients with myocardial ischemia. Effects on prognosis and evaluation of mechanisms.

BACKGROUND: Previous studies have demonstrated that myocardial ischemia can be elicited by mental stress in the laboratory and during daily life and that ischemia induced by mental stress is associated with an increased risk for future cardiac events in patients with coronary artery disease. OBJECTIVES: To examine the extent to which ischemia induced by mental stress can be modified by exercise stress management, and to evaluate the impact of these interventions on clinical outcomes. METHODS: One hundred seven patients with coronary artery disease and ischemia documented during mental stress testing or ambulatory electrocardiographic monitoring were randomly assigned to a 4-month program of exercise or stress management training. Patients living at a distance from the facility formed a nonrandom, usual care comparison group. Myocardial ischemia was reassessed following treatment, and patients were contacted annually for as long as 5 years to document cardiac events, including death, nonfatal myocardial infarction, and cardiac revascularization procedures. RESULTS: Twenty-two patients (21%) experienced at least 1 cardiac event during a mean (+/- SD) follow-up period of 38 +/- 17 months. Stress management was associated with a relative risk of 0.26 compared with controls. The relative risk for the exercise group also was lower than that of controls, but the effect did not reach statistical significance. Stress management also was associated with reduced ischemia induced by mental stress and ambulatory ischemia. CONCLUSION: These data suggest that behavioral interventions offer additional benefit over and above usual medical care in cardiac patients with evidence of myocardial ischemia.

Fetal alcohol syndrome: diagnosis, management, and prevention.

Fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE) encompass a pattern of birth defects in persons whose mother ingested alcohol during pregnancy. Persons with FAE display fewer of the FAS traits. The hallmarks of FAS are pre- and postnatal growth retardation, central nervous system dysfunction, and characteristic facial dysmorphology. However, its effects can be multi-systemic--encompassing the cardiac, skeletal, and muscular systems, as well as presenting as lack of coordination, hyperactivity, diminished or distorted sense of danger, and lack of ability to function as an independent adult. The frequent incidence of this constellation of symptoms has a far-reaching impact (familial, medical, educational, and societal) because a myriad of professionals and large amounts of funding are used to help manage FAS/FAE children and adults. This article identifies, for a primary care provider, the essential characteristics of FAS/FAE and discusses available management options. Early diagnosis and continued education are advantageous at all levels, benefiting the individual and all of society.

Affective reorganization in the infant, the mother, and the dyad: the role of upright locomotion and its timing.

Clinical theory is replete with rich observations that the onset of walking engenders an enhancement of emotional expression in the infant. Yet, no empirical research exists on this subject. Moreover, the importance of normal timing variations in the onset of developmental transitions has not been a topic of investigation in most developmental research. In this naturalistic home study, "earlier" and "later" walking groups were delineated on the basis of timing of entry into this developmental transition. Age-held constant analyses indicated that earlier walkers and their mothers generally showed a rise in positive exchanges as well as "testing of wills" across the transition to walking. These changes were less clear for the later walkers. Differences were observed also between the two groups even prior to walking. These findings suggest that future studies should take account of timing variations in the onset of a developmental transition.

Effects of diets high in sucrose or aspartame on the behavior and cognitive performance of children.

BACKGROUND: Both dietary sucrose and the sweetener aspartame have been reported to produce hyperactivity and other behavioral problems in children. METHODS: We conducted a double-blind controlled trial with two groups of children: 25 normal preschool children (3 to 5 years of age), and 23 school-age children (6 to 10 years) described by their parents as sensitive to sugar. The children and their families followed a different diet for each of three consecutive three-week periods. One diet was high in sucrose with no artificial sweeteners, another was low in sucrose and contained aspartame as a sweetener, and the third was low in sucrose and contained saccharin (placebo) as a sweetener. All the diets were essentially free of additives, artificial food coloring, and preservatives. The children's behavior and cognitive performance were evaluated weekly. RESULTS: The preschool children ingested a mean (+/- SD) of 5600 +/- 2100 mg of sucrose per kilogram of body weight per day while on the sucrose diet, 38 +/- 13 mg of aspartame per kilogram per day while on the aspartame diet, and 12 +/- 4.5 mg of saccharin per kilogram per day while on the saccharin diet. The school-age children considered to be sensitive to sugar ingested 4500 +/- 1200 mg of sucrose per kilogram, 32 +/- 8.9 mg of aspartame per kilogram, and 9.9 +/- 3.9 mg of saccharin per kilogram, respectively. For the children described as sugar-sensitive, there were no significant differences among the three diets in any of 39 behavioral and cognitive variables. For the preschool children, only 4 of the 31 measures differed significantly among the three diets, and there was no consistent pattern in the differences that were observed. CONCLUSIONS: Even when intake exceeds typical dietary levels, neither dietary sucrose nor aspartame affects children's behavior or cognitive function.

