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Early Identification (early + identification)
Selected AbstractsEarly identification of non-remission in first-episode psychosis in a two-year outcome studyACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2010E. Simonsen Simonsen E, Friis S, Opjordsmoen S, Mortensen EL, Haahr U, Melle I, Joa I, Johannessen JO, Larsen TK, Røssberg JI, Rund BR, Vaglum P, McGlashan TH. Early identification of non-remission in first-episode psychosis in a two-year outcome study. Objective:, To identify predictors of non-remission in first-episode, non-affective psychosis. Method:, During 4 years, we recruited 301 patients consecutively. Information about first remission at 3 months was available for 299 and at 2 years for 293 cases. Symptomatic and social outcomes were assessed at 3 months, 1 and 2 years. Results:, One hundred and twenty-nine patients (43%) remained psychotic at 3 months and 48 patients (16.4%) remained psychotic over 2 years. When we compared premorbid and baseline data for the three groups, the non-remitted (n = 48), remitted for <6 months (n = 38) and for more than 6 months (n = 207), duration of untreated psychosis (DUP) was the only variable that significantly differentiated the groups (median DUP: 25.5, 14.4 and 6.0 weeks, respectively). Three months univariate predictors of non-remission were being single, longer DUP, core schizophrenia, and less excitative and more negative symptoms at baseline. Two-year predictors were younger age, being single and male, deteriorating premorbid social functioning, longer DUP and core schizophrenia. In multivariate analyses DUP, negative and excitative symptoms predicted non-remission at 3 months, but only DUP predicted at 2 years. Conclusion:, Long DUP predicted both 3 month and 2-year non-remission rates in first-episode psychosis. [source] Diagnostic Accuracy of Handheld Echocardiography for Evaluation of Aortic StenosisECHOCARDIOGRAPHY, Issue 5 2010Arnd Schaefer M.D. Background: Symptomatic severe aortic stenosis is associated with increased mortality and morbidity. Early identification of these patients by echocardiography is crucial. We conducted this study to evaluate a handheld ultrasound device (HCU) in patients with suspected severe aortic stenosis (AS) in comparison to a standard echocardiography device (SE). Methods: A HCU (Vivid I; GE Healthcare) and a SE device (Philips iE 33) were used to evaluate 50 consecutive patients with suspected severe AS. Two consecutive echocardiographic studies were performed by two experienced and blinded examiners using HCU and SE device. AS was graded by mean transaortic pressure, aortic valve area (AVA), and indexed AVA (AVA adjusted for body surface area). Results: Mean difference for mean transaortic gradient, AVA and indexed AVA for the SE and HCU device were 1.28 mmHg (,0.70 to 3.26 mmHg), ,0.02 cm2 (,0.06 to 0.01 cm2), and ,0.01 cm2/m2 (,0.03 to 0.01 cm2/m2), respectively. Discrepancies between both devices were not associated with misinterpretation of the degree of AS. Conclusion: Our study demonstrates that HCU can be used to evaluate patients with suspected AS. (ECHOCARDIOGRAPHY 2010;27:481-486) [source] Screening for fetal alcohol syndrome: is it feasible and necessary?ADDICTION BIOLOGY, Issue 2 2000Larry Burd The potential to utilize screening strategies to improve the identification and outcome of persons with fetal alcohol syndrome (FAS) is reviewed. FAS is a condition where screening and surveillance activities would be appropriate. Development of FAS screening and surveillance programs is encouraged because the disorder is expensive. People with FAS have poor outcomes as adults with less than 10% living independently. Several useful tools and models are available. Screening would improve ascertainment and prevalence estimates. Early identification could improve access to services and long term outcome, secondary disabilities and, by extension, excess disability in affected children could be decreased. Lastly, mothers who are at the highest risk to have additional children with FAS could be identified and offered treatment. While both screening and surveillance activities are discussed, the principle focus of this article is a review of the screening process. Two screening tools and several screening methodologies for FAS are available. Since no test will be appropriate in all settings, screening tests need to be selected depending on the setting and population of interest. Screening for FAS should