Effects of dehydroepiandrosterone (DHEA) on cardiovascular risk factors in older women with frailty characteristics.

OBJECTIVE: this analysis was to investigate the effects of dehydroepiandrosterone (DHEA) on cardiovascular risk factors in older women with frailty characteristics. DESIGN, SETTING AND PARTICIPANTS: the study was a double-blind, randomised, placebo-controlled trial of 99 women (mean 76.6 +/- 6.0 year) with the low DHEA-S level and frailty. INTERVENTION: participants received 50 mg/day DHEA or placebo for 6 months; all received calcium (1,000-1,200 mg/day diet) and supplement (combined) and cholecalciferol (1,000 IU/day). Women participated in 90-min twice weekly exercise regimens, either chair aerobics or yoga. MAIN OUTCOME MEASURES: assessment of outcome variables included hormone levels (DHEA-S, oestradiol, oestrone, testosterone and sex hormone-binding globulin (SHBG)), lipid profiles (total cholesterol, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol and triglycerides), body composition measured by dual energy absorptiometry, glucose levels and blood pressure (BP). RESULTS: eighty-seven women (88%) completed 6 months of study; 88% were pre-frail demonstrating 1-2 frailty characteristics and 12% were frail with > or =3 characteristics. There were significant changes in all hormone levels including DHEA-S, oestradiol, oestrone and testosterone and a decline in SHBG levels in those taking DHEA supplements. In spite of changes in hormone levels, there were no significant changes in cardiovascular risk factors including lipid profiles, body or abdominal fat, fasting glucose or BP. CONCLUSION: research to date has not shown consistent effects of DHEA on cardiovascular risk, and this study adds to the literature that short-term therapy with DHEA is safe for older women in relation to cardiovascular risk factors. This study is novel in that we recruited women with evidence of physical frailty.

Periodontitis case definition affects the association with renal function in kidney transplant recipients.

AIM: The aim of this analysis was to investigate the association between periodontal status and renal allograft function in a cohort of renal transplant patients using different periodontitis case definitions. MATERIAL AND METHODS: Fifty-eight kidney transplant patients were included. The subjects were classified into two groups, deterioration or stable/improvement of renal allograft function as expressed by the difference in glomerular filtration rate (GFR) between two time points at least 6 months apart. Chronic periodontitis was defined as: (1) two or more interproximal sites with clinical attachment level (CAL) ≥4 mm or two or more interproximal sites with probing depth (PD) ≥5 mm (DEF1); (2) PD ≥ 5 or CAL ≥ 4 in at least six proximal sites (DEF2); and (3) PD ≥ 5 or CAL ≥ 4 in at least two proximal sites in each quadrant (DEF3). RESULTS: In a multivariate linear regression model, none of the continuous periodontal variables were significantly associated with deterioration of allograft function. Of the three definitions of chronic periodontitis, only DEF2 emerged as significantly more prevalent in subjects with GFR deterioration and was a statistically significant predictor of GFR deterioration over time. CONCLUSION: These findings underscore the importance of periodontitis 'case definition' in the observed statistical associations between periodontitis and systemic disease.

Oral Candida infection and colonization in solid organ transplant recipients.

INTRODUCTION: Oral Candida carriage and infection have been reported to be associated with a greater risk for systemic infection in transplant recipients; however, a systematic analysis of the oral Candida titers and species has not been previously conducted. The objectives of this study were to determine the prevalence of oropharyngeal candidiasis, the oral carrier status, Candida titers and species in this population. METHODS: Ninety kidney and heart transplant subjects and 72 age-matched healthy controls were included. Swabs from the oral mucosa and a standardized amount of unstimulated saliva were plated on Chromagar Candida, and colony-forming units per millilitre were calculated. Initial speciation was based on colony color and was confirmed by standard germ tube, biotyping, or polymerase chain reaction assays. RESULTS: Infection with C. albicans was detected in seven transplant subjects and none of the controls. The transplant group had significantly higher oral Candida titers than the control group. There were no statistically significant relationships between the dose or type of immunosuppressants and oral Candida titers or infection. A significantly higher percentage of transplant subjects were colonized by more than one species, compared with control subjects. The most frequent species combination in transplant subjects was C. albicans and C. glabrata. C. glabrata was isolated from 13.5% of transplant carriers and none of the controls. CONCLUSIONS: Increased oral Candida infection and carriage titers were found in the transplant population. Although the majority of transplant patients were colonized by C. albicans, C. glabrata appears to emerge as the second most prevalent species.

