The association between cheese consumption and cardiovascular risk factors among adults.

BACKGROUND: Although current dietary guidelines recommend limiting foods high in fat and saturated fat, such as high-fat dairy, the effect of cheese consumption on body composition and cardiovascular risk factors is largely unknown. METHODS: Participants from a US population-based survey, NHANES III, aged 25-75 years who completed a food frequency questionnaire and had measures of body composition and cardiovascular risk factors were included (n = 10 872). Linear regression was used to compare anthropometrics, blood lipids, blood pressure and blood glucose across categories of cheese consumption (combined full and low-fat). RESULTS: In women, more frequent cheese consumption was associated with higher HDL-C and lower LDL-C (p for trend, < 0.05). However, in men, more frequent cheese consumption was associated with a higher body mass index (BMI), waist circumference, HDL-C and LDL-C, and diastolic blood pressure (p for trend, < 0.05). Men consuming 30 + servings/month had significantly higher BMI, waist circumference, and diastolic blood pressure compared to nonconsumers (P < 0.05). CONCLUSIONS: More frequent cheese consumption was associated with less favourable body composition and cardiovascular risk profile in men, but with a more favourable cardiovascular risk profile in women. However, the type of cheese consumed by men and women may have differed resulting in opposing trends on body composition and cardiovascular risk factors.

Cigarette smoking is associated with energy balance in premenopausal African-American adult women differently than in similarly aged white women.

OBJECTIVE: To investigate the differential association of cigarette smoking with energy balance in African-American and white premenopausal women. DESIGN: Cross-sectional study of energy balance, weight, and smoking in women. SUBJECT: A total of 374 women: 191 African-American (mean age=29.8+/-6.5 y) and 183 white women (mean age=28.9+/-7.1 y). MEASUREMENTS: Weight, cigarette smoking habits, resting energy expenditure, dietary intake, and physical activity. RESULTS: There were no significant differences in dietary intake by race or smoking status. The model for physical activity was significant (P=0.0004), with body mass index (BMI) having the largest effect on activity (P<0.001). Smoking status was related to activity, with the heaviest smokers reporting more activity than nonsmokers (P=0.008) or light smokers (P=0.028). The model for resting energy expenditure (REE) was significant (P<0.0001), with the largest again being BMI (P<0.001). There was also an interaction between ethnicity and smoking status (P<0.0001) such that African-American nonsmokers and light smokers tended to have lower REE than several other groups, most often the African-American moderate heavy smokers. The model for BMI was significant (P<0.0001) with an interaction for ethnicity and smoking status (P=0.0009). African-American nonsmokers and light smokers had significantly higher BMIs than most of the other groups. CONCLUSION: African-American women who were the heaviest smokers had a lower adjusted BMI than the heaviest smoking white women. This effect, at least partially, may be related to an increased REE in the African-American smoking women. While energy intake did not appear to be important in this relationship, energy expended in physical activity appeared to be increased with smoking, as was REE.

Quantitative criteria for insomnia.

Formal diagnostic systems (DSM-IV, ICSD, and ICD-10) do not provide adequate quantitative criteria to diagnose insomnia. This may not present a serious problem in clinical settings where extensive interviews determine the need for clinical management. However, lack of standard criteria introduce disruptive variability into the insomnia research domain. The present study reviewed two decades of psychology clinical trials for insomnia to determine common practice with regard to frequency, severity, and duration criteria for insomnia. Modal patterns established frequency (> or =3 nights a week) and duration (> or =6 months) standard criteria. We then applied four versions of severity criteria to a random sample and used sensitivity-specificity analyses to identify the most valid criterion. We found that severity of sleep onset latency or wake time after sleep onset of: (a) > or =31 min; (b) occurring > or =3 nights a week; (c) for > or =6 months are the most defensible quantitative criteria for insomnia.

Association between the inception of a SAFE KIDS Coalition and changes in pediatric unintentional injury rates.