be conducted in a variety of settings and in populations of both high and moderate risk. The results would also provide important data to influence public policy development and resource allocation. Appropriate evaluation of the efficacy, efficiency and effectiveness of FAS screening tools and methodologies would be important before utilization in screening programs. [source] The Colorado Haemophilia Paediatric Joint Physical Examination Scale: normal values and interrater reliabilityHAEMOPHILIA, Issue 1 2007M. R. HACKER Summary., ,Persons with haemophilia often experience their first joint haemorrhage in early childhood. Recurrent bleeding into a joint may lead to significant morbidity, specifically haemophilic arthropathy. Early identification of the onset and progression of joint damage is critical to preserving joint structure and function. Physical examination is the most feasible approach to monitor joint health. Our group developed the Colorado Haemophilia Paediatric Joint Physical Examination Scale to identify earlier signs of joint degeneration and incorporate developmentally appropriate tasks for assessing joint function in young children. This study's objectives were to establish normal ranges for this scale and assess interrater reliability. The ankles, knees and elbows of 72 healthy boys aged 1 through 7 years were evaluated by a physical therapist to establish normal ranges. Exactly 10 boys in each age category from 2 to 7 years were evaluated by a second physical therapist to determine interrater reliability. The original scale was modified to account for the finding that mild angulation in the weight-bearing joints is developmentally normal. The interrater reliability of the scale ranged from fair to good, underscoring the need for physical therapists to have specific training in the orthopaedic assessment of very young children and the measurement error inherent in the goniometer. Modifications to axial alignment scoring will allow the scale to distinguish healthy joints from those suffering frequent haemarthroses. [source] Early change in bilirubin levels is an important prognostic factor in severe alcoholic hepatitis treated with prednisoloneHEPATOLOGY, Issue 6 2003Philippe Mathurin M.D. Early identification of patients with severe (discriminant function ,32) biopsy-proven alcoholic hepatitis (AH) who are not responding to corticosteroids would be clinically relevant. Our goal was to develop simple criteria that will help physicians to promptly identify nonresponders to corticosteroids. A total of 238 patients were included. We used 6 months survival as an end point because of the rule requiring 6 months for listing alcoholic patients for transplantation. Overall survival at 1 and 6 months was 85% ± 2.3% and 64.3% ± 3.3%, respectively. An early change in bilirubin levels (ECBL) at 7 days (defined as bilirubin level at 7 days lower than bilirubin level on the first day of treatment) was observed in 73% of patients. At 7 days, in patients with ECBL, bilirubin decreased (84 ± 75 ,mol/L [4.94 ± 4.40 mg/dL]), whereas it increased in patients without ECBL (76.5 ± 77 ,mol/L [4.50 ± 4.54 mg/dL], P < .0001). Ninety-five percent of patients with ECBL continued to have improved liver function during treatment. At 6 months, survival of patients with ECBL was significantly higher than that of patients without ECBL, 82.8% ± 3.3% versus 23% ± 5.8%, P < .0001. On multivariate analysis, ECBL, discriminant function and creatinine were independent prognostic variables, and ECBL had the most important prognostic value. In conclusion, ECBL is a very simple predictive factor for identifying nonresponders. A recommendation to discontinue corticosteroids after 7 days in patients without ECBL, suggested by our results, awaits additional confirmation. [source] Early identification of recipients with progressive histologic recurrence of hepatitis C after liver transplantationHEPATOLOGY, Issue 5 2000Raghavakaimal Sreekumar Approximately half of patients undergoing liver transplantation (LT) for hepatitis C virus (HCV) develop histologic evidence of recurrence within the first postoperative year. Early identification of recipients at risk for more severe recurrence of HCV may be useful in selecting patients for antiviral therapy. We determined whether recipients at greatest risk for more severe recurrence of HCV can be identified by pre- and/or early post-LT HCV-RNA levels in serum or tissue. Serum and tissue samples were prospectively collected pre-LT and