A longitudinal analysis of the impact of childhood stress on weight status among Chinese youth.

Limited research has explored longitudinal impact of stress on negative health outcomes, including overweight and obesity in Asian societies. Using data from a longitudinal school-based health promotion study conducted in Wuhan, China from 1999 to 2004, this study investigated the longitudinal effects of childhood stress exposure, including stressors related to school, family, peers, violence and health on overweight, and obesity risk during the transition to adolescence among 2179 Chinese adolescents. Results showed that health stressors were consistently related to higher BMI Z score for both boys and girls baseline, it also predicted higher likelihood of overweight status over time for girls. This finding highlights a particularly challenging time period for girls, suggesting a particular challenging time they face at the intersection of puberty and demanding school environment.

Regional inequality in radiology research output in the UK: a 5-year bibliometric study.

The objective of this study was to describe the patterns of peer-reviewed general radiology publication rates with reference to deaneries in the UK. This was a retrospective bibliometric analysis of publications in the six highest cited general radiology journals. Publications were identified using a manual search in PubMed between 2005 and 2009. Publications originating from UK radiology departments were identified and subcategorised into primary institution of origin, deanery and publication type. The total number of radiology trainees in each deanery was obtained from the General Medical Council. 913 publications were included in the study. Original papers constituted 48.7% (n=445), review articles 30.3% (n=277) and case reports 17.4% (n=159). The median number of publications in each deanery was 27 [interquartile range (IQR) 11-60], and the median number of publications per trainee was 0.49 (IQR 0.31-0.88). The largest proportion of publications came from the London deanery (n=354, 38.8%), followed by Eastern 86 (9.4%), Oxford and Yorkshire 70 (7.7% each). Relative to the number of trainees within each deanery, Oxford had the highest number of publications per trainee (1.78), followed by East Midlands (1.5), London (1.25) and Eastern (0.99). There was a significantly higher publication rate for those deaneries with academic radiologists (p<0.0001). There is a marked difference in the volume of published work in the general radiology literature among UK deaneries, even accounting for differences in the number of trainees. This probably means that opportunities for training in research are similarly non-uniform.

Functional assessment of glaucoma.

Several studies have correlated the location of visual field defect on some of these newer tests to location of optic nerve damage with good results. In addition, there is an important and direct relationship between the psychophysical measures of visual function and location of damage. When a given individual had vision loss on more than one test, the same area of the visual field is affected. In addition, as soon as a repeatable defect is identified on perimetry, progression of the defect on later fields occurs within or adjacent to the initially identified area. These findings have significant implications for the care and follow-up of patients with glaucoma. Using these more sensitive tests has improved greatly our detection of early glaucomatous damage. Follow-up testing that concentrates the evaluation to areas already damaged should improve greatly our ability to identify true change from the significant physiologic variability present in glaucoma.

Performance characteristics of the 3-D OSEM algorithm in the reconstruction of small animal PET images. Ordered-subsets expectation-maximixation.

Rat brain images acquired with a small animal positron emission tomography (PET) camera and reconstructed with the three-dimensional (3-D) ordered-subsets expectation-maximization (OSEM) algorithm with resolution recovery have better quality when the brain is imaged by itself than when inside the head with surrounding background activity. The purpose of this study was to characterize the dependence of this effect on the level of background activity, attenuation, and scatter. Monte Carlo simulations of the imaging system were performed. The coefficient of variation from replicate images, full-width at half-maximum (FWHM) from point sources and image profile fitting, and image contrast and uniformity were used to evaluate algorithm performance. A rat head with the typical levels of five and ten times the brain activity in the surrounding background requires additional iterations to achieve the same resolution as the brain-only case at a cost of 24% and 64% additional noise, respectively. For the same phantoms, object scatter reduced contrast by 3%-5%. However, attenuation degraded resolution by 0.2 mm and was responsible for up to 12% nonuniformity in the brain images suggesting that attenuation correction is useful. Given the effects of emission and attenuation distribution on both resolution and noise, simulations or phantom studies should be used for each imaging situation to select the appropriate number of OSEM iterations to achieve the desired resolution-noise levels.

Interior-point methodology for 3-D PET reconstruction.

