Computational models for detection of endocrinopathy in subfertile males.

The observation that men with sperm density greater than 10 million/ml had low probability of endocrinopathy led to a refinement in the evaluation of subfertility. Using statistical methods, we sought to provide a more accurate prediction of which patients have an endocrinopathy, and to report the outcome as the odds of having disease. In addition, by examining the parameters that influenced the model significantly, the underlying pathophysiology might be better understood. Records of 1035 men containing variables including testis volume, sperm density, motility as well as the presence of endocrinopathy were randomized into 'training' and 'test' data sets. We modeled the data set using linear and quadratic discriminant function analysis, logistic regression (LR) and a neural network. Wilk's regression analysis was performed to determine which variables influenced the model significantly. Of the four models investigated, LR and a neural network performed the best with receiver operating characteristic areas under the curve of 0.93 and 0.95, respectively, correlating to a sensitivity of 28% and a specificity of 99% for the LR model, and a sensitivity and specificity of 56 and 97% for the neural network model. Reverse regression yielded P-values for the testis volume and sperm density of <0.0001. The neural network and LR models accurately predicted the probability of an endocrinopathy from testis volume, sperm density and motility without serum assays. These models may be accessed via the Internet, allowing urologists to select patients for endocrinologic evaluation at http://www.urocomp.org.

Cross-system service use among VA mental health patients living in Philadelphia.

There are few published studies of cross-system use of multiple systems of mental health care. This study examines use of VA and non-VA services in Philadelphia County. Results indicated that rates of cross-system use overall are fairly low (16 to 17% of patients across all years), are generally declining over time, and account for a small proportion of total all-system costs (4%). Veterans who used more VA inpatient services also used more non-VA services, and veterans who used fewer VA outpatient services used more non-VA services, indicating that cross-system use may be a quality indicator for the accessibility or acceptability of outpatient care.

The effect of surfactant on birthweight-specific neonatal mortality rate, New York City.

PURPOSE: Surfactant has been shown to cause decreased neonatal mortality rate (NMR) in randomized studies of preterm infants. It is not clear whether the introduction of surfactant caused a decrease in neonatal mortality in a community. This study explores the hypothesis that the introduction of surfactant in 1990 to 1991 explains a decrease in neonatal mortality in New York City (NYC) among infants with birthweight of 500 to 1499 g. METHODS: For each of the 20 hospitals in New York City that began using surfactant in 1990 or 1991, we compared the NMR in the 2 years before the introduction of surfactant with the NMR in the 2 years after its introduction. Poisson regression models were fit to the death rates, adjusting for birthweight and other determinants of neonatal mortality. RESULTS: NMR in the 20 hospitals decreased by 13.7% (from 231.3 to 199.6 neonatal deaths per 1000 live births). This decrease remained significant after adjusting for birthweight and other risk factors. Infants with birthweight 1000 to 1249 grams benefited most from the introduction of surfactant; their NMR decreased by 19.6%. After adjusting for birthweight, those born before the introduction of surfactant were 1.18 times as likely to die in the first 27 days as those born after the introduction of surfactant (95% CI 1.04, 1.33). CONCLUSION: It appears that surfactant had a significant impact on NMR in NYC among very low birthweight babies.

Older adult patients with both psychiatric and substance abuse disorders: prevalence and health service use.

The prevalence and service use among older adults with concurrent psychiatric and substance abuse disorders (the "dually diagnosed") was examined in a cross-sectional survey of a representative national sample of Department of Veterans Affairs mental health program patients (N = 91,752). Rates of dual diagnosis declined significantly (P = 0.001) as the age of the respondents increased (26.7% of patients < 65 years; 6.9% of patients > or = 65 years). Dually diagnosed older adult patients had longer inpatient stays for substance abuse and more outpatient substance abuse visits than did non-dually diagnosed elderly patients, and more outpatient general psychiatric visits than all the contrast groups. Dual diagnosis appears less common among older compared to younger patients, although their heavy use of certain (particularly, outpatient psychiatric) services suggests that should more dually diagnosed patients survive to old age their consumption of some forms of mental health care is likely to be high.

Validity of self-reported cancer history: a comparison of health interview data and cancer registry records.

Few studies have addressed the accuracy of self-reported cancer history, although epidemiologic studies routinely use self-reported information as the sole source of exposure or outcome data or as a criterion for exclusion from study participation. In this paper, false-negative reporting of cancer history is examined in a community-based sample by comparing interview data with tumor registry records. Subjects were participants in the 1980 New Haven Epidemiologic Catchment Area study; in 1995, cancer records (from 1935 onward) were obtained by linking the sample to the Connecticut Tumor Registry. Analyses focused on 263 individuals who had at least one tumor reported to the Connecticut Tumor Registry prior to participation in the Epidemiologic Catchment Area study. The overall rate of false-negative reporting was 39.2%. Logistic regression analysis revealed that false-negative reporting was significantly associated with non-White race, older age, increased time since cancer diagnosis, number of previous tumors, and type of cancer treatment received. In addition, false-negative reporting varied widely by cancer site, ranging from 0% for melanoma skin cancer to 83.3% for central nervous system cancers. The false-negative rate for breast cancer was 20.8%, that for colon and prostate cancers was 42.1%, and that for bladder cancer was 61.5%. Implications of these findings for prevalence estimation and future epidemiologic studies are discussed.