at 7 days, 4 months, 1 year, and at 3 years posttransplantation from patients undergoing LT for HCV. Hepatitis activity index (HAI) and fibrosis stage (FS) were assessed in all liver biopsies. Forty-seven patients (32 men) were studied. Higher HCV-RNA levels at 4 months post-LT (,109 copies/mL, n = 29) were associated with higher HAI at 1 year and at 3 years post-LT. The HAI seen on protocol biopsies at 4 months correlated significantly with fibrosis stage (FS) at 1 year (r = .56, P , .001) and 3 years (r = .53, P = .002). Higher HCV-RNA levels at 7 days and 4 months post-LT were sensitive (66% and 84%, respectively) and specific (92% and 63%, respectively) in identifying recipients with an HAI greater than 3 at 3 years. Higher pre- and early post-LT HCV-RNA levels are associated with more severe recurrence of HCV. The correlation of early HAI with subsequent FS suggests that higher mean HAI will eventually translate into more advanced stages of fibrosis. Patients at risk for more severe post-LT recurrence of HCV can be identified by early posttransplant HCV-RNA levels. [source] Prevalence and incidence of urinary incontinence of Swiss nursing home residents at admission and after six, 12 and 24 monthsJOURNAL OF CLINICAL NURSING, Issue 18 2008Susi Saxer Aims and objectives., To study the prevalence and incidence of urinary incontinence in a Swiss nursing home population at admission and at six, 12, 18 and 24 months after admission. Background., No prevalence data for urinary incontinence in people older than 65 years living in nursing homes are available in Switzerland and other German-speaking parts of Europe. Prevalence of urinary incontinence elsewhere varies between 49% and 77%. Methods., This is a secondary analysis of the data of the minimum data set of the Resident Assessment Instrument 2.0 in which 2719 residents were assessed. Prevalence rates and incidence were calculated at admission and at six, 12, 18 and 24 months after admission. Special focus was placed on sex- and age-related differences. Results., Prevalence of urinary incontinence was 51·5% (men 51·4%, women 51·5%) and was found to rise with increasing age. At the time of admission, 37% (men 43%, women 34%) were urinary incontinent. The prevalence increased from admission to 24 months after admission. Conclusion., The high prevalence rates indicate the relevance of the problem for residents and caregivers alike. Early identification of individuals likely to become incontinent is crucial in the development of interventions and the prevention of urinary incontinence in this vulnerable population. Relevance to clinical practice., The study provides valuable data about the extent of the problem of urinary incontinence in nursing homes. [source] Impact of Alcohol Exposure After Pregnancy Recognition on Ultrasonographic Fetal Growth MeasuresALCOHOLISM, Issue 5 2006Nancy S. Handmaker Background: More than 3 decades after Jones and Smith (1973) reported on the devastation caused by alcohol exposure on fetal development, the rates of heavy drinking during pregnancy remain relatively unchanged. Early identification of fetal alcohol exposure and maternal abstinence led to better infant outcomes. This study examined the utility of biometry for detecting alcohol-related fetal growth impairment. Methods: We obtained fetal ultrasound measures from routine ultrasound examinations for 167 pregnant hazardous drinkers who were enrolled in a brief alcohol intervention study. The fetal measures for women who quit after learning of their pregnancies were compared with measures for women who continued some drinking throughout the course of their pregnancies. Because intensity of alcohol consumption is associated with poorer fetal outcomes, separate analyses were conducted for the heavy (average of ,5 drinks per drinking day) alcohol consumers. Fetal measures from the heavy-exposed fetuses were also compared with measures from a nondrinking group that was representative of normal, uncomplicated pregnancies from our clinics. Analyses of covariance were used to determine whether there were differences between groups after controlling for influences of gestational age and drug abuse. Results: Nearly half of the pregnant drinkers abstained after learning of their pregnancies. When women reportedly quit drinking early in their pregnancies, fetal growth measures were not significantly different from a non,alcohol-exposed group, regardless of prior drinking patterns. Any alcohol consumption postpregnancy recognition