Interior-point methods have been successfully applied to a wide variety of linear and nonlinear programming applications. This paper presents a class of algorithms, based on path-following interior-point methodology, for performing regularized maximum-likelihood (ML) reconstructions on three-dimensional (3-D) emission tomography data. The algorithms solve a sequence of subproblems that converge to the regularized maximum likelihood solution from the interior of the feasible region (the nonnegative orthant). We propose two methods, a primal method which updates only the primal image variables and a primal-dual method which simultaneously updates the primal variables and the Lagrange multipliers. A parallel implementation permits the interior-point methods to scale to very large reconstruction problems. Termination is based on well-defined convergence measures, namely, the Karush-Kuhn-Tucker first-order necessary conditions for optimality. We demonstrate the rapid convergence of the path-following interior-point methods using both data from a small animal scanner and Monte Carlo simulated data. The proposed methods can readily be applied to solve the regularized, weighted least squares reconstruction problem.

Ethnic differences in adolescent smoking prevalence in California: are multi-ethnic youth at higher risk?

OBJECTIVE: Although ethnic differences in adolescent smoking have been well documented, smoking among multi-ethnic adolescents has received little research attention. This study examined smoking prevalence and tobacco related psychosocial risk factors among multi-ethnic adolescents in California, as compared with white, African American, Asian American, and Hispanic adolescents. DESIGN: This study used a cross sectional design. Data were obtained from the independent evaluation of the California Tobacco Control, Prevention, and Education Program. SETTING: Students completed a paper-and-pencil survey in their classrooms. SUBJECTS: Data were collected from a stratified random sample of 5072 eighth grade students (age 13-14 years) in California during the 1996-97 school year. The data were weighted by school enrollment in analyses to make the estimates representative of the population of California students attending public schools. MAIN OUTCOME MEASURES: Outcome variables included self reported smoking prevalence, susceptibility to smoking, access to tobacco, and related attitudes, beliefs, and behaviours. Ethnicity was assessed with a self reported, "check all that apply" question. RESULTS: Results indicated that multi-ethnic adolescents were at higher risk than single-ethnic adolescents on several variables, including 30 day cigarette smoking prevalence, lifetime smokeless tobacco use, buying cigarettes, receiving cigarette offers, and expected friends' reaction if the respondent smoked. For several other variables (lifetime cigarette smoking prevalence, susceptibility to smoking, and number of friends who smoked), Hispanic adolescents were at higher risk than all other ethnic groups including multi-ethnic adolescents. Although susceptibility to smoking was highest among Hispanics, multi-ethnic adolescents scored significantly higher on susceptibility than the three other single-ethnic groups. CONCLUSIONS: Multi-ethnic adolescents may be at increased risk for smoking and may have easier access to cigarettes. Culturally targeted smoking prevention interventions for adolescents should address the unique social challenges faced by multi-ethnic adolescents that may increase their risk for smoking.

Patterns of medical practice in cystic fibrosis: part I. Evaluation and monitoring of health status of patients. Investigators and Coordinators of the Epidemiologic Study of Cystic Fibrosis.

This report characterizes patterns of evaluation and monitoring of the health status of patients with cystic fibrosis (CF) as observed in the Epidemiologic Study of Cystic Fibrosis (ESCF), and compares these practices to published guidelines. All patients (18,411) who enrolled in ESCF at 194 study sites in the United States and Canada from December 1, 1993 to December 31, 1995 were considered for study. Patients enrolled before January 1, 1995 with >/=1 healthcare encounters during 1995 (12,631) were included in the analysis. Patients enrolled after January 1, 1995 (5,266), or who died (354), withdrew from the study (128), or were lost to follow-up (21) were excluded. Frequency of encounters (outpatient and hospital), spirometry, respiratory tract cultures, and chest radiographs were recorded during a 1-year period (1995) and analyzed by gender, age, severity of lung disease, and presence of any Pseudomonas species in the respiratory tract. The 12,631 patients had 53,024 outpatient visits. In 57.5% of patients, the recommended criteria of >/=4 total visits per year were met. Only 27.4% of all patients had >/=4 routine visits; 3.1% had only sick visits, and 59.0% had no sick visits. One third (34.6%) were hospitalized at least once, for a total of 8,561 hospitalizations. Older patients with lower pulmonary function and Pseudomonas in their respiratory tract had fewer routine visits and more sick visits, and were hospitalized more than were younger patients. In three fourths (75.8%) of patients the recommended criterion of two spirometry assessments per year was met, whereas in 79.3% the criterion of one culture was met, and in 68.3% the criterion of one radiograph/year was met. We conclude that in the majority of CF patients, the recommended criteria for routine evaluation and monitoring were met. However, in a rather substantial number they were not. An increase in the utilization of healthcare resources was observed in patients with more severe disease. This information will help to establish benchmarks for future quality assessment programs.