Hypertension affects neurobehavioral functioning.

This study compared the neurobehavioral performance of hypertensive and normotensive men and women using neuropsychological, information-processing, and psychometric assessments. One hundred subjects, including 68 hypertensive and 32 normotensive individuals, completed a test battery that yielded scores on measures of speed of information processing, verbal and figural memory, psychosocial functioning, Type A behavior, and locus of control. Results showed that, compared with the normotensive individuals, the hypertensives performed more poorly on a set of tasks that measure speed of information processing and short-term memory (Digit Symbol, Digit Span (Backwards), and Reaction Time (slope)). The hypertensives also reported higher levels of state anxiety relative to their normotensive counterparts. The effects of hypertension on neurobehavioral functioning could not be accounted for on the basis of age or education.

Failure of exercise to reduce blood pressure in patients with mild hypertension. Results of a randomized controlled trial.

OBJECTIVE: --To assess the effects of physical exercise training on blood pressure in patients with mild hypertension. DESIGN: --Randomized controlled trial. SETTING: --Hospital-based cardiac rehabilitation program. PATIENTS: --Ninety-nine men and women with untreated mild hypertension (systolic blood pressure, 140 to 180 mm Hg; diastolic blood pressure, 90 to 105 mm Hg) were included in the volunteer sample. INTERVENTIONS: --Subjects were randomly assigned to a 4-month program of aerobic exercise training, strength and flexibility training, or to a waiting list control group. MAIN OUTCOME MEASURES: --The main outcome measures were systolic and diastolic blood pressures measured four times with a random zero sphygmomanometer on 3 separate days in a clinic setting. RESULTS: --After 4 months of exercise training, subjects in the aerobic exercise group did not exhibit greater reductions in blood pressure than subjects in the control group. We expected a differential decline of 5 mm Hg between the aerobic exercise and waiting list control groups and found a difference of -1.0 +/- 16 mm Hg and -1.2 +/- 10 mm Hg at alpha = .05 for systolic and diastolic blood pressure, respectively. CONCLUSIONS: --Moderate aerobic exercise alone should not be considered a replacement for pharmacologic therapy in nonobese patients with mild hypertension.

Statistical constraints on the use of single cases in neuropsychological research.

In a recent study by Miceli, Silveri, Romani, and Caramazza (Brain and Language, 1989, 36, 447-492), free speech records for 20 unselected Italian-speaking agrammatic patients were analyzed along a variety of linguistic parameters, with particular emphasis on substitution and omission errors within traditional "part of speech" categories. The authors draw two strong conclusions: (1) the variability observed in this sample is too great to justify grouping these patients (or any coherent subset of the patients) into the "same" clinical category; (2) the extensive variability displayed by these patients reflects meaningful and very specific patterns of dissociation that would be lost if patients were grouped together in a common category called "aggrammatism." In a reanalysis of the Miceli et al. data, we conclude that the evidence does not justify either of these conclusions. First, we provide a set of mathematical simulations demonstrating that the dissociations claimed by Miceli et al. could have occurred entirely by chance, if samples of speech were drawn randomly from a "universe of discourse" characterized by error rates similar to those displayed by patients in this study. This randomization method has considerable generality, and could prove useful to other investigators interested in determining the number and type of dissociations that are likely to occur by chance in individual and/or group studies. Second, we demonstrate that there are many confounding factors that could account for the variability observed by Miceli et al., including differences in neurological status, education, and the strategies that patients elect to deal with their limitations.

A maximum likelihood procedure for the analysis of group and individual data in aphasia research.