Acculturation and the lifetime risk of psychiatric and substance use disorders among Hispanics.

Between 1981 and 1995, approximately 5 million people from either Mexico, Cuba, Central America, or South America immigrated to the United States. Some regional studies have suggested that as Hispanic immigrants become acculturated to American society, their risk of mental illness increases sharply. This study examined the lifetime risk of psychiatric and substance use disorders among U.S. Hispanic subgroups and the specific role of nativity, parental nativity, language preferences, and other sociodemographic characteristics as risk factors for these disorders. The study used the National Comorbidity Survey (NCS), a national probability sample of 8098 U.S. adults aged 15 to 54. Selected DSM-III-R psychiatric diagnoses were collapsed into eight categories. When compared with non-Hispanic whites, Mexican-Americans were less likely to have any psychiatric disorder. After multivariate adjustment, acculturation items predicted greater risk of having any DSM-III-R disorders for Mexican-Americans and "other" Hispanics and greater risk of having a substance abuse disorder for Puerto Ricans, among other significant relationships. The results suggest that there is likely to be an increasing prevalence of psychiatric and substance use disorders among Hispanics that may be attributable to increasing levels of acculturation among the more than 5 million recent immigrants from Latin America.

Childhood risk factors for criminal justice involvement in a sample of homeless people with serious mental illness.

It has been suggested that criminal justice involvement among the homeless, particularly those with mental illness, is largely situational. The objective of this study was to assess, in a sample of homeless seriously mentally ill people, the prevalence of childhood conduct disorder behaviors as a risk factor for adult criminal activity as well as the extent and types of adult criminal justice contact. Data were taken from the national ACCESS program, which conducted extensive baseline interviews with 7,222 homeless seriously mentally ill adults. The interview assessed demographics, childhood risk factors for criminal activity such as conduct disorder behaviors, foster care, and parental abuse, as well as current illness severity and recent criminal justice contact. The 2-month arrest rate in this sample was much higher than national rates (11% compared with 1% annually in the general population). Although most arrests were for minor crimes (10.8%), there were also substantial rates of arrest for major (2.7%) and substance-related charges (2.0%). The prevalence of a history of conduct disorder behavior was also substantial (55% in male subjects, 40% in female subjects), and conduct disorder was a strong predictor of recent criminal justice involvement, even after controlling for other predictors of arrest (odds ratio = 1.76 for major crimes, 1.49 for minor crimes, and 1.98 for substance-related crimes). Recent literature has criticized a trend to criminalize homeless mentally ill persons for attempting to get needed food, shelter, or medical attention. However, these data indicate that at least some proportion of arrests in this population are of people who have been exhibiting antisocial behavior since early adolescence, and that early antisocial behavior is a strong predictor of all types of recent arrests in this population.

Bile salt micellar electrokinetic chromatography of bilirubin and related compounds.

The interaction of bilirubin, biliverdin, bilirubin dimethyl ester, biliverdin dimethyl ester, xanthobilirubic acid, and xanthobilirubin methyl ester with trihydroxy and dihydroxy bile salt solutions is investigated by micellar electrokinetic chromatography (MEKC). The capacity factor of each compound is measured in solutions of the different bile salts over the pH range of 6.5-9.0. The capacity factor of bilirubin increases with pH below 7 in all bile salt solutions. Biliverdin and xanthobilirubin show essentially identical capacity factors for all bile salts. Biliverdin dimethyl ester and xanthobilirubin methyl ester also have very similar capacity factors, which are greater than those of the carboxy analogs, in trihydroxy bile salts. The capacity factors of these esters are higher in the dihydroxy bile salts, with the capacity factor of biliverdin dimethyl ester being twice that of xanthobilirubin methyl ester. Factors involved in the MEKC analysis of these compounds are discussed.

Pulmonary amyloidoma and hilar adenopathy. Rare manifestations of primary amyloidosis.

Three cases of primary intrathoracic amyloidosis are reported. Two of these three patients initially had localized parenchymal pulmonary amyloid tumors (or pulmonary amyloidomas). The third patient developed bilateral enlargement of the hilar lymph nodes as a manifestation of primary amyloidosis. These rare manifestations of primary amyloidosis are illustrated, and their clinical signifiance is discussed. Amyloidoma should be considered in patients with unexplained pulmonary nodules or enlargement of hilar lymph nodes.