TET1 contributes to allergic airway inflammation and regulates interferon and aryl hydrocarbon receptor signaling pathways in bronchial epithelial cells.

Previous studies have suggested a role for Tet1 in the pathogenesis of childhood asthma. However, how Tet1 contributes to asthma remains unknown. Here we used mice deficient for Tet1 in a well-established model of allergic airway inflammation and demonstrated that loss of Tet1 increased disease severity including airway hyperresponsiveness and lung eosinophilia. Increased expression of Muc5ac, Il13, Il33, Il17a, Egfr, and Tff2 were observed in HDM-challenged Tet1-deficient mice compared to Tet1+/+ littermates. Further, transcriptomic analysis of lung RNA followed by pathway and protein network analysis showed that the IFN signaling pathway was significantly upregulated and the aryl hydrocarbon receptor (AhR) pathway was significantly downregulated in HDM-challenged Tet1-/- mice. This transcriptional regulation of the IFN and AhR pathways by Tet1 was also present in human bronchial epithelial cells at base line and following HDM challenges. Genes in these pathways were further associated with changes in DNA methylation, predicted binding of transcriptional factors with relevant functions in their promoters, and the presence of histone marks generated by histone enzymes that are known to interact with Tet1. Collectively, our data suggest that Tet1 inhibits HDM-induced allergic airway inflammation by direct regulation of the IFN and AhR pathways.

The impact of junk food marketing regulations on food sales: an ecological study.

OBJECTIVE: To evaluate the impact of junk food broadcast marketing policies on nationwide junk food sales and identify policy characteristics effective in reducing sales. METHODS: Country policy data (n = 79) were categorized in a thorough literature review and analysed using a repeated measures design against data on food sales per capita. Study conducted in United States, 2017. RESULTS: Countries with junk food broadcast marketing policies saw a decrease in junk food sales per capita after implementation, while those without said policies saw an increase (p = 0.013). Countries with statutory policies saw a decrease in sales per capita, while those with only self-regulation saw an increase (p = 0.004). Audience restrictions (p = 0.024) and standardized nutrition criteria (p = 0.008) were policy characteristics significantly associated with a decrease in sales per capita. CONCLUSIONS: Utilizing a novel approach to evaluate junk food broadcast marketing policies, the study demonstrated that countries with statutory policies saw a significant decrease in junk food sales per capita not seen in countries with no or only self-regulatory policies. To effectively reduce exposure to child-targeted junk food marketing, governments should establish strong, comprehensive statutory regulations. Additionally, countries that implement junk food marketing policies can use food sales data to track policy effectiveness.

Diesel exhaust and house dust mite allergen lead to common changes in the airway methylome and hydroxymethylome.