Identification of adolescents at risk for smoking initiation: validation of a measure of susceptibility.

Primary prevention of smoking in adolescents requires effective screening instruments for identifying those adolescents who are most likely to experiment with cigarettes. This study investigated the predictive value of a measure of susceptibility to smoking (the lack of a firm commitment not to smoke) for predicting smoking initiation 1 and 2 years later among 687 seventh-grade nonsmokers. Results showed that susceptible adolescents were approximately two to three times more likely to experiment with cigarettes during the ensuing 2 years than were nonsusceptible adolescents. At the lower levels of smoking, these relationships persisted even after controlling for psychosocial variables. Measures of susceptibility to smoking could be an effective tool for identifying adolescents at increased risk of experimenting with cigarettes or assessing their readiness for smoking-prevention programs.

Independent evaluation of the California Tobacco Education Program.

OBJECTIVE: To monitor the implementation of tobacco control programs and research in accordance with California's Proposition 99, approved by the voters in 1988, which increased the state's cigarette tax by 25 cents and designated one quarter of the increased revenue-approximately $100 million per year-to develop statewide media campaigns and to fund local health departments, community-based organizations, schools, and agencies working with high risk populations. METHODS: The authors evaluated the extent and the effectiveness of the implementation independently with standardized forms developed to track any tobacco-related information and activities, local media campaigns, changes in local policies and ordinances, training sessions, and prevention and cessation programs. Activities were reported on the forms to the authors monthly or quarterly. RESULTS: The evaluation indicated that local health departments, community-based organizations, and other group produced an exceedingly high volume of diverse tobacco control activities throughout the state. They reached a variety of ethnic groups and high risk populations with their programs. The data also show that local health departments and competitive grantees responded with an overall shift in their approach to tobacco control and moved from interventions focused primarily on individual people to broader, more community- and environment-oriented interventions. Additionally, analysis of the wholesale tobacco tax revenues revealed that per capita purchasing continued to decline in California at a rate greater than in the rest of the United States. CONCLUSION: The evaluation demonstrated that Proposition 99 accomplished much of what it set out to do-reducing tobacco prevalence, reaching out to underserved populations, and heightening the awareness of the dangers of environmental tobacco smoke.

Individual differences in risk of child abuse by adolescent mothers: assessment in the perinatal period.

Abuse risk potential and parenting attitudes of 66 adolescent mothers were examined during the perinatal period using self-report instruments. Approximately one-half of the sample was considered to be at significant risk. Specific risk factors included distress, rigidity in parenting attitudes, and inappropriate expectations of children. Younger adolescents were at greater risk of abuse, advocated the use of physical punishment more strongly, and reported greater unhappiness than older adolescents. Teens reporting limited social support were also at greater risk for abuse. Low acceptance of the pregnancy was related to abuse potential for parenting, but not pregnant, adolescents. A history of maltreatment was related to self-reported problems with family members but not to overall risk. Implications for the prevention of abuse among adolescent mothers are discussed.

Cost-effectiveness of epoetin alfa therapy for anemia of end-stage renal disease.

