The Triglyceride to HDL Ratio and Its Relationship to Insulin Resistance in Pre- and Postpubertal Children: Observation from the Wausau SCHOOL Project.

Insulin resistance (IR) is a risk factor for ischemic heart disease and diabetes and raises the triglyceride/high-density lipoprotein (TG/HDL) ratio in adults, but is not well defined in children. Purpose. To investigate the TG/HDL ratios in children as an IR marker. Methods. Wausau SCHOOL Project assessed 99 prepubertal and 118 postpubertal children. The TG/HDL ratio was correlated with numerous risk factors. Results. TG/HDL ratio was significantly correlated with QUICKI, HOMA-IR, zBMI, waist-to hip ratio, systolic and diastolic BP, LDL size and LDL number. A group of 32 IR children (HOMA-IR > 1 SD from the mean, i.e., >2.45) had significantly higher TG/HDL (3.11 ± 1.77) compared to non-IR children (1.86 ± 0.75). A TG/HDL ratio of ≥2.0 identified 32 of the 40 children deemed IR by HOMA-IR (>2.45) with a sensitivity of 0.80 and a specificity of 0.66. Children with TG/HDL ratio ≥3 were heavier and had higher BP, glucose, HOMA-IR, LDL number, and lower HDL level, QUICKI, and LDL size, regardless of pubertal status. Conclusion. The TG/HDL ratio is strongly associated with IR in children, and with higher BMI, waist hip ratio, BP, and more athrogenic lipid profile.

Cardiovascular risk profile: comparison between white and Southeast Asian youth in Wausau SCHOOL Project.

INTRODUCTION: The Wausau School Children Have Early Onset Of Leading Risk Factors of Cardiovascular Disease and Diabetes Mellitus (SCHOOL) Project is a community-based effort to assess the cardiovascular (CV) health of students in the Wausau School District (WSD). It has been previously demonstrated that risk factors for CV disease are prevalent and increase with age. Wausau is also a major relocation center for Southeast Asian (SEA) immigrants. Few data are available on the CV health of SEA immigrants. This investigation compares the relative frequency of CV risk factors in SEA and white students in the WSD. METHODS: A random selection of 2nd, 5th, 8th, and 11th grade students provided demographic data, health history, sex-adjusted body mass index (BMI), fasting glucose levels, blood pressure levels, and nuclear magnetic resonance lipid profiles (Liposcience). This included 519 white and 48 SEA students. To assess for CV disease risk factors, study participants were examined for dyslipidemia, hypertension, impaired fasting glucose levels, above-normal body weight, and history of smoking. RESULTS: Risk factors for CV disease increased with age for both white and SEA participants. The mean number of risk factors in SEA participants was 1.63 compared to 1.12 for white participants (P=0.016). The mean number of risk factors also increased significantly across grade levels (P=0.001). There was no difference in mean BMI values (P=0.58). No significant differences were found in triglycerides, total cholesterol, LDL cholesterol, HDL cholesterol, blood pressure, or glucose values. Dyslipidemia was present in 53% of SEA students and 42% of white students (P=0.14). CONCLUSION: CV risk factors are common in school-age children, and the number of risk factors increases with age. SEA students presented a greater prevalence of CV risk factors than white students, but were not significantly more overweight. Interestingly, in a relatively short time period after immigration, first-generation SEA youth have developed a number of CV risk factors equal to or greater than those of their white counterparts.

Short-term hearing aid benefit in a large group.

