Severity of leukoaraiosis in large vessel atherosclerotic disease.

BACKGROUND AND PURPOSE: The severity of white matter hyperintensity, or leukoaraiosis, is a marker of cerebrovascular disease. In stroke, WMH burden is strongly linked to lacunar infarction; however, impaired cerebral perfusion due to extracranial or intracranial atherosclerosis may also contribute to WMH burden. We sought to determine whether WMH burden is associated with extracranial or intracranial stenosis in patients with AIS. MATERIALS AND METHODS: Patients with AIS with admission head/neck CTA and brain MR imaging were included in this analysis. "Extracranial stenosis" was defined as >50% stenosis in the extracranial ICA, and "intracranial," as >50% stenosis in either the middle, anterior, or posterior cerebral arteries on CTA, on either side. WMHV was determined by using a validated semiautomated protocol. Multiple regression was used to assess the relationship between WMHV and extracranial/intracranial atherosclerosis. RESULTS: Of 201 subjects, 51 (25.4%) had extracranial and 63 (31.5%) had intracranial stenosis. Mean age was 62 ± 15 years; 36% were women. Mean WMHV was 12.87 cm(3) in the extracranial and 8.59 cm(3) in the intracranial stenosis groups. In univariate analysis, age (P < .0001), SBP and DBP (P = .004), and HTN (P = .0003) were associated with WMHV. Extracranial stenosis was associated with greater WMHV after adjustment for intracranial stenosis (P = .04). In multivariate analysis including extracranial stenosis, only age (P < .0001) and HTN (P = .03) demonstrated independent effects on WMHV. CONCLUSIONS: In our cohort of patients with AIS, age and HTN were the strongest determinants of the WMHV severity. Future studies are warranted to unravel further association between WMHV and cerebral vessel atherosclerosis.

Does class matter? SES and psychosocial health among Hungarian adolescents.

Previous research finds a significant relationship between socioeconomic inequalities and health status: individuals with lower income, education, and occupational prestige have and report more health problems. Interestingly, this relationship is not consistent across the life cycle: health differences among adolescents across socioeconomic groups are not as clearly defined. Using data (n = 1,039) on adolescents from southern Hungary, we examine the role of socioeconomic differences in predicting psychosocial health. We argue that this investigation is of particular importance in a post-communist system where the general perception of SES is undergoing significant transformation. Findings show that classical' SES (socioeconomic status) indicators (manual/nonmanual occupational status) were not significant predictors of psychosocial health in this sample of Hungarian adolescents. While parents' employment status as a 'objective' SES indicator had limited effect, SES self-assessment, as a subjective SES variable, proved to be a strong predictor of adolescents' psychosocial health. We discuss the implications of these findings for the broader SES-health literature with specific attention paid to the impact these relationships may have for adolescent and young adult development in a post-communist country like Hungary.

Dangerous places: exposure to violence and its mental health consequences for the homeless.

The association between exposure to violence and symptoms of mental health problems among 161 homeless adults in a mid-sized Southern metropolitan area was examined. Results indicated a significant relationship between witnessing violence and the reporting of mental health symptoms; no relationship was found between criminal victimization and symptom reporting. Implications for clinical practice and social policy are discussed.

Exposure to violence and posttraumatic stress symptomatology among abortion clinic workers.

The intent of this study was to examine the relationship between exposure to abortion clinic violence, either as a victim or witness, and the reporting of posttraumatic stress disorder (PTSD) symptoms among clinic employees. Semi-structured interviews with 71 clinic workers from eight abortion clinics in a Southeastern state were used for analyses. Findings showed that as victims, clinic workers experienced moderate forms of violence and witnessed greater variety and numbers of violent acts. Twenty-one percent of the sampled workers reported symptoms similar to the syndrome described in the DSM-IIIR/DSM-IV classification for PTSD. A multivariate analysis showed that even when controlling for significant life circumstances and stressors outside the clinic setting, witnessing violence was a significant predictor of PTSD symptomatology.

Aggression and environmental risk among low-income African-American youth.

PURPOSE: This study examined the extent to which individual, family, and environmental factors discriminated between aggressive and nonaggressive African-American youth. METHODS: One hundred fifty African-American boys and girls from eight housing communities in a medium sized Alabama central city were surveyed. From this nonrandom sample, information was collected concerning respondents' demographics, family characteristics, exposure(s) to violence, questions pertaining to weapon possession, and a peer-nominated question on aggression. Multivariate analysis was employed to differentiate aggressive from nonaggressive youth. RESULTS: Discriminant function analysis found gender (males) and age (older) to be important discriminators between nonaggressive and aggressive youth. In addition, a significant amount of separation between these groups was accounted for by their varying degrees of exposure to violence, specifically as a witness to and victim of violence, and their possession of a weapon. CONCLUSIONS: Findings provide evidence that victimization and witnessing violence were significantly related to aggressive behavior among this sample of African-American youth. In addition, this study confirms the clinical significance of environment and its potential role in predicting physical health, mental health, and social and behavioral outcomes for youth.