The cost-effectiveness of epoetin alfa therapy for anemia in 20 patients with end-stage renal disease was retrospectively studied. Ten patients on continuous ambulatory peritoneal dialysis (CAPD) were given subcutaneous epoetin alfa as part of a multicenter, protocol-controlled study of the efficacy of epoetin alfa. Ten patients on in-center hemodialysis were given intravenous epoetin alfa as part of their routine clinical care. Change in hematocrit was used as the measure of effectiveness of epoetin alfa. Medication, laboratory, and transfusion costs were monitored for the six months preceding the initiation of epoetin alfa and the first six months of treatment. The cost of therapy increased for all patients by an average of $2722 +/- 1118; transfusion costs decreased, whereas medication and laboratory costs increased. Laboratory costs were significantly greater in CAPD patients than in hemodialysis patients during epoetin alfa therapy; no significant differences in medication costs or transfusion costs were noted between the groups. The mean increase in hematocrit for all patients was 7.4 volume percent. Following the initial change in hematocrit, further therapeutic response did not appear to be determined by increasing expenditures. Epoetin alfa was shown to be effective in treating anemia in patients with end-stage renal disease, but it was associated with higher costs of therapy.

National TV smoking cessation program and contest in Finland.

BACKGROUND: In the fall of 1986 the North Karelia Project in cooperation with Finnish TV 2 arranged an eight-part nationwide smoking cessation TV program. The Project, also arranged a smoking cessation contest coinciding with the TV program in cooperation with four major voluntary public health organizations and the national health service. The TV program featured two studio groups of local volunteers: one from Turku (southwestern Finland) and the other from North Karelia, where there was more intensive community support for the activity. RESULTS: Based on a national survey of a representative population sample, the reported viewing rates (at least one part) of the working-age population (15-64 years, smokers and nonsmokers) were 64% in North Karelia, 45% in Turku, and 46% nationally (P less than 0.001). Among smokers who had watched at least one session of the TV program, 7.7% reported to have tried to quit smoking in North Karelia, 4.1% in Turku, and 7.5% nationally. Altogether, 16,089 smokers participated in the contest; again the highest participation rate was in North Karelia. The 6-month success rate among the smokers who participated in the contest was 22% in North Karelia, 18% in Turku, and 17% nationally (P less than 0.05). Men were more likely to succeed in quitting: among men the 6-month success rate was 22% and among women 15% (P less than 0.001). CONCLUSIONS: The results and experiences indicate high viewing and participation and a beneficial cost-effect ratio. They also stress the importance of community support activities in enhancing the effects of a media-based health promotion program.

Characteristics of eighth-grade students who initiate self-care in elementary and junior high school.

The purpose of this paper is to examine whether children who care for themselves for longer periods of time are at increased risk of poor grades, truancy, anger, family conflict, stress, risk-taking, and peer influences (in addition to the increased risk of substance use previously reported). Demographic characteristics of eighth-grade students who initiate self-care in junior high school are compared with those initiating self-care in elementary school. Further, increased risks for those initiating self-care in elementary school are examined. Over two thirds of the respondents (67.8%) cared for themselves after school without adult supervision at some time during the week; 23.5% for 1 to 4 hours per week, 15.7% for 5 to 10 hours per week, and 28.6% for 11 or more hours per week. Of those in self-care, 48.5% initiated self-care during elementary school and 51.5% during junior high school. Students who were in the highest category of self-care (greater than or equal to 11 hours per week) vs those in self-care zero hours per week were 1.5 to 2 times as likely to score high on risk-taking, anger, family conflict, and stress, to be more likely to see their friends as their major source of influence, and to attend more parties. The self-reports of academic grades did not differ. The grade of initiation of self-care (elementary vs junior high school) conferred additional risk for drinking alcohol (odds ratio = 1.4), risk-taking tendencies (odds ratio = 1.5), and attending parties (odds ratio = 1.6).

Drug use prevention programs, gender, and ethnicity: evaluation of three seventh-grade Project SMART cohorts.

One-year follow-up data from three seventh-grade cohorts of Project SMART were examined to assess the effects of two social psychology-based programs within each of six subgroups: males, females, Asians, blacks, Hispanics, and whites. The three cohorts (total N = 5,070) were those receiving curriculum or serving as controls as seventh-graders in 1982-1983, 1983-1984, and 1984-1985 school years. The outcome measures used were composite indices based on lifetime and recent use items for cigarettes, alcohol, and marijuana. The major analysis was ANCOVA on classroom means for the composite indices at post-test, using pretest classroom means for the indices as a covariate. The results showed clear prevention effects for females but not for males. Overall prevention effects were strongest for cigarette smoking, but were also evident for alcohol. Significant sex by program interactions, showing differential program effects for males and females, were found for cigarettes and marijuana, but not for alcohol. There was a nonsignificant trend suggesting that the programs were most effective for Asians and least effective for whites.