The limitations inherent in group versus case studies appear to lie in a complementary distribution, underscoring the importance of combining both strategies within a single research program. However, this compromise approach requires analytic tools that permit us to combine and evaluate individual and group data in a common format. Maximum likelihood estimation (MLE) belongs to a family of procedures for determining goodness of fit. MLE can be used in conjunction with a linear or nonlinear model of the way that sources of information combine to determine a given behavioral outcome; such models can be used to estimate the distance between two groups, the degree to which an individual case deviates from a given empirically or theoretically defined group profile, and the degree to which one individual case resembles another. We offer a demonstration of how MLE can be used to evaluate group and individual profiles, in a cross-linguistic study of sentence comprehension in nonfluent aphasic speakers of English, Italian, and German. This includes a demonstration in which the MLE models for each language are "lesioned" to simulate several competing accounts of receptive agrammatism.

Aerobic exercise reduces levels of cardiovascular and sympathoadrenal responses to mental stress in subjects without prior evidence of myocardial ischemia.

Thirty-seven healthy type A men (mean age 42 years) were randomly assigned to either an aerobic exercise training group or to a strength and flexibility training group. Before exercise, subjects underwent comprehensive physiologic and behavioral assessments, including graded exercise treadmill testing with direct measurement of oxygen consumption (VO2) and measurement of cardiovascular (heart rate, systolic and diastolic blood pressure and rate pressure product) and neuroendocrine (epinephrine and norepinephrine) responses to mental arithmetic. The aerobic exercise consisted of walking and jogging at an intensity of greater than or equal to 70% maximal heart rate reserve for 1 hour 3 times/week for 12 consecutive weeks. The strength training consisted of 1 hour of circuit Nautilus training 2 times/week for 12 weeks. At the completion of the exercise program, all subjects underwent repeat testing. For the aerobic group, peak VO2 increased significantly from 33.6 to 38.4 ml/kg/min (p less than 0.001), whereas the strength group only achieved a slight increase from 34.5 to 35.6 ml/kg/min (difference not significant). During the mental arithmetic, the aerobic group experienced a greater reduction in levels of heart rate, diastolic blood pressure and rate pressure product than the strength group (after completing the exercise training programs). The aerobic group also tended to secrete less epinephrine and to show a faster recovery than the strength group after the exercise program. In addition, the aerobic group tended to exhibit less cardiovascular reactivity to mental stress after exercise training. These data suggest that aerobic exercise reduces levels of cardiovascular and sympathoadrenal responses during and after mental stress.

Feelings of depression and parenting competence of mothers of handicapped and nonhandicapped infants: a longitudinal study.

Relations of maternal depression and feelings of parenting competence with measures of child characteristics and mother's social support system were examined across time. Full assessments were made of mothers of handicapped infants at infant ages 11, 15, 19, and 27 months and mothers of nonhandicapped infants at infant ages 6, 11, 15, 19, and 27 months. Although the two groups of infants differed significantly in level of functioning and difficulty of caregiving, the two groups of mothers did not differ on the measures of maternal depression and feelings of parenting competence. In the handicapped group, caregiving difficulty predicted maternal depression, and the quality of family relations predicted the mothers' feelings of parenting competence. In the nonhandicapped group, both feelings of depression and of parenting competence were predicted by child irritability and the quality of family relations.

Health-related quality of life in inflammatory bowel disease. Functional status and patient worries and concerns.

The assessment of health-related quality of life may be an adjunct to understanding the chronic illness experience and its effects on health outcomes. In this study, we evaluated health-related quality of life of 150 patients with inflammatory bowel disease (63 ulcerative colitis, 87 Crohn's disease). We used a standardized measure, the Sickness Impact Profile, and a questionnaire we developed that elicits and prioritizes the disease-related worries and concerns of patients with IBD. Our preliminary data indicate that: (1) IBD patients experience moderate functional impairment more in the social and psychological than in the physical dimensions; (2) Crohn's disease patients report psychosocial dysfunction to a greater degree than ulcerative colitis patients; (3) IBD patients report greatest concerns about having surgery, degree of energy, and body image issues such as having an ostomy bag; and (4) functional status and patient concerns correlate better with other measures of health status and previous health care utilization than the physician's rating of disease activity. We believe that questionnaires measuring health-related quality of life (HRQOL) can be used in research and patient care to extend the clinical assessment of patients with IBD. Further work is needed to determine the role of HRQOL relative to disease activity and other physician-based assessments in predicting health outcomes.