among the heavy drinkers resulted in reduced cerebellar growth as well as decreased cranial to body growth in comparison with women who either quit drinking or who were nondrinkers. Amphetamine abuse was predictive of larger cranial to body growth ratios. Conclusions: Alterations in fetal biometric measurements were observed among the heavy drinkers only when they continued drinking after becoming aware of their pregnancies. Although the reliance on self-reported drinking is a limitation in this study, these findings support the benefits of early abstinence and the potential for ultrasound examinations in the detection of fetal alcohol effects. [source] Use of ultrasonography to facilitate surgical removal of non-enteric foreign bodies in 17 dogsJOURNAL OF SMALL ANIMAL PRACTICE, Issue 8 2004K. L. Staudte Plant material foreign bodies may cause vague clinical signs at the time of initial presentation but can progress to cause persistent or recurrent abscessation, sinus tract formation and debilitating disease, due to migration of the foreign body, severe tissue reaction and secondary infection. Ultrasonography is a non-invasive technique that can be used to identify precisely the presence, location and size of radiolucent foreign bodies. Early identification of foreign bodies using ultrasonography facilitates surgical retrieval before further migration and tissue injury occur. This paper reviews the ultrasonographic findings and outcome in 17 dogs with non-enteric, radiolucent, plant material foreign bodies. [source] Alcohol Use Disorders Among Emergency Department,Treated Older Adolescents: A New Brief Screen (RUFT-Cut) Using the AUDIT, CAGE, CRAFFT, and RAPS-QFALCOHOLISM, Issue 5 2004Thomas M. Kelly Abstract: Background: Early identification of alcohol use disorders (AUD) among emergency department (ED)-treated patients is important for facilitating intervention and further evaluation outside EDs. A number of brief screening instruments have been developed for identifying patients with AUD, but it is not clear whether they are practical and perform well with older adolescents in an ED setting. This study contrasted four brief screening instruments for detecting DSM-IV,defined AUD and tested a newly developed brief screen for use among ED-treated older adolescents. Methods: The Alcohol Use Disorders Identification Test (AUDIT), the CAGE, the CRAFFT, and a modified RAPS-QF were given to 93 alcohol-using older adolescents (55% men; aged 18,20 years) in an ED. Receiver operator characteristic analyses were used to evaluate the performance of brief screens against the criterion of a lifetime DSM-IV alcohol abuse or dependence diagnosis. Results: Of existing instruments, the AUDIT had the best overall performance in identifying AUD (sensitivity, 82%; specificity, 78%). A new, shorter screening instrument composed of two AUDIT items, two CRAFFT items, and one CAGE item (RUFT-Cut) performed as well as the AUDIT (sensitivity, 82%; specificity, 78%). Conclusions: Among existing alcohol screening instruments, the AUDIT performed best for identifying ED-treated older adolescents with alcohol use disorders. The RUFT-Cut is a brief screening instrument for AUD that shows promise for identifying ED-treated older adolescents who are in need of intervention or further evaluation. Future research should focus on use of the RUFT-Cut in other settings with larger, more diverse samples of adolescents. [source] Preventing Pediatric Obesity: Assessment and Management in the Primary Care SettingJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 2 2002FAANP, Lorna Schumann PhD Purpose To review the literature on and discuss the role of the primary care provider in assessing and managing overweight children before they become obese. Data Sources Selected research, national guidelines and recommendations, and the professional experience of the authors. Conclusions The focus of primary care involves early detectionand family interventions that are designed for lifestyle modifications, specifically for improved nutrition and an increase in regular physical activity, to achieve optimal child health. Early identification and management of children who exceed a healthy weight for height, gender, and age will prevent the increasing incidence of pediatric obesity. Early prevention and management of pediatric overweight and obesity will also decrease the potential for associated medical and psychosocial problems. Implications For Practice Pediatric obesity has risen dramatically