Book prices and costs for a small-hospital library: a subject analysis.

An analysis of the Brandon/Hill lists has provided individual price figures to assist the librarian of a small hospital in calculating book costs associated with establishing and maintaining an up-to-date collection suited to institutional needs. For the fifty-three subject categories analyzed, the following were calculated over the past twenty-two years: average price per title, size and cost of the category, number of new titles or editions, percentages price increases, and cost of maintaining a basic collection. Used in conjunction with local purchasing data, these figures can be useful in budget preparation.

Activity involvement, risk-taking, demographic variables, and other drug use: prediction of trying smokeless tobacco.

Four activity participation variables (clubs, sports, church, and parties); two indices of "risk-taking" (preference for risk-taking, getting into trouble at school); three demographic variables (sex, ethnic group, socioeconomic status); and two drug use variables (trial of cigarettes and alcohol) were examined as correlates and prospective predictors of trial of smokeless tobacco in two cohorts of seventh graders in urban Los Angeles. The data were analyzed separately for males and females. Cross-sectional logistic regression analyses indicated that correlates of trying smokeless tobacco among the seventh-grade cohorts or among these same cohorts in the eighth grade (considering those persons who had not tried smokeless tobacco in seventh grade) generally included being white, trying cigarettes, risk-taking, and attending parties. Prospective logistic regression analyses with data from subjects who had not tried smokeless tobacco in the seventh grade indicated that predictors of subsequent trial of it generally included only being white and having tried cigarettes. Sports participation predicted onset only in one cohort of female subjects but not in males. Some activities that have been proposed as being predictive of smokeless tobacco use (e.g., sports participation) are generally irrelevant for a large sample of young adolescents in urban Los Angeles. White male cigarette smokers, regardless of the activities they have engaged in, are most likely to try smokeless tobacco.

Rapid contrast sensitivity assessment in keratoconus.

Contrast sensitivity derangement may accompany keratoconus even in the presence of normal or near normal Snellen visual acuity. This has been demonstrated with computer-driven contrast sensitivity test devices. The purpose of this study was to evaluate the utility and efficacy of rapid screening devices for contrast sensitivity testing. However, such devices are often cumbersome and difficult to use clinically. We tested 12 patients with keratoconus on 2 simple chart systems designed to test contrast sensitivity in a rapid and clinically useful manner: the Vistech chart and the Regan multi-contrast visual acuity charts. Both devices detected the contrast sensitivity abnormalities present in early keratoconus, but some patients [with greater than or equal to 6/12 (20/40) visual acuity] were unable to respond to areas of the charts corresponding to high spatial frequency and/or low contrast tasks. Such simple wall charts may be useful in measuring the visual abnormalities in early keratoconus, in monitoring the progression of the disease, and in evaluating various treatment options.

Win some, lose some: parental hypertension and heart rate change in an incentive versus response cost paradigm.

Fowles (1983), citing evidence from separate studies, suggests that both incentive and response cost paradigms increase heart rate and should be subsumed under Gray's (1975) 'appetitive motivational system'. Shock avoidance and loss of reward (response cost) contingencies, while aversive, appear to evoke this motivational system; consequently both should elicit heart rate increases independent of anxiety. The present investigation compared magnitude of heart rate changes observed under conditions of winning and losing money. Results showed: no differences between incentive and response cost conditions; no effect of state anxiety on heart rate in these conditions, despite an elevation of state anxiety on the task day relative to a subsequent relaxation day assessment; and some evidence for the presence under both such appetitive conditions of cardiovascular hyperresponsivity among offspring of hypertensive parents. The results suggest a need for systematic parametric studies of experimental conditions.

Balancing program and research integrity in community drug abuse prevention: project STAR approach.

This paper focuses on the process of community-based drug prevention programming using an ongoing, multiple community project (Project STAR) as an illustration. Particular attention is paid to problems and strategies for balancing program and research integrity over the long-term. Specific strategies are discussed for obtaining and sustaining support for the program, quality control throughout program delivery, and accommodation of both research and program objectives.