Fighting among America's youth: a risk and protective factors approach.

Using three nationally representative, stratified samples of youth, this paper examines health-comprising behavior (fighting) using a risk and protective factors model. In addition, the interplay between risk and protective factors is explored in an attempt to specify their precise role in acting as either mediators or buffers in the risk-taking process. Regression results indicate some similarities among the three samples and the general model's utility in predicting self-reported fighting among youth. Specifically, general environmental risk variables in the form of exposure to violence (threats and victimization) were consistent predictors of fighting among all age groups (grades 3 through 12). Upon closer inspection, analysis revealed that protective factors were not effectively mediating the relationship between risks and risk-taking behavior. Results from the multiplicative regression analysis indicate that protective factors in some circumstances act as buffers; when protective factors are absent or at their weakest, the negative impact of risk on health-compromising behavior was clearly present. Overall, the findings underscore the importance of taking a multidimensional approach to examining risk-taking behavior among youth where individual-level, family, school, and community factors are all considered in the design of prevention strategies.

Gender differences in medical school attrition rates, 1973-1992.

Retention is a critical problem in medical school education. We report here on research that examined gender differences in attrition rates between 1973 and 1992. Using secondary data compiled from the annual reports on undergraduate education published in JAMA, both descriptive and inferential analyses of medical school attrition rates were conducted. Data show that medical school attrition rates have steadily increased across the country since 1973 and that women drop out of medical school at consistently greater rates than men. These results highlight the importance of future analyses that attempt to delineate the causes as well as the consequences of dropping out of medical school for women and the institutions that support them.

Exposure to violence and presence of depression among low-income, African-American youth.

Distributional properties and correlates of the Children's Depression Inventory (CDI) were presented for a sample (n = 221) of low-income, African-American youths between 7 and 18 years of age. The results showed that younger children and those living in a household without their mother reported more depressive symptoms. Regression analyses revealed that victims of violence reported more depressive symptoms. However, chronic exposure to violence, in the form of witnessing violent acts, was not significantly related to depression. On further inspection, it was discovered that witnessing violence had a negative effect on depression. This finding, although somewhat unexpected, may be the result of some youths possessing a set of extraordinary coping mechanisms that help to insulate them from negative environmental experiences.

The prevalence and consequences of exposure to violence among African-American youth.

The objective of this study was to examine the relationship between chronic exposure to community violence and post-traumatic stress disorder (PTSD) symptoms in a nonrandom sample (N = 221) of low-income African-American youth between 7 and 18 years old. Results showed males were more likely than females to be victims of and witnesses to violent acts; there were no other significant sociodemographic differences in the degree of exposure to violence. PTSD symptom reporting was moderately high for this sample of youth; 54 youth (27.1%) met all three of the diagnostic criteria considered. Regression analyses revealed that being victimized and witnessing violence were significantly related to the reporting of PTSD symptoms. These symptoms were more extreme among victimized females and victimized youth who had no primary males living with them in the household (i.e., fathers and/or brothers). Exposure to violence among youth is clearly significant to their reporting of PTSD symptomatology, yet the clinical implications of this relationship remain largely unexplored.

A comparison of homeless, community-wide, and selected distressed samples on the CES-Depression Scale.

Center for Epidemiological Studies (CES) Depression Scale results for surveys of homeless, community-wide and selected distressed samples are compared. Nearly four times the percentage of homeless fit the criterion for clinical caseness (a score of 16+) compared to the general population (74 to 19 percent). None of the distressed samples exhibited a higher rate except psychiatric patients diagnosed as acutely depressive. High rates of depression have implications for social policies directed toward homelessness.

Effects of prostaglandins, thromboxanes, and inhibitors of their synthesis on renal and gastrointestinal function in the newborn period.

We have reviewed current thoughts concerning the interplay between prostaglandins and renal and gastrointestinal function with a focus on the possible alteration in the latter functions that would be expected when prostaglandin synthesis is inhibited in premature infants receiving indomethacin for closure of the patent ductus arteriosus. It would appear that administration of even small doses of indomethacin may be associated with transient oliguria. Although speculation exists about whether indomethacin may promote the development of necrotizing enterocolitis in these infants, there is no convincing evidence of a cause-effect relationship.

Alterations in the maternal behavior of rats rearing malnourished offspring.

Investigations of maternal behavior of mothers fed a low-protein diet indicated deficits in retrieval and in the rate of nest-building. In addition, they indicated a concomitant increase in time spent with young when assessed during periods not associated with the retrieval/nest-building test session. The adrenalectomized mother, another case that produces growth-stunted progeny, was compared with both low-protein and control mothers for maternal behavior. Unlike the low-protein mother, the adrenalectomized mother did not exhibit retrieval or nest-building deficits; however, the adrenalectomized mother did display an increase in time spent with young. These data suggest that although deficits in retrieval and nest-building can be attributed to the nutritional condition of the mother, the stimulus characteristics of the malnourished pup are important in eliciting the increased time spent with the litter.