Exposures to diesel exhaust particles (DEP) from traffic and house dust mite (HDM) allergens significantly increase risks of airway diseases, including asthma. This negative impact of DEP and HDM may in part be mediated by epigenetic mechanisms. Beyond functioning as a mechanical barrier, airway epithelial cells provide the first line of immune defense towards DEP and HDM exposures. To understand the epigenetic responses of airway epithelial cells to these exposures, we exposed human bronchial epithelial cells to DEP and HDM and studied genome-wide 5-methyl-cytosine (5mC) and 5-hydroxy-methylcytosine (5hmC) at base resolution. We found that exposures to DEP and HDM result in elevated TET1 and DNMT1 expression, associated with 5mC and 5hmC changes. Interestingly, over 20% of CpG sites are responsive to both exposures and changes in 5mC at these sites negatively correlated with gene expression differences. These 5mC and 5hmC changes are located in genes and pathways related to oxidative stress responses, epithelial function and immune cell responses and are enriched for binding sites of transcription factors (TFs) involved in these pathways. Histone marks associated with promoters, enhancers and actively transcribed gene bodies were associated with exposure-induced DNA methylation changes. Collectively, our data suggest that exposures to DEP and HDM alter 5mC and 5hmC levels at regulatory regions bound by TFs, which coordinate with histone marks to regulate gene networks of oxidative stress responses, epithelial function and immune cell responses. These observations provide novel insights into the epigenetic mechanisms that mediate the epithelial responses to DEP and HDM in airways.

Nasal DNA methylation is associated with childhood asthma.

AIM: We aim to study DNA methylation (DNAm) variations associated with childhood asthma. METHODS: Nasal DNAm was compared between sibling pairs discordant for asthma, 29 sib pairs for genome-wide association studies and 54 sib pairs for verification by pyrosequencing. Associations of methylation with asthma symptoms, allergy and environmental exposures were evaluated. In vitro experiments and functional genomic analyses were performed to explore biologic relevance. RESULTS: Three CpGs were associated with asthma. cg14830002 was associated with allergies in nonasthmatics. cg23602092 was associated with asthma symptoms. cg14830002 and cg23602092 were associated with traffic-related air pollution exposure. Nearby genes were transcriptionally regulated by diesel exhaust, house dust mite and 5-aza-2'-deoxycytidine. Active chromatin marks and transcription factor binding were found around these sites. CONCLUSION: We identified novel DNAm variations associated with childhood asthma and suggested new disease-contributing epigenetic mechanisms.

Clinical, Immune, and Microbiome Traits of Gingivitis and Peri-implant Mucositis.

Tissues surrounding dental implants and teeth develop clinical inflammation in response to microbial stimuli. However, the literature suggests that differences exist in the microbial insult and inflammatory responses leading to gingivitis and peri-implant mucositis. In this pilot study, the authors use for the first time a systems biology approach to comprehensively evaluate clinical parameters, selected inflammatory markers, and the microbiome of subject-matched tooth and implant sites during native inflammation and in response to experimental plaque accumulation. Fifteen subjects with 2 posterior implants and corresponding contralateral teeth were examined at enrollment; at day 0, after reinstitution of gingival/mucosal health; at days 7, 14, and 21, during stent-mediated oral hygiene (OH) abstention; and at day 42, after resumption of OH. The subgingival microbiome was evaluated via 16S rRNA gene sequencing and 8 selected inflammatory markers measured in crevicular fluid. Comparison of teeth and implants via general linear models based on orthogonal polynomials showed similar responses in clinical parameters, inflammatory mediators, and proportions of individual microbial taxa during OH abstention. Implants, however, accumulated less plaque and underwent more heterogeneous shifts in microbiome structure. A multilevel, within-group, sparse partial least squares analysis of covariation of microbial, inflammatory, and clinical parameters throughout all study visits found inflammation around teeth and implants positively correlated with IL-1 alpha and IL-1 beta and with the proportions of Selenomonas, Prevotella, and 5 species-level phylotypes. Gingivitis, however, showed a stronger positive correlation with lactoferrin and IL-1ra and a stronger negative correlation with Rothia. Peri-implant mucositis, on the contrary, correlated positively with certain microbial taxa not associated with gingivitis by a previous study or the current one. In summary, differences existed between implants and tooth sites in microbiome evolution during OH abstention and in the correlation of specific inflammatory mediators and microbial taxa with clinical inflammation. Common biological features, however, were also identified for gingivitis and mucositis.

Elevated serum interleukin-6 (IL-6) in solid-organ transplant recipients is positively associated with tissue destruction and IL-6 gene expression in the periodontium.