in the United States during the last two decades; it is a significant child health problem that is preventable and largely under-diagnosed and under-treated. It is essential to discuss prevention of obesity with parents at every well-child visit; treatment should be initiated when patterns of weight gain exceed established percentiles for increasing height for age and gender. [source] Early identification of haemodynamic response to pharmacotherapy is essential for primary prophylaxis of variceal bleeding in patients with ,high-risk' varicesALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 1 2009P. SHARMA Summary Background, A beta-blocker is recommended for primary prophylaxis of variceal bleeding; however, only one-third have hepatic venous pressure gradient (HVPG) response. The role of addition of isosorbide-5-mononitrate (ISMN) to beta-blocker and benefits of HVPG-guided ,a la carte' approach remain unclear. Aim, To determine the benefits of HVPG-guided pharmacotherapy in primary prophylaxis of variceal bleeding using beta-blocker and ISMN. Patients and methods, Consecutive patients of cirrhosis, with high-risk varices, with no previous variceal bleeding were included. After baseline HVPG, patients received incremental propranolol to achieve HR of 55/min. After one-month, HVPG was repeated to determine response (<12 mmHg or ,20% reduction). ISMN was added in nonresponders and HVPG repeated. Patients were followed up for 24 months. Results, Of 56 patients (age 47 ± 13, males 79%) from 89 eligible patients, 21 (38%) responded to beta-blocker alone. Six additional patients responded to combination. Thus, overall 48% (27/56) patients responded. Variceal bleeding occurred in seven of 56 (13%) patients [one of 27 (4%) responder, five of 23 (22%) nonresponders and one of six (17%) with unknown response; P = N.S.]. The actuarial probability of variceal bleeding at median 24 months was 4% in responders and 22% in nonresponders (P < 0.05). Ten (18%) patients developed adverse effects to propranolol and six of 35 (17%) to nitrates requiring dose reduction. Risk factors of variceal bleed were grade IV varices and haemodynamic nonresponse. Conclusions, For primary prophylaxis, a beta-blocker is effective in 38% and addition of ISMN raises the response rate to about half of patients. The HVPG-guided ,a la carte' approach may be considered for these patients. [source] Molecular identification and characterization of rifampicin-resistant Mycobacterium tuberculosis isolates by line probe assay: an approach for rapid diagnosis of multidrug-resistant tuberculosisLETTERS IN APPLIED MICROBIOLOGY, Issue 3 2008C. Bicmen Abstract Aim:, Early identification and characterization of rifampicin-resistant (Rr) Mycobacterium tuberculosis isolates recovered from the samples of tuberculosis (TB) patients in the Aegean (West Anatolian) Region was intended. Methods and Results:, Sixty isolates [47 (78·3%) multidrug-resistant (MDR)], which were identified as M. tuberculosis complex and phenotypically resistant to rifampicin by both BACTEC mycobacteria growth indicator tube (MGIT) 960 and 460 systems were analysed by a commercial line probe assay (INNO-LiPA Rif TB). The concordance of LiPA with the in vitro susceptibility test was found as 98·3%. Among the isolates, S531L (R5 pattern; 46·7%) and L511P/R, S512T, Q513L/K (,S1 pattern; 11·7%) were the most frequent mutation patterns. As compared with the BACTEC systems and conventional techniques for cultivation, identification and in vitro susceptibility testing, INNO-LiPA Rif TB after cultivation in BACTEC MGIT 960 system provided an average of 20 days early diagnosis of RrM. tuberculosis isolates. Conclusions:, Rapid molecular identification and characterization of RrM. tuberculosis isolates after BACTEC MGIT 960 cultivation would be useful for faster diagnosis, infection control and planning of accurate treatment in MDR-TB patients. Significance and Impact of the Study:, Patients with MDR-TB need a specified treatment and efficient follow-up strategies. Rapid and practical methodologies to diagnose and follow these patients should be applied in routine use. [source] Early identification of ,at-risk' students by the parents of paediatric patientsMEDICAL EDUCATION, Issue 9 2005Maree O'Keefe Introduction, Assessment of medical student clinical skills is best carried out using multiple assessment methods. A programme was developed to obtain parent evaluations of medical student paediatric interview skills for feedback and