OBJECTIVE: To assess the relationship between the implementation of a SAFE KIDS Coalition and pediatric unintentional injury rates. SETTING: Shelby County, Tennessee. DESIGN: Retrospective observational analysis. PATIENTS: County residents nine years of age or younger presenting to the children's medical center, its emergency department, or its outpatient clinics from 1990-97. INTERVENTION: Implementation of a SAFE KIDS Coalition. MAIN OUTCOME MEASURES: Rates of unintentional injuries targeted by the SAFE KIDS Coalition that resulted in hospitalization or in death. Rates of motor vehicle occupant injuries that resulted in hospitalization or in death. Rates of non-targeted unintentional injuries, namely injuries secondary to animals and by exposure to toxic plants. Rates of severe injuries (defined as those targeted injuries that required hospitalization or resulted in death), and specifically, severe motor vehicle occupant injuries were compared before and after the inception of the coalition using Poisson regression analysis. RESULTS: The relative risk of targeted severe injury rates decreased after implementation of the coalition even after controlling for changes in hospital admission rates. Specifically, severe motor vehicle occupant injury rates decreased 30% (relative risk 0.70; 95% confidence interval 0.54 to 0.89) after initiation of the coalition. CONCLUSIONS: The implementation of a SAFE KIDS Coalition was associated with a decrease in severe targeted injuries, most notably, severe motor vehicle occupant injuries. Although causality cannot be determined, these data suggest that the presence of a coalition may be associated with decreased severe unintentional injury rates.

Sunscreen standards tested with differently filtered solar simulators.

BACKGROUND: The COLIPA standard for solar simulators permits a range of spectral filtration. Published studies comparing the SPFs of sunscreen formulas show that a range of SPFs is generally expected between laboratories. Specifically, three studies determining the SPFs of sunscreen standards have been performed in a series of laboratories and differences exceeding 50% have been reported. No studies to date have specifically examined potential differences in performance of Standard Sunscreen Test Formulas with varying solar simulator spectra within the permitted range of optical filtration. METHODS: In a paired clinical trial, two SPF standard sunscreen formulas were tested using two solar simulators that complied with the COLIPA standard for solar simulators but were filtered differently. One solar simulator was filtered as supplied by the manufacturer and delivered a high percentage of UVB; the other solar simulator was modified by removing the visible absorbing filter to deliver energy more closely resembling sunlight in the UVA-1 part of the spectrum, with a lower percentage of UVB. RESULTS AND CONCLUSION: The result was that the SPF of each standard sunscreen was almost 50% greater with the unmodified solar simulator than with the modified solar simulator. In vitro evaluation of the sunscreen standards predicted similar differences due to the spectral differences of the solar simulators, which appears to rule out reciprocity failure. However, reciprocity failure of the control MEDs was observed. The total intensity of the modified lamp was approximately 3 times that of the unmodified lamp.

Changes in attitudes and perceptions about research in physical therapy among professional physical therapist students and new graduates.

BACKGROUND AND PURPOSE: The physical therapy profession, through its published educational accreditation standards and its normative model of professional education, has addressed the importance of educating physical therapist students in the basic principles and application of research. The purpose of this study was to conduct a longitudinal study of students relative to (1) their perception of knowledge with respect to research, (2) their perception of what source should be used (evidence-based practice or traditional protocols) for clinical decision making, and (3) their perception of what should be used in a clinical setting for patient management. SUBJECTS: Thirty-six students during the final year of their professional program from a sample of 115 physical therapist students who requested 2 consecutive physical therapist classes completed the entire sequence of pretest and posttest survey administrations. Seventy-nine students did not complete the entire sequence. METHODS: A 10-item 5-point Likert-type questionnaire was designed by the authors to probe the students' attitudes and perceptions about research, their level of comfort and confidence in reading and applying research findings published in the literature, and their personal habits regarding reading the professional literature. An expert panel consisting of internal and external reviewers was used for construction of the questionnaire. The questionnaire was completed by the students immediately preceding their research methods course, immediately after the completion of that course, and following the second research course, which included statistics and development of a research proposal. The subjects also completed the questionnaire after 1 year of physical therapy practice. Friedman's analysis of variance was used as an omnibus test to detect differences across time. In addition, a follow-up analysis using the Wilcoxon signed-rank procedure to examine differences between baseline data and data obtained during each follow-up was done for all items to determine whether a difference occurred at a time other than at the final posttest survey administration. RESULTS: The students showed differences on 5 of the 10 items on the questionnaire during the study. DISCUSSION AND CONCLUSION: These items related to reading peer-reviewed professional journals, critically reading professional literature, relevance and importance of evidence-based clinical practice, and level of comfort with knowledge in research.