BACKGROUND: The number of transplanted solid organs and life expectancy after transplantation are steadily rising worldwide. Inflammation is widely recognized as playing a pivotal role in transplant rejection, and several studies have shown that serum interleukin-6 (IL-6) levels can identify individuals who are at greater risk for rejection. Given the known association between IL-6 and chronic periodontitis, the aim of our study was to assess the periodontal status of solid-organ transplant subjects compared to systemically healthy controls, to quantify the IL-6 levels in the serum and periodontal tissues, and to explore their association. METHODS: Forty-seven heart and kidney transplant and 18 systemically healthy age-matched individuals were recruited. Subjects received a complete periodontal examination, and blood and periodontal tissue samples were collected for quantification of IL-6 protein and mRNA levels, respectively. RESULTS: Transplant subjects had significantly higher serum IL-6 levels and slightly but statistically significantly increased mean probing depths than healthy controls. Multivariable linear regression analysis adjusting for gender, diabetes, smoking, and immunosuppressant dose showed that the mean probing depth, number of missing teeth, and mean percentage of sites with > or =4 mm attachment loss were independent predictors for elevated serum IL-6 levels. Transplant subjects with chronic periodontitis had higher mean serum IL-6 levels than those without chronic periodontitis, and there was a positive correlation between periodontal IL-6 gene expression levels and serum IL-6 protein levels. CONCLUSIONS: Periodontal tissue destruction and local IL-6 synthesis are associated with elevated serum IL-6 levels in transplant recipients. This may have serious implications in solid-organ transplant deterioration and chronic rejection.

Buspirone treatment of anxious alcoholics. A placebo-controlled trial.

BACKGROUND: Symptoms of anxiety are common in alcoholics and may contribute to relapse following initiation of abstinence. Buspirone hydrochloride, a serotonin1A partial agonist, has a pharmacologic profile that may be particularly suited to the treatment of anxious alcoholics. METHODS: We conducted a randomized, 12-week, placebo-controlled trial of buspirone in 61 anxious alcoholics, all of whom also received weekly relapse prevention psychotherapy. Outcomes were measured at the end of treatment and at a 6-month follow-up evaluation. RESULTS: Buspirone therapy was associated with greater retention in the 12-week treatment trial, reduced anxiety, a slower return to heavy alcohol consumption, and fewer drinking days during the follow-up period. CONCLUSIONS: Buspirone appears to have a useful role in the treatment of anxious alcoholics. Further research is needed to clarify which patient characteristics and concomitant treatments result in optimal response to buspirone therapy.

The short-term effects of conjugated estrogen on bone turnover in older women.

Estrogen replacement therapy (ERT) prevents bone loss and fracture in early postmenopausal women, but its benefit for women over 70 yr of age has not been determined. We have examined the effect of a short course of ERT on biochemical markers of bone turnover in older women. Eleven women (mean age, 77 yr) were given conjugated estrogen (Premarin; 0.625 mg/day) for 6 weeks. Biochemical markers were measured on serum and urine collected at baseline (two samples), after 5 and 6 weeks of ERT, and 5 and 6 weeks post-ERT. Markers of bone formation were osteocalcin, bone alkaline phosphatase, and type I procollagen peptide. Markers of bone resorption were total urinary hydroxyproline, total and free pyridinoline and deoxypyridinoline cross-links, type I collagen cross-linked N-telopeptides, and serum C-terminal cross-linked telopeptide. Data were analyzed by repeated measures multivariate analysis of variance to estimate the overall effect of ERT on the biochemical markers. Markers of bone resorption decreased during ERT and returned to baseline after ERT (P < 0.05). Markers of bone formation declined less during ERT and continued to decline after ERT (P < 0.05). We conclude that ERT reduces bone turnover in older women and that markers of bone turnover may be useful in assessing the response to treatment in this age group.

Placebo-controlled trial of fluoxetine as an adjunct to relapse prevention in alcoholics.

