Bacteremia in Kenyan children presenting with malaria.

Since the etiologies and clinical outcomes of bacteremia in children with Plasmodium falciparum infections, particularly in areas of holoendemic malaria transmission, are largely unexplored, blood cultures and comprehensive clinical, laboratory, hematological, and nutritional parameters for malaria-infected children (aged 1 to 36 months, n = 585 patients) were investigated at a rural hospital in western Kenya. After the exclusion of contaminant microorganisms, the prevalence of bacteremia was 11.7% in the cohort (n = 506), with nontyphoidal Salmonella spp. being the most common isolates (42.4%). Bacteremia was found to occur in a significantly higher proportion of females than males and was associated with elevated blood glucose concentrations and lowered malaria parasite and hemoglobin (Hb) levels compared to those in abacteremic participants. In addition, the incidences of respiratory distress and severe malarial anemia (SMA; Hb level of <6.0 g/dl) were nonsignificantly greater in children with bacteremia. Mortality was 8.5-fold higher in children with bacteremia. Multivariate logistic regression analyses revealed that bacteremia was significantly associated with reduced incidences of high-density parasitemia (HDP; ≥ 10,000/µl) and increased incidences of malnutrition (i.e., underweight; weight-for-age Z score of <-2 using the NCHS system). Since previous studies showed that bacteremia caused by Gram-negative organisms is associated with enhanced anemia and mortality, multivariate logistic regression was also performed separately for randomly age- and gender-matched children with bacteremia caused by Gram-negative organisms (n = 37) and for children found to be abacteremic (n = 74). These results revealed that the presence of bacteremia caused by Gram-negative organisms was significantly associated with reduced HDP, enhanced susceptibility to respiratory distress, SMA (Hb level of <6.0 g/dl), and being underweight (Z score, <-2). Data presented here from a region of holoendemic P. falciparum transmission demonstrate that although bacteremia is associated with reduced malaria parasitemia, a number of unfavorable clinical outcomes, including malnutrition, respiratory distress, anemia, and mortality, are elevated in children with bacteremia, particularly in cases of Gram-negative origin.

Infant temperament and eating style predict change in standardized weight status and obesity risk at 6 years of age.

OBJECTIVE: Little research has addressed the relationships among infant temperament, eating styles and obesity risk. To address this gap, we tested whether infant temperament and eating patterns at the age of 1 year are associated with a greater increase in standardized weight status, and greater obesity risk at 6 years of age. DESIGN: A secondary, prospective analysis of the Colorado Adoption Study was conducted. The main predictor variables were infant temperament (that is, emotionality, activity, attention span-persistence, reaction to food and soothability) and eating domains (that is, reactivity to food, predictable appetite and distractability at mealtime) at the age of 1 year, along with the body mass index (BMI) of biological mothers. The outcome measures were child weight and height (length) assessed at ages 1 through 6 years, from which weight-for-length and BMI were computed along with the standardized indexes (z-scores) and percentiles. Overweight/obesity status was computed at each year as well. PARTICIPANTS: A primarily White sample of 262 boys and 225 girls, assessed at ages 1 through 6 years, along with their mothers. RESULTS: Among boys, greater attention span-persistence was associated with reduced standardized weight status gain (ß=-0.15, P<0.05) and reduced obesity risk (odds ratio (OR)=0.46, P=0.06). Among girls, greater soothability and negative reaction to food were associated with greater standardized weight status gain (ß=0.19, P<0.01; and ß=0.16, P<0.05, respectively) and increased obesity risk (OR=3.72, P=0.03; and OR=2.81, P=0.08, respectively). Biological mothers' obesity status predicted obesity risk in boys (OR=3.07, P=0.01) and girls (OR=5.94, P=0.03). CONCLUSIONS: Male infants with less attention span, and female infants with greater soothability or a more negative food reaction, showed greater increases in standardized weight and were more likely to be overweight/obese at the age of 6 years. The role of infant temperament in pediatric obesity onset warrants greater research.

Suppression of RANTES in children with Plasmodium falciparum malaria.

Severe malarial anemia (MA) is the primary manifestation of severe malaria among children in areas of holoendemic Plasmodium falciparum transmission. Although overproduction of inflammatory-derived cytokines are implicated in the immunopathogenesis of severe MA, chemokines such as regulated on activation, normal T-cell expressed and secreted (RANTES, CCL5) are largely unexplored in childhood malaria. We found that RANTES is decreased during severe MA (p<0.01), and associated with suppression of erythropoiesis (p<0.05) and malaria-induced thrombocytopenia (p<0.05). These findings suggest that thrombocytopenia may be a source of reduced RANTES which may contribute, at least in part, to suppression of erythropoiesis in children with malarial anemia.

Cognitive impairment among the dually-diagnosed: substance use history and depressive symptom correlates.