Respiratory syncytial virus infections in the pediatric intensive care unit: clinical characteristics and risk factors for adverse outcomes.

OBJECTIVES: To describe the clinical characteristics of infants admitted to a pediatric intensive care unit (PICU) with respiratory syncytial virus (RSV) infection, including the prevalence of indications for RSV passive antibody prophylaxis (as currently recommended by the American Academy of Pediatrics), and to identify risk factors that predict adverse outcomes among this population. DESIGN: Retrospective medical record review. SETTING: Tertiary care PICU. PATIENTS: Children <2 yrs of age admitted to PICU for the management of RSV disease during the 1994-95, 1995-96, and 1996-97 RSV seasons. MEASUREMENTS AND MAIN RESULTS: The medical records of 89 infants were reviewed. Of these, 55% were born before 36-wks gestation, 14% had chronic lung disease that required medical therapy within the previous 6 months, and 30% met at least one indication for RSV passive antibody prophylaxis. Seven infants had congenital heart disease, five had upper airway abnormalities, and six had various noncardiac congenital malformations. Logistic regression was used to determine which characteristics were associated with prolonged durations (>75th percentile) of mechanical ventilation, PICU stay, and hospital stay. Prolonged mechanical ventilation was associated with congenital heart disease (p = 0.014), chronic lung disease (p = 0.007), and noncardiac congenital malformations (p = 0.022). Only congenital heart disease was associated with prolonged PICU stay (p = 0.004) or prolonged hospital stay (p = 0.006). All of the infants with airway abnormalities had prolonged ventilator days, PICU days, and hospital days. Currently recommended indications for RSV passive antibody prophylaxis were not predictive of prolonged ventilation, PICU stay, or hospital stay. CONCLUSIONS: A minority of infants admitted to our PICU for severe RSV disease meet currently recommended indications for RSV passive antibody prophylaxis. Risk factors that predict prolonged durations of ventilation, PICU stay, or hospital stay among this population include congenital heart disease, chronic lung disease, upper airway abnormalities, and noncardiac congenital malformations.

Serum carotenoids and markers of inflammation in nonsmokers.

One explanation for discrepant results between epidemiologic studies and randomized trials of beta-carotene and cardiovascular disease may be a failure to consider inflammation as a confounder. To evaluate the potential for such confounding, the authors relate the serum concentrations of five carotenoids (alpha-carotene, beta-carotene, beta-cryptoxanthin, lycopene, and lutein/zeaxanthin) to levels of three inflammatory markers (C-reactive protein, fibrinogen, and white blood cell count) measured during the Third National Health and Nutrition Survey, 1988-1994. The analysis included 4,557 nonsmoking participants aged 25-55 years. Adjusted concentrations of all five carotenoids were significantly lower in those with C-reactive protein levels above 0.88 mg/dl (p = 0.001). There was a trend toward lower adjusted beta-cryptoxanthin concentrations with increasing level of fibrinogen (p value test for trend = 0.01), but other carotenoids were not related. Many of the carotenoid concentrations were lower among participants with high white blood cell counts. After log transformation, only adjusted mean beta-carotene levels were significantly lower in those with white blood cell counts above 7.85 x 10(9)/liter (p < 0.01). These cross-sectional data do not clarify the biologic relation between carotenoids and C-reactive protein but, to the extent that the carotenoids are associated with C-reactive protein levels, a carotenoid-heart disease association may be, in part, an inflammation-heart disease association.

Do sweat calcium losses affect bone mass during firefighter training?