to identify students at risk of poor performance in summative assessments. Method, A total of 130 parent evaluations were obtained for 67 students (parent participation 72%, student participation 58%). Parents completed a 13-item questionnaire [Interpersonal Skills Rating Scale (IPS) maximum score 91, higher scores = higher student skill level]. Students received their individual parent scores and de-identified class mean scores as feedback, and participants were surveyed regarding the programme. Parent evaluation scores were compared with student performance in formative and summative faculty assessments of clinical interview skills. Results, Parents supported the programme and participating students valued parent feedback. Students with a parent score that was less than 1 standard deviation (SD) below the class mean (low IPS score students) obtained lower faculty summative assessment scores than did other students (mean ± SD, 59% ± 5 versus 64% ± 7; P < 0.05). Obtaining 1 low IPS score was associated with a subsequent faculty summative assessment score below the class mean (sensitivity 0.38, specificity 0.88). Parent evaluations combined with faculty formative assessments identified 50% of students who subsequently performed below the class mean in summative assessments. Conclusions, Parent evaluations provided useful feedback to students and identified 1 group of students at increased risk of weaker performance in summative assessments. They could be combined with other methods of formative assessment to enhance screening procedures for clinically weak students. [source] Responding to the crisis: RALLY's developmental and relational approachNEW DIRECTIONS FOR YOUTH DEVELOPMENT, Issue 120 2008Gil G. Noam The authors introduce the RALLY (Responsive Advocacy for Life and Learning in Youth) approach. RALLY is a school- and afterschool-based approach addressing academic success, youth development, and mental health for youth. Based on developmental and relational principles, RALLY's main goals are to promote students' resiliency, development, and academic functioning, as well as to reduce the typical adolescent's risks. By implementing a new professional role of RALLY practitioners, who are developmental specialists and interconnect the different social worlds of students, RALLY creates the resources to provide social opportunities and quality practices to meet students' needs and facilitate their growth. A three-tiered system helps to implement mental health and educational practice, thus providing differential support for students with different needs. Early identification of risks and resiliencies helps to avoid chronicity and pinpoint adequate treatments as soon as possible. [source] Fetal alcohol syndrome and developing craniofacial and dental structures , a reviewORTHODONTICS & CRANIOFACIAL RESEARCH, Issue 4 2006LB Sant'Anna Structured abstract Authors ,, Sant'Anna LB, Tosello DO Objectives ,, Fetal alcohol syndrome (FAS) is a collection of signs and symptoms seen in children exposed to alcohol in the prenatal period. It is characterized mainly by a distinct pattern of craniofacial malformations, physical and mental retardation. However, with the increased incidence of FAS, there is a great variation in the clinical features of FAS. Design ,, Narrative review. Results ,, This review describes data from clinical and experimental studies, and in vitro models. Experimental studies have shown that alcohol has a direct toxic effect on the ectodermal and mesodermal cells of the developing embryo, particularly in the cells destined to give rise to dentofacial structures (i.e. cranial neural crest cells). Other effects, such as, abnormal pattern of cranial and mandibular growth and altered odontogenesis are described in detail. The exact mechanism by which alcohol induces its teratogenic effects remains still unknown. The possible mechanisms are outlined here, with an emphasis on the developing face and tooth. Possible future research directions and treatment strategies are also discussed. Conclusion ,, Early identification of children affected by prenatal alcohol exposure leads to interventions, services, and improved outcomes. FAS can be prevented with the elimination of alcohol consumption during pregnancy. We need to provide education, target high-risk groups, and make this issue a high priority in terms of public health. [source] The Mechanism of Hearing Loss in Paget's Disease of Bone,THE LARYNGOSCOPE, Issue 4 2004Edwin M. Monsell MD Abstract