The present study examined the effects of substance use history and depressive symptomatology on the cognitive functioning of 149 male and 72 female dually diagnosed inpatients. Logistic regression models examined the effects of life-time alcohol and cocaine use, previous month's alcohol and cocaine use and depression on abstract reasoning as assessed by the Shipley Institute of Living Scale (SILS) and neuropsychological functioning as measured by the Screening Test for the Luria-Nebraska Neuropsychological Battery (ST-LNNB). Results indicated differential effects of substance use across the two cognitive outcome measures. Specifically, a significant relationship was demonstrated for previous month's alcohol use on Shipley classification. However, after adjusting for possible borderline cases, previous month's alcohol use dropped to non-significance and in its stead an association between Shipley classification and life-time use was demonstrated. No significant effects were demonstrated for cocaine use, recent alcohol use, depressive symptoms or any of the interaction terms. The Luria-Nebraska performance classifications were significantly associated with both educational level and life-time cocaine use. No significant relationships were obtained for previous month's cocaine use, the alcohol use variables, depressive symptoms, or any of the interactions terms. The degree of classification agreement between the two outcome measures was slightly better than chance (kappa = 0.24 for ST-LNNB and traditional or full scale SILS; kappa = 0.35 for ST-LNNB and modified SILS). These kappa coefficients suggest that the SILS and ST-LNNB assess partially independent dimensions of cognitive functioning. The findings are discussed in light of previous research and implications for clinical assessment and treatment are outlined.

A preliminary analysis of the perceived risks of misusing multiple substances, trait anxiety, and approval motivation.

In a sample of college undergraduates, perceptions of the risks associated with the misuse of substances such as alcohol, cigarettes, and marijuana were evaluated, and the correlations of risk ratings with trait anxiety and approval motivation were examined. The results indicated (a) a temporally stable, hierarchical ordering of risk means that ranged from illicit to licit substance pairs; (b) a string negative correlation between perceived risk means and corresponding standard deviations, suggesting that greater variability was associated with lower perceived risk; (c) small to small/moderate correlations between high risk ratings and trait anxiety; and (d) small to small/moderate correlations between risk ratings and approval motivation. These findings provide a first approximation of young adults' perceptions of the possible risks involved in the misuse of multiple substances and suggest that such perceptions are not confounded by dispositional anxiety of by social desirability response bias. The results discussed in light of their implications for alcohol and drug education.

Novel methods for analyzing multifaceted personality scales: sense of coherence and depression as an example.

Multifaceted personality scales assess multiple related facets or dimensions and, as such, they are typically made up of correlated subscales. In some cases, the degree of correlation among subscales can be so high as to render the use of standard procedures for evaluating a subscale's relative importance (e.g., beta weights or bivariate correlations) dubious. In such cases of high predictor multicollinearity, researchers are faced with few viable options and, in response, many turn to multiple regression when examining predictor-criterion associations (for example, interpreting semipartial correlations and incremental variance estimates). In an effort to broaden researchers' options and thereby allow for greater interpretive clarity, z tests for comparing dependent zero-order correlations and R. G. Malgady's (1987) methods for comparing two dependent semipartial correlations and for comparing dependent semipartial and zero-order correlations are proposed as additional techniques for analyzing predictor (or subscale) criterion associations in the context of predictor collinearity. Worked examples of both techniques are provided, using a dataset on sense of coherence and depression. Finally, relevant computer programs for implementing the aforementioned techniques are noted.

Normative perceptions in relation to substance use and HIV-risky sexual behaviors of college students.

In this study, 410 college students completed a survey assessing their personal substance use patterns and sexual behavior and their perceptions of other students' substance use and sexual behavior. Two parallel sets of questions were presented to reflect the two contextual conditions of being drunk or high versus being not drunk or high. Results indicated that number of recent sexual partners and normative perceptions of HIV-risky sexual behavior were the strongest predictors of personal HIV-risky behavior when not drunk or high. HIV-risky behavior when drunk or high was predicted by personal substance use as well as by number of recent partners and normative perceptions of peer sexual behavior. These findings suggest that HIV-prevention programs for college students should aim to correct overinflated perceptions of other students' high-risk sexual behavior.

Epidemic protection zones: centred on cases or based on connectivity?

When an exotic infectious disease invades a susceptible environment, protection zones are enforced. Historically, such zones have been shaped as circles of equal radius (ER), centred on the location of infected premises. Because the ER policy seems to assume that epidemic dissemination is driven by a similar number of secondary cases generated per primary case, it does not consider whether local features, such as connectivity, influence epidemic dispersal. Here we explored the efficacy of ER protection zones. By generating a geographically explicit scenario that mimicked an actual epidemic, we created protection zones of different geometry, comparing the cost-benefit estimates of ER protection zones to a set of alternatives, which considered a pre-existing connecting network (CN) - the road network. The hypothesis of similar number of cases per ER circle was not substantiated: the number of units at risk per circle differed up to four times among ER circles. Findings also showed that even a small area (of <115 km(2) ) revealed network properties. Because the CN policy required 20% less area to be protected than the ER policy, and the CN-based protection zone included a 23.8% greater density of units at risk/km(2) than the ER-based alternative, findings supported the view that protection zones are likely to be less costly and more effective if they consider connecting structures, such as road, railroad and/or river networks. The analysis of local geographical factors (contacts, vectors and connectivity) may optimize the efficacy of control measures against epidemics.

incor: a computer program for testing differences among independent correlations.