Although participation in vigorous exercise is associated with increased bone mass, recent evidence suggests that loss of calcium in sweat may result in a negative calcium balance and, ultimately, a decrease in bone mass. Anthropometric characteristics, habitual physical activity levels, dietary calcium intake, bone mineral content, and bone turnover markers were measured in 42 male recruits before and after 4 months of firefighter training. During two strenuous mid-training sessions, sweat calcium concentrations were measured; they averaged 1.1 mM. Whole body and total hip bone mineral content increased significantly, as did one marker of bone formation, and were not associated with sweat calcium concentration. This study demonstrates that intense physical training sessions that produce high sweat rates do not have an adverse effect on the bone mineral content of healthy young men.

Bone density in Ehlers-Danlos syndrome.

Ehlers-Danlos Syndrome (EDS) is the most common inherited disorder of connective tissue recognized. The objectives of the present study were to determine bone mineral density (BMD) and biochemical markers of bone metabolism in EDS. Twenty-three subjects with Type III EDS and 23 matched controls underwent BMD measurement by dual-Energy X-ray absorptiometry (DXA) of the lumbar spine and femoral neck. Health history questionnaires and biochemical markers of bone and connective tissue metabolism were also assessed. No significant differences in BMD at the lumbar spine or differences in biochemical markers of bone and connective tissue metabolism were found between EDS subjects and controls. EDS subjects had a significantly decreased BMD at the femoral neck compared with controls, but this difference disappeared after adjustment for body height, weight and physical activity levels.

Nasal quantity of respiratory syncytical virus correlates with disease severity in hospitalized infants.

OBJECTIVE: To evaluate the relationship between nasal quantity of respiratory syncytial virus (RSV) and disease severity in hospitalized infants without underlying cardiopulmonary disease or immunodeficiency. METHODS: Nasal aspirates were obtained from hospitalized infants <24 months of age with recently identified RSV infection and evaluated for RSV quantity by a standard plaque assay on HEp-2 cell monolayers. Subjects were classified as having "severe" disease if they required mechanical ventilation at the time of sample collection and as having "nonsevere" disease if they did not. Linear modeling was used to determine the relationship between nasal RSV quantity and various independent variables, including disease severity. RESULTS: Nasal aspirates from 39 patients were evaluated. Age, gender and mean duration of time from symptom onset to sample acquisition (5 days) were similar between the severe (n = 15) and nonsevere (n = 24) groups. Significantly more infants were born at <35 weeks gestation in the severe disease group (7 of 15 vs. 3 of 24, P = 0.017), and infants born at <35 weeks gestation were significantly more likely to be of non-Caucasian ethnicity than were infants born at > or =35 weeks gestation (8 of 10 vs. 12 of 29, P = 0.035). The linear model found that higher nasal RSV quantities were associated with severe disease [mean +/- SEM, 5.06 +/- 0.34 log plaque-forming units (pfu)/ml vs. 3.91 +/- 0.35 log pfu/ml, P = 0.022], gestational age > or =35 weeks (5.44 +/- 0.27 log pfu/ml vs. 3.52 +/- 0.45 log pfu/ml, P = 0.002) and non-Caucasian ethnicity (5.16 +/- 0.30 log pfu/ml vs. 3.80 +/- 0.37 log pfu/ml, P = 0.006). CONCLUSIONS: Nasal RSV quantity correlates with disease severity in hospitalized infants with recently identified RSV infection.

An evaluation of the impact of a self-care coping intervention on psychological and clinical outcomes in adolescents with newly diagnosed cancer.

The demands of cancer treatment are particularly challenging for newly diagnosed adolescents. If attempts to cope with these demands are unsuccessful, adolescents may not comply with or may refuse treatment. As a result, their chances of survival are decreased. The purpose of this study, guided by the Adolescent Self-Sustaining Model, was to determine the effects of a three-part educational intervention designed to facilitate copying on psychological (hopefulness, hopelessness, self-esteem, self-efficacy and symptom distress) and clinical outcomes (treatment toxicity) among adolescents newly diagnosed with cancer. This two-site study used a longitudinal experimental two-group design with adolescents randomly assigned to the intervention or control group. Four measurement points spanning the first 6 months of treatment were included in the design. Of 93 eligible adolescents, 78 (46 females and 32 males) agreed to participate. No statistically significant differences between the intervention and control groups, or between male and female participants, were detected at any measurement point. Differences in scores over time within groups were noted. Explanations for the lack of group differences are offered, as are recommendations for strengthening the intervention and design for future testing.