OBJECTIVE: The authors tested the hypothesis that fluoxetine, when used in combination with relapse prevention psychotherapy, directly reduces relapse frequency and severity for alcoholics. METHOD: The authors conducted a randomized, placebo-controlled trial of fluoxetine (up to a maximum of 60 mg/day) for 12 weeks in combination with weekly psychotherapy for 101 alcohol-dependent subjects who were not selected on the basis of comorbid major depression. Outcomes were measured at the end of treatment and 6 months after treatment. RESULTS: Placebo-treated subjects were more complaint with the medication regimen and remained in the study longer than fluoxetine-treated subjects. There was significantly less alcohol consumption in both groups during treatment than before treatment. These effects persisted during the posttreatment period. Although fluoxetine treatment had no significant effects on alcohol consumption, it reduced Hamilton Depression Rating Scale scores more than placebo treatment among subjects with current major depression. CONCLUSIONS: Fluoxetine at a dose of 60 mg/day is probably not of use for relapse prevention in alcoholics with mild to moderate alcohol dependence and no comorbid depression. In alcoholics with major depression, the drug may reduce depressive symptoms. Subsequent studies with fluoxetine should probably focus on more severely alcohol-dependent subjects or those with comorbid depression.

Brain morphometric analysis in neurofibromatosis 1.

RATIONALE AND OBJECTIVES: To investigate the relationships between brain and skull base growth in patients with neurofibromatosis 1 (NF1) compared with healthy control subjects using brain magnetic resonance imaging (MRI) for morphometric analysis. METHODS: Evaluated patients included children who underwent T1- and T2-weighted or dual-echo proton density axial and T1-weighted sagittal brain MRI from January 1, 1988, to December 31, 1995. Study subjects (n = 27) received a diagnosis of NF1 by accepted National Institutes of Health clinical criteria and were compared with an age- and sex-matched control group (n = 43). Twenty-four predetermined ventricular and brain parenchymal dimensions and area calculations were evaluated. Data were analyzed using 2-tailed t tests, chi2 analysis, analysis of variance, and analysis of covariance adjusted for age and sex. Correlational analyses with respect to subject type and age were performed separately. RESULTS: There were 27 patients (20 boys, aged 1.0-17.7 years; mean age, 8.8 years) and 43 controls (22 boys, aged 0.1-17.7 years; mean age, 5.9 years). The mean ages between groups (boys, girls, and totals) were not statistically different. Significant differences were appreciated for 6 of 24 measures. Patients with NF1 had a significantly larger bicaudate width (P = .002), biatrial width (P<.001), and biparietal diameter (P = .003), but not hemispheric length. They also had significantly increased iter measures (P = .004), descending sigmoid sinus (P<.001), and an age-specific increase in brainstem height (P = .03) not seen in controls. CONCLUSIONS: Patients with NF1 experience dynamic changes in brain morphometry, resulting in a predominant lateral volume expansion of the supratentorial compartment and an increasing velocity of brainstem growth as they age. These data underscore brain-region-specific parenchymal overgrowth potential.

Brain morphometric analysis in achondroplasia.