An interactive fortran program (incor) performs the Paul (1989) procedure for testing the null hypothesis that more than two independent population correlations are equivalent. The program also performs subsequent range tests for comparing all possible pairwise correlations.

A macrophage migration inhibitory factor promoter polymorphism is associated with high-density parasitemia in children with malaria.

Macrophage migration inhibitory factor (MIF) is a pleiotropic cytokine that regulates innate and adaptive immune responses to bacterial and parasitic infections. Functional promoter variants in the MIF gene influence susceptibility to inflammatory diseases in Caucasians. As the role of genetic variation in the MIF gene in conditioning malaria disease outcomes is largely unexplored, the relationship between a G to C transition at MIF -173 and susceptibility to high-density parasitemia (HDP) and severe malarial anemia (SMA) was examined in Kenyan children (aged 3-36 months; n=477) in a holoendemic Plasmodium falciparum transmission region. In a multivariate model, controlling for age, gender, HIV-1 status, and sickle-cell trait, MIF -173CC was associated with an increased risk of HDP compared to MIF -173GG. No significant associations were found between MIF -173 genotypic variants and susceptibility to SMA. Additional studies demonstrated that homozygous G alleles were associated with lower basal circulating MIF levels relative to the GC group. However, stimulation of cultured peripheral blood mononuclear cells with malarial pigment (hemozoin) increased MIF production in the GG group and decreased MIF production in the GC group. Thus, variability at MIF -173 is associated with functional changes in MIF production and susceptibility to HDP in children with malaria.

Tension-reduction expectancies and alcoholic beverage preferences revisited: associations to drinking frequency and gender.

The relationships among drinking frequency, gender, beverage preference, and tension-reduction outcome expectancies were examined. Subjects consisted of 503 social-drinking college undergraduates. Results indicated that regardless of preferred beverage type, "high" versus "low" frequency drinkers endorsed significantly greater tension-reduction expectancies. Results also indicated that males and "frequent" drinkers preferred beer as their primary alcoholic beverage. Supplemental analyses suggested that drinking frequency partially confounded the relationship between gender and beverage preference. These results extend and refine previous research and have implications for alcohol misuse prevention and early intervention.

Factorial validity and equivalency of the Alcohol Expectancy Questionnaire Tension-Reduction Subscale across gender and drinking frequency.

The first aim of the present study was to examine whether the items on the Alcohol Expectancy Questionnaire Tension-Reduction Subscale (TR-AEQ) measure a common underlying factor. The second and third aims, respectively, were to assess the factorial invariance of the TR-AEQ across gender and drinking frequency. Subjects were 503 social-drinking college undergraduates. Confirmatory factor analyses indicated that a common-factor model with seven pairs of correlated disturbances fit the data well. Equivalence testing yielded factorial invariance across gender and partial factorial invariance across drinking frequency. These data support the factorial validity of the TR-AEQ and have implications for psychometric assessment and the evaluation and identification of problem drinking behavior.

Irrational beliefs, perceived availability of social support, and anxiety.

Based on the assumption that individual difference factors can influence aspects of the social environment, it was predicted that individuals who exhibit high levels of irrational beliefs would appraise their interpersonal environment as less supportive than would individuals with lower levels of irrational beliefs. The second prediction was that irrational beliefs would be related positively to anxiety. Thirdly, it was expected that perceived social support would be related inversely to anxiety. The final prediction was that deficits in social support among individuals who exhibit irrational beliefs may account, in part, for their relatively high levels of anxiety. Results based on questionnaire data obtained from 39 college students supported all four hypotheses.

Dimensional characteristics of the SCL-90-R: evaluation of gender differences in dually diagnosed inpatients.

The dimensional characteristics of the SCL-90-R were assessed for both male and female dually diagnosed inpatients. Subjects included 402 males and 227 females who presented with concurrent psychiatric and substance use disorders at a private psychiatric hospital. Confirmatory factor analyses resulted in the rejection of four previous measurement models for both genders including the original nine symptom dimensions. Subsequent principal component analyses resulted in four- and seven-component solutions for males and females, respectively; the majority of item covariation was accounted for by the first component. These results are consistent with previous research that has suggested a primary global distress factor and are in contrast to studies that have demonstrated factorial invariance across gender.

Primary prevention of alcohol misuse: overview and annotated bibliography.

Following an overview of conceptual and methodological issues related to alcohol misuse primary prevention and a brief discussion of the most frequently employed primary prevention strategies, a comprehensive annotated bibliography of the alcohol misuse primary prevention literature is presented. Several benefits of presenting detailed annotations, such as allowing readers to (a) examine the various prevention program components, (b) identify the presence or absence of methodological shortcomings, (c) identify whether or not high-risk groups were included as program participants, and (d) evaluate the feasibility of program implementation, are also highlighted. The present article complements previous reviews which have often mixed together the findings of primary and secondary prevention studies and which have typically reported the effects of prevention programming on multiple substance misuse outcomes simultaneously. The practice of simultaneously reporting multiple substance misuse outcomes has made it difficult to interpret the specific effects that primary prevention programs have had on alcohol misuse per se.