Short-term benefit in a very large group (N = 4,584) following hearing aid treatment was estimated using a revised version of the Self-Assessment of Communication (SAC-Hx). A total of 4,584 veterans with adult-onset hearing loss and mean audiometric findings consistent with a mild to severe, sloping, symmetrical, sensorineural hearing impairment were fitted with hearing aids. Responses to the SAC-Hx were gathered prior to and then 6 weeks following hearing aid fitting. Benefit was defined as the difference between the baseline and the posttreatment SAC-Hx scores. Hearing aid treatment resulted in robust and statistically significant benefit in each category of self-perceived communication consequences. Prior experience influenced benefit: New hearing aid users demonstrated the greatest magnitude of benefit, but even previously satisfied and dissatisfied users obtained significant benefit after new hearing aid fitting. Duration of experience did not have a remarkable effect on the magnitude of benefit: All groups with various durations of experience obtained comparable benefit. Severity of the baseline scores paralleled degree of hearing impairment when impairment was defined using a better ear pure tone average at 1,000, 2,000, 3,000, and 4,000 Hz. Also, severity of perceived communication consequences paralleled poorer monosyllabic word recognition. Hearing aid treatment provided a functional, robust, and statistically significant benefit to individuals in all categories of hearing impairment (normal, mild, moderate, severe, and profound). This report demonstrates the feasibility of the SAC-Hx as a tool to efficiently assess outcome domains in hearing aid fitting.

Benefit of adding pioglitazone to statin therapy in non-diabetic patients with the metabolic syndrome.

Statins frequently do not control all of the lipid abnormalities found in patients with the metabolic sydrome. Pioglitizone (PIO), an insulin sensitizing agent, has been shown to have favorable lipid effects in diabetic patients. Little information is available regarding the effect of combined statin and PIO therapy in non-diabetic patients with the metabolic syndrome. We report our experience of adding PIO to statin therapy in non-diabetic patients with the metabolic syndrome. Pioglitazone was administered to 24 non-diabetic patients in our lipid clinic who were already on a statin yet continued to have significant lipid abnormalities. All patients had characteristic lipid abnormalities and clinical features of the metabolic syndrome. The treatment period was 59+/-29 (range 7-123) weeks. Lipid profiles, fasting glucose, and alanine aminotransferase were assessed before and at least 6 weeks after pioglitazone was added to statin. Triglyceride levels decreased from 307+/-295mg/dL to 173+/-129mg/dL (P=0.003), non-high-density lipoprotein cholesterol (non-HDL) decreased from 151+/-53mg/dL to 130+/-49mg/dL, (P=0.003), and high-density lipoprotein cholesterol (HDL) levels increased from 42+/-11mg/ dL to 45+/-12mg/dL, (P=0.039). The addition of PIO to statin in non-diabetic patients with metabolic sydrome produced significant additional benefits in the lipid profile over statin monotherapy. Favorable effects were seen in triglycerides, HDL, and non-HDL levels. Study limitations include: this is a small non-blinded observational study in which patients served as their own controls. The duration of combination therapy and type of statin employed were variable.

School children have leading risk factors for cardiovascular disease and diabetes: the Wausau SCHOOL project.

INTRODUCTION: Risk factors for cardiovascular disease and diabetes acquired in childhood commonly persist in later life and are particularly strong predictors of subclinical atherosclerosis in young adults. A rising tide of obesity and other lifestyle-related risk factors threatens to negate much of the success achieved in the prevention and treatment of these diseases. The SCHOOL project (School Children Have Leading Risk Factors for Cardiovascular Disease and Diabetes), was designed to measure the prevalence and magnitude of known risk factors in school-age children in Wausau, Wis. METHODS: Demographic data, anthropomorphic measures, family health history, diet and activity indices, and numerous laboratory measures were collected from a representative sample of students in grades 2, 5, 8, and 11. RESULTS: Clinically important disturbances of lipid metabolism were very common, even in the youngest participants. Of the children studied, 39% had at least 1 lipid abnormality and 22% had 2 or more. Abnormal blood pressure, overweight, and cigarette smoking were present in 29%, 16%, and 11% respectively. While elevated fasting glucose levels were uncommon, insulin resistance was noted in 25% of the sampled population and nearly 50% of sampled children with a body mass index greater than the 85th percentile in this survey. The number of children with multiple risk factors rose dramatically with age. By 11th grade, 38% of those surveyed had 2 or more risk factors and 23% had 3 or more. CONCLUSIONS: Using conservative definitions, significant abnormalities of lipid metabolism and other risk factors for cardiovascular disease and diabetes were common in our children. Risk profiles in older adolescents were worse than in the younger students and similar to what would be expected for adults with known coronary heart disease. In our community there is a growing consensus that we must take advantage of the multiple opportunities that exist to favorably alter the lifestyle patterns that put our children at risk.