Maternal calcium supplementation and fetal bone mineralization.

OBJECTIVE: To determine the effect of maternal calcium supplementation during pregnancy on fetal bone mineralization. METHODS: Healthy mothers with early ultrasound confirmation of dates and singleton pregnancies were enrolled in a double-masked study and randomized before 22 weeks' gestation to 2 g/day of elemental calcium or placebo until delivery. Maternal dietary intake at randomization and at 32-33 weeks' gestation was recorded with 24-hour dietary recalls. Dual-energy x-ray absorptiometry measurements of the whole body and lumbar spine of the neonates were performed before hospital discharge. RESULTS: The infants of 256 women (128 per group) had dual-energy x-ray absorptiometry measurements during the first week of life. There were no significant differences between treatment groups in gestational age, birth weight, or length of the infants, or in the total-body or lumbar spine bone mineral content. However, when bone mineral content was analyzed by treatment group within quintiles of maternal dietary calcium intake, total body bone mineral content (mean +/- standard error of the mean) was significantly greater in infants born to calcium-supplemented mothers (64.1+/-3.2 versus 55.7+/-2.7 g in the placebo group) in the lowest quintile of dietary calcium intake (less than 600 mg/day). The effect of calcium supplementation remained significant after adjustment for maternal age and maternal body mass index and after normalization for skeletal area and body length of the infant. CONCLUSION: Maternal calcium supplementation of up to 2 g/day during the second and third trimesters can increase fetal bone mineralization in women with low dietary calcium intake. However, calcium supplementation in pregnant women with adequate dietary calcium intake is unlikely to result in major improvement in fetal bone mineralization.

Racial differences in the correlation between gonadal androgens and serum insulin levels.

OBJECTIVE: We previously demonstrated a direct correlation between serum insulin levels and gonadal androgens (testosterone and androstenedione) in a group of obese hyperandrogenic predominantly black women. Subsequent work by others in predominantly white women showed conflicting results. To examine these potentially important racial differences further, 14 premenopausal females from each ethnic group, of similar age, BMI, and waist-to-hip ratio, were studied. RESEARCH DESIGN AND METHODS: We measured baseline gonadal androgens, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS), and leutinizing hormone (LH)/follicle-stimulating hormone ratio. Serum glucose, insulin, and C-peptide were measured at baseline and during a 2-h oral glucose tolerance test (area under the curve [AUC]). Insulin sensitivity was measured by glucose decrement during the first 15 min of an intravenous insulin tolerance test. RESULTS: Simple correlation analysis revealed a significant direct correlation in blacks (but not whites) between gonadal androgens and AUC for glucose, insulin, and C-peptide. Race-by-covariate interaction models reinforced the simple correlation finding. Cholesterol level was also correlated to all androgens in blacks, but not in whites. We also found that whites had higher serum triglycerides and greater AUC glucose than blacks. CONCLUSIONS: We conclude that there is a significant direct correlation between gonadal androgens and stimulated glucose, insulin, and C-peptide in blacks but not in whites. Thus, the previously reported direct correlation between gonadal hyperandrogenism and hyperinsulinemia may be a race-dependent phenomenon, hitherto an unreported observation. The implications of these findings are discussed.

Relationship between static and dynamic foot postures in professional baseball players.