RATIONALE AND OBJECTIVES: We undertook an MRI brain morphometric analysis to investigate the relationships between brain and skull base growth and clinical function in patients with achondroplasia as compared to normal controls. METHODS: Patients selected for evaluation included pediatric patients who underwent T1 and T2 or dual-echo, proton-density axial T1- and T2-weighted and T1 sagittal brain MRI during 1988 to 1992. Study subjects (n = 11) were diagnosed with achondroplasia by clinical and radiologic criteria and compared to an age- and gender-matched control group (n = 25). Twenty-four predetermined ventricular and brain parenchymal dimensions and area calculations were evaluated. Data were analyzed using two-tailed t tests, chi-squared analysis, ANOVA, and ANCOVA, adjusting for age and sex. Correlational analyses with respect to subject type and age were done separately. RESULTS: There were 36 patients (11 subjects with 15 MRI examinations, mean age 2.3 years, and 25 controls with 26 MRI examinations, mean age 3.0 years). Significant differences existed for 11/17 measures. Achondroplasts had a significantly larger bifrontal width (p < 0.0001), bicaudate width (p < 0.0001), frontal horn diagonal length (p < 0.05), biatrial width (p < 0.0001), biparietal diameter (p < 0.05), and iter to incisural line distance (p < 0.0001). Achondroplasts had significantly smaller frontal lobe depths (p < 0.01), optic tract angles (p < 0.0001), foramen magnum diameters (p < 0.0001), and sinojugular transition zones (p < 0.05). There were no differences in brainstem heights or fourth ventricular widths between achondroplasts and controls. Furthermore, with respect to age, frontal lobe depth was smaller when compared to controls and the descending sigmoid sinus area became increasingly larger. CONCLUSIONS: Achondroplastic subjects experience dynamic changes in brain morphometry resulting in a rostral displacement of the brainstem with gradual compression of the frontal lobes due to enlargement of the supratentorial ventricular spaces commensurate with an increase in venous sinus distension.

Use of logistic regression in comparing multiple limiting dilution analyses of antigen-reactive T cells.

Traditionally, statistical analyses of multiple limiting dilution analyses have used linear regression in comparing the fit of each analysis to a single-hit Poisson model. Multiple analyses can, however, result in an inflated type I error leading to spurious rejection of the null hypothesis. Logistic regression was used as an umbrella statistic to analyze eight limiting dilution analyses for antigen-reactive T cells from two mouse strains (SJL/J; B10.S), at two priming doses of antigen, for each of two antigens (porcine myelin basic protein, PMBP; purified protein derivative of M. tuberculosis, PPD) used to induce experimental allergic encephalomyelitis (EAE). This proved superior to traditional methods: six of the eight strain/dose/antigen combinations were consistent with a viable model, whereas only three of eight were consistent with the Poisson single-hit model. Moreover, only three of the resultant 32 standardized residual values (four per group times eight groups) fell outside the 95% confidence interval. Logistic regression, therefore, is recommended when nominal dependent measures can be structured as a function of more than one independent variable.

An evaluation of autonomic nervous system function in patients with Prader-Willi syndrome.

OBJECTIVE: Prader-Willi syndrome (PWS) is a complex multisystem genetic disorder in which many cardinal features may have a neurologically based pathophysiology involving both the central and peripheral components of the autonomic nervous system. Autonomic nervous system function was studied noninvasively in a group of subjects with PWS and control subjects to determine whether autonomic nervous system dysfunction exists as part of the PWS. DESIGN/SETTING: This cross-sectional study was performed in the neurophysiology laboratory at a tertiary care facility. METHODS: Evaluation included anthropometric measurements and calculation of a body mass index (BMI). Simultaneous electrocardiography and serial recordings of pulse rate and systolic/diastolic mean arterial blood pressures during orthostatic maneuvers were taken. Pupillary response to the instillation of dilute pilocarpine and measurements of plasma norepinephrine at rest and after standing were also obtained. Results were analyzed using two-tailed t tests, Fisher exact test, analysis of variance, and analysis of covariance adjusting for age, gender, and BMI. PATIENTS: There were 14 subjects with PWS (8 female, 6 male; aged 4 to 40 years, mean age 16 years) and 8 control subjects (4 female, 4 male; aged 5 to 37 years, mean age 19 years). RESULTS: Abnormal findings were obtained only in subjects with PWS. Analysis of covariance adjusting for age, gender, and BMI revealed a trend for subjects with PWS to have lower resting diastolic blood pressure (P < .09) and significantly less change in diastolic blood pressure after standing (P < .02). Subjects with PWS had significantly greater BMI than did control subjects (P < .001), which correlated significantly with all pulse rate measurements where the greater the BMI the higher the pulse rate at rest (r = .25, P < .04) and the lower the pulse rate after arising from lying to standing at both 15 and 30 seconds (r = .17, P < .1; r = .55, P < .08 respectively). Pupillary constriction of 2 mm or more was seen in 7 of 14 subjects with PWS and in no control subjects (P < .004). The 30:15 R-R interval ratio was abnormal in 6 of 14 subjects with PWS and in no control subjects (P < .03). CONCLUSIONS: These results suggest that patients with PWS have a detectable underlying autonomic dysfunction characterized principally by diminished parasympathetic nervous system activity.