Recidivism among spousal abusers: predictions and program evaluation.

The relative effectiveness of two interventions for dealing with 200 court-referred spousal abusers is examined. The overall failure rate is 17.5%, with most recidivism occurring during the first 6 months after treatment. Offenders who completed a 14-week group treatment program called SAFE manifest significantly lower rates of recidivism (10.6%) than do offenders who did not complete the mandated treatment (38.8%). Some high-risk clients are referred to a cognitive restructuring treatment program called R&R, and those completing both programs (despite their high-risk status) have a recidivism rate of only 23.5%. Prediction of recidivism is difficult, with the LSI-R scores correctly predicting only 66% of the outcomes, using a cut score of 11.5. The exploration of other predictors is encouraged.

Effect of body mass index on insulin resistance and lipids in prepubertal and postpubertal children: SCHOOL observations.

As part of the School Children Have Early Onset of Leading Risk Factors for Cardiovascular Disease and Diabetes Mellitus (SCHOOL) project, this study examines the effect of elevated body mass index on metabolic parameters and its relationship to insulin resistance in prepubertal and postpubertal students from the Wausau School District in central Wisconsin. Two hundred forty-seven nondiabetic students were randomly selected (125 prepubertal [2nd graders] and 122 postpubertal [11th graders]). Waist/hip ratio and body mass index corrected for age and sex were calculated. Fasting insulin, glucose, and nuclear magnetic resonance lipid profiles were measured. Relative insulin resistance was defined as quantitative insulin sensitivity check index > 1 SD below the mean of normal-weight children. Twenty-eight percent of 2nd graders and 33% of 11th graders were overweight. Relative insulin resistance was present in 47% of overweight 2nd graders and 51 % of overweight 11th graders and was associated with higher triglycerides, lower high-density lipoprotein, smaller low-density lipoprotein particles and, in 11th graders, higher waist/hip ratio. Relative insulin resistance prevalence is high among overweight children and adolescents. Biomarkers of increased risk of adverse cardiovascular outcomes are already present in overweight school children.

Detecting symptom- and test-coached simulators with the test of memory malingering.

The ability of the Test of Memory Malingering (TOMM; Tombaugh, 1996) to detect feigned-memory impairment was explored. The TOMM was administered to three groups: (a) a control group instructed to perform optimally, (b) a symptom-coached group instructed to feign memory problems after being educated about traumatic brain injury symptomatology, and (c) a test-coached group instructed to feign memory problems after being educated about test-taking strategies to avoid detection. The recommended cutoff scores (Tombaugh, 1996) on Trial 2 and the Retention Trial produced overall classification accuracy rates of 96%, with high levels of sensitivity and specificity. Although the symptom-coached group performed more poorly on the TOMM relative to the test-coached group, the test was equally sensitive in detecting suboptimal effort across the different coaching paradigms.

The Rey AVLT Serial Position Effect: a useful indicator of symptom exaggeration?

This investigation explored the usefulness of serial position patterns during word recall on the Rey Auditory Verbal Learning Test (RAVLT; Rey, 1964) as an indicator of poor effort. Significantly better recall for early (primacy) and recent (recency) material defines the serial position effect (SPE; Rundus, 1971). The SPE on the RAVLT was examined in four groups: normal controls (NC), symptom-coached simulators (SC), test-coached simulators (TC), and a group of moderate to severe subacute traumatic brain injury (TBI) patients. Normal control participants and TBI patients demonstrated the expected SPE. Only the SC simulators clearly suppressed the primacy effect. The SPE appears neither sensitive nor specific enough to be used independently of more sensitive symptom validity tests in the detection of suboptimal effort. It may be especially problematic when used with clients presenting with sophisticated styles of exaggeration and in settings with lower base rates of compromised effort.