STUDY DESIGN: Observational study of static and dynamic foot postures in professional baseball players. BACKGROUND: Throughout the course of a professional baseball season, running, cutting, and sprinting activities can produce a breakdown in players' foot function, causing overuse injuries. OBJECTIVES: To investigate the relationship between static and dynamic foot postures; to determine the occurrence of abnormal foot postures in professional baseball players and the incidence of overuse injuries in the lower extremity; and to compare the foot postures of pitchers to those of positional players. METHODS AND MEASURES: The foot postures of 74 professional baseball players were evaluated at rest and during gait. Measures of static foot posture were obtained with a goniometer and included the subtalar neutral position, forefoot/rearfoot position, ankle joint dorsiflexion, tibial angle in standing, and calcaneal angle in standing. The FootTrak motion analysis system provided measures of dynamic foot posture (rearfoot supination and pronation) during the stance phase of gait. A questionnaire was completed by players who reported previous lower extremity injuries. The chi-square statistic was used to determine the associations between forefoot position (varus or valgus) and the amount of foot pronation during gait. RESULTS: The forefoot varus and calcaneal valgus in standing was significantly associated with the maximum pronation during the stance phase of gait. Of the 65 players who demonstrated excessive pronation (> 8 degrees), 28 (43%) also reported a previous lower extremity injury. No statistically significant difference occurred, however, between injured and uninjured players with respect to the mean values of static or dynamic foot posture. In addition, foot postures were not associated with a player's position. CONCLUSIONS: Selected measures of static rearfoot and forefoot postures may have value in predicting dynamic rearfoot movement during the stance phase of gait. Excessive pronation in the baseball players we studied was not found to be a significant contributing factor in the development of overuse injuries.

Changes in maternal middle cerebral artery blood flow velocity associated with general anesthesia in severe preeclampsia.

UNLABELLED: In women with severe preeclampsia, significant increases in mean arterial pressures (MAP) are common after rapid induction of general anesthesia (GA) and tracheal intubation. The objectives of this prospective study were to assess the effects of the rapid induction-intubation technique on middle cerebral artery (MCA) flow velocity in severe preeclampsia and to examine the correlation between mean MCA flow velocity (Vm) and MAP. Eight women with severe preeclampsia (study group) and six normotensive women at term (control group) scheduled to undergo cesarean section under GA were studied. Before induction, patients in the study group received i.v. labetalol in divided doses to lower diastolic pressures to <100 mm Hg. Anesthesia was induced with pentothal 4-5 mg/kg, followed by succinylcholine 1.5 mg/kg to facilitate tracheal intubation. A transcranial Doppler was used to measure Vm. Both Vm and MAP were recorded before induction and every minute for 6 min after intubation. In the study group, after the administration of labetalol, MAP decreased from 129 +/- 9 to 113 +/- 9 mm Hg (P < 0.05), and Vm decreased from 59 +/- 11 to 54 +/- 10 cm/s (P < 0.05). After intubation, MAP increased from 113 +/- 9 to 134 +/- 5 mm Hg (P < 0.001), and Vm increased from 54 +/- 10 to 70 +/- 10 cm/s (P < 0.001). In the control group, while MAP increased significantly from 89 +/- 6 to 96 +/- 4 mm Hg (P < 0.05) after intubation, the concurrent increase in Vm from 49 +/- 5 to 54 +/- 7 cm/s was not significant. There was a significant positive pooled correlation between Vm and MAP (r = 0.5, P < 0.0006) in the study group but not in the control group (r = 0.24). After induction and intubation, both Vm and MAP values were significantly increased in the study group patients at all observation points compared with the control group patients. The findings indicate that Vm increases significantly after rapid-sequence induction of GA and tracheal intubation in women with severe preeclampsia, and there seems to be a direct relationship between MAP and Vm. IMPLICATIONS: In women with severe preeclampsia, rapid-sequence induction of general anesthesia and tracheal intubation can cause severe hypertension. Our results indicate that the increase in blood pressure is associated with a significant increase in maternal cerebral blood flow velocity and that there is a significant correlation between these two variables.

Hopefulness and its characteristics in adolescents with cancer.

Hopefulness in adolescents with cancer serves critical functions related to the adolescents' sense of well-being and commitment to treatment. Given these critical functions, it is important to determine the essential characteristics of hopefulness, which include the degree and dynamism of hopefulness and the nature and attributes of hoped-for objects. The purposes of this two-site study were to describe the degree and dynamism of hopefulness at four time points during the first 6 months of adolescents' treatment for newly diagnosed cancer, to identify and describe the adolescents' hoped-for objects, and to evaluate potential relationships between the characteristics of hopefulness and patient gender, age, diagnosis, and time point in treatment. Seventy-eight adolescents completed the Hopefulness Scale for Adolescents, the Hopelessness Scale, and the Hopefulness Interview Question at each time point. Hopefulness scores were higher and hopelessness scores substantially lower than reported in other tested samples. Adolescents identified a total of 57 different hopes. Differences by age, gender, and diagnosis were found.