Analysis of skull anthropometric measurements in patients with neurofibromatosis type-1.

RATIONALE AND OBJECTIVES: The authors studied selected anthropometric measurements of plain postero-anterior and lateral skull roentgenograms to ascertain whether these were useful in distinguishing patients with clinically probable neurofibromatosis type-1 from controls. METHODS: A retrospective review of medical records of patients for whom skull roentgenograms were available was conducted. Patients were assigned to one of three groups: definite neurofibromatosis type-1 (DNF), probable neurofibromatosis type-1 (PNF), and controls. A blinded analysis of 29 measurements, 9 qualitative assessments, and 3 area/volume calculations was performed. RESULTS: There were 58 patients (29 controls, 14 DNF, and 15 PNF). The majority (75%) of all predetermined landmarks could be ascertained in 43 of these subjects. After age and gender were held constant, analysis of covariance showed that both DNF and PNF subjects could be distinguished from controls, but not from each other when comparing the mean: sella turcica height (P < .001), sella turcica depth (P < .005), skull width (P < .001), skull length (P < .002), skull height (P < .003), and skull volume (P < .0001). CONCLUSIONS: Anthropometric analysis of skull roentgenograms coupled with results of clinical examination improves the ability to distinguish between patients with DNF and PNF from controls.

Neuropsychologic findings in cocaine-dependent outpatients.

1. Nineteen recently abstinent cocaine-dependent males were compared to 16 control subjects on a battery of neuropsychological tests. 2. The performance of cocaine-dependent subjects was inferior to the control group on tasks assessing higher level verbal skills, and on a task requiring logical sequencing of complex visual stimuli. 3. Cocaine users also performed poorly on a delayed visual memory task and on a verbal generation task, but performed better than the control group on a task assessing simple visual-motor speed. 4. Possible reasons for these findings are discussed, as are the treatment implications of these findings.

Effects of decisional control and work orientation on persistence in preventive health behavior.

Examined persistence in the daily use of fluoride mouthrinse among adolescents as a function of an induced-choice manipulation concerning self-management strategies and freedom to participate in the program. Seventh-grade boys and girls from urban and suburban schools were randomly assigned to a series of either high- or low-choice decisional control manipulations; their daily, home use of fluoride was monitored over a 20-week period. In order to ameliorate the relatively lower persistence rates found previously among suburban (vs. urban) students, all students were given self-management and action instructions as per previous studies. Although suburban students still declined in persistence relative to urban students, female students who received high choice persisted at a higher rate than girls who received low choice. Boys, for the most part, were unaffected by the manipulation. In addition, students' self-reported work orientation was also positively associated with persistence.

Utility of the AUDIT for identification of hazardous or harmful drinking in drug-dependent patients.

We evaluated the psychometric properties of the alcohol use disorders identification test (AUDIT), a ten-item screening test for identification of hazardous drinkers, in a sample of 82 patients with DSM-III-R drug dependence. AUDIT showed good internal consistency (alpha = 0.94) and a unitary factor structure. Receiver operating characteristics analysis showed the AUDIT to be comparable to the Michigan alcoholism screening test (MAST) in identifying individuals with a current alcohol use disorder and superior to the MAST for those who are hazardous drinkers. In this patient sample, AUDIT performed well at the recommended cut-off score of > or = 8. We recommend use of the AUDIT for identification of hazardous and harmful drinking among individuals with a drug use disorder.