Synaptophysin immunohistochemistry densitometry measurement in resected human hippocampus: implication for the etiology of hippocampal sclerosis.

Synaptophysin (SY) is a protein expressed at presynaptic vesicles. SY immunohistochemistry (IHC) was undertaken in surgically resected hippocampal specimens from 25 patients with intractable epilepsy. All were investigated with chronic ictal EEG videotelemetry, which showed a temporal onset in each case, and all had normal magnetic resonance imaging (MRI). The density of reaction product of SY IHC was used to generate optical density (OD) measurements as an estimate of synaptic density in CA1 and CA4 fields (ODCA1 and ODCA4), and inner third and outer two-thirds of the molecular layer of the dentate gyrus (ODIML and ODOML). There was significant correlation between ODCA1 (r=0.619, P=0.001) and ODCA4 (r=0.639, P=0.001) and onset age of epilepsy. There was no correlation between ODCA1 and duration of epilepsy. There was correlation between ODCA4 and duration (r=-0.412, P=0.041), but partial correlations showed no significant correlation between ODCA4 and duration when controlling for onset, although correlation between ODCA4 and onset when controlling for duration remained significant (r=0.536, P < 0.01). Univariate ANOVA revealed onset age to be the only predictor of ODCA1 and ODCA4. Chronological age and duration were not predictors. There was no correlation between ODIML or ODOML and either onset age or duration. ODIML and ODOML were not predicted by onset age, duration or chronological age. These findings support the hypothesis that the major cause of hippocampal sclerosis is an age specific insult rather than the result of repeated seizures.

Prediction of verbal memory loss in individuals after anterior temporal lobectomy.

PURPOSE: Decreased memory function represents the area of greatest neuropsychological morbidity after anterior temporal lobectomy (ATL), particularly for left ATL candidates. We wished to identify easily derived demographic and neuropsychological predictors of risk of pre- to postoperative memory decline using only information available preoperatively. METHODS: We assessed decline in memory as measured by the California Verbal Learning Test (CVLT) by deriving multiple regression equations using the following measures as independent variables: age at onset, chronological age at time of surgery, sex, Full Scale IQ (FSIQ), level of education, and preoperative memory scores. In all, 203 patients (93 males, 110 females), undergoing ATL (107 left, 96 right) with preoperative and 6-month postoperative testing, were examined. RESULTS: The combination of age, FSIQ, sex, side of surgery and preoperative score was highly predictive (p-values < 0.0001) of postoperative memory scores. Higher postoperative scores were associated with higher preoperative score, younger chronological age, higher FSIQ, female sex, and right side of resection. Reliable change index (RCI) values were used to estimate meaningful decline on the total score across five trials. Logistic regression analysis showed preoperative score and age to be predictors of RCI decline for left-sided resections. Sensitivity of decline (> or =90th centile RCI) prediction was 56%, and specificity was 95%. Validation in 30 patients from a separate population of patients undergoing left ATL produced similar figures. CONCLUSIONS: The derived regression equations can accurately predict verbal memory decline on a list-learning task in approximately 50% of individual patients undergoing ATL, and false-positive prediction errors are very rare.

Physicians' experiences with Medicaid managed care: the Tennessee American College of physicians survey on TennCare.

Despite widespread introduction of Medicaid managed care (MMC), physicians have not been surveyed regarding its impact on patient care. This study documented physician experiences with MMC in Tennessee, where a statewide experimental managed care program (TennCare) delivers services through 12 capitated managed care organizations (MCOs). Practicing Tennessee American College of Physician (ACP) members (n = 1,181) were questioned regarding recent experience with the TennCare program, assessment of the program, and suggestions for improvement. The results, derived from 306 physician respondents (response rate 26%), were as expected, based on findings of a prior administrative focus group and independent surveys. Physicians' experiences were similar regardless of practice type. Most physicians rated the TennCare program as either fair (43%) or poor (42%) overall. The majority cited administrative complexity as a major problem that frequently adversely affected patient care. Physician experience suggests that administrative procedures and medication formularies should be streamlined and standardized to improve patient care.