Objectives/Hypothesis The mechanism of hearing loss (HL) in Paget's disease of bone was investigated. The present study was a systematic, prospective, controlled set of clinical investigations to test the hypothesis that there is a general underlying mechanism of HL in Paget's disease of bone and to gain additional insights into the auditory and otologic dynamics of this disease. Specific questions were 1) whether the mechanism is cochlear or retrocochlear and 2) whether the bone mineral density of the cochlear capsule is related to hearing levels. Study Design Several double-blinded, cross-sectional, prospective, correlational studies were conducted in a population of elderly human subjects with skull involvement with Paget's disease versus a control population of elderly subjects free of Paget's disease. Demographic and clinical data were recorded. Longitudinal observations were made in subjects under treatment. Methods Subjects were recruited from a Paget's disease clinic. Pure-tone auditory thresholds, word recognition, and auditory brainstem responses (ABRs) were recorded. The dimensions of the internal auditory canals were measured using computed tomographic (CT) images and digital image analysis. The precision, accuracy, and temporal stability of methods to measure the bone mineral density of the cochlear capsule and an adjacent area of nonotic capsule bone were validated and applied. Correlations were sought between hearing levels and cochlear capsule bone mineral density. Results ABRs were recorded in 64 ears with radiographically confirmed Paget's disease involving the skull. Responses were absent in eight ears, all of which had elevated high pure-tone thresholds. ABRs were interpreted as normal in 56 ears; none were abnormal. The mid-length diameter and minimum diameter of the internal auditory canal of 68 temporal bones from subjects with Paget's disease were found to have no statistically significant relationship to hearing thresholds. The Pearson product-moment correlation coefficients (age- and sex-adjusted) in the group with Paget's disease involving the temporal bone were ,0.63 for left ears and ,0.73 for right ears for high-frequency air conduction pure-tone thresholds (mean of 1, 2, and 4 kHz) versus cochlear capsule density. Correlation coefficients (age- and sex-adjusted) between cochlear capsule density and air-bone gap (mean at 0.5 and 1 kHz) for the affected group were ,0.67 for left ears and ,0.63 for right ears. All correlations between hearing thresholds and cochlear capsule density in pagetic subjects were significant at P < .001. The regressions were consistent throughout the ranges of hearing level. There were no significant correlations between cochlear capsule mean density and hearing level in the volunteer subjects. Conclusions The evidence supports the existence of a general, underlying, cochlear mechanism of pagetic HL that is closely related to loss of bone mineral density in the cochlear capsule. This mechanism accounts well for both the high-frequency sensorineural HL and the air-bone gap. Early identification, radiographic diagnosis of temporal bone involvement, and vigorous treatment with third-generation bisphosponates are important to limit the development and progression of pagetic HL. [source] Telomere length predicts poststroke mortality, dementia, and cognitive declineANNALS OF NEUROLOGY, Issue 2 2006Carmen Martin-Ruiz PhD Objective Long-term cognitive development is variable among stroke survivors, with a high proportion developing dementia. Early identification of those at risk is highly desirable to target interventions for secondary prevention. Telomere length in peripheral blood mononuclear cells was tested as prognostic risk marker. Methods A cohort of 195 nondemented stroke survivors was followed prospectively from 3 months after stroke for 2 years for cognitive assessment and diagnosis of dementia and for 5 years for survival. Telomere lengths in peripheral blood mononuclear cells were measured at 3 months after stroke by in-gel hybridization. Hazard ratios for survival in relation to telomere length and odds ratios for dementia were estimated using multivariate techniques, and changes in Mini-Mental State Examination scores between baseline and 2 years were related to telomere length using multivariate linear regression. Results Longer telomeres at baseline were associated with reduced risk for death (hazard ratio for linear trend per 1,000bp = 0.52; 95% confidence interval, 0.28,0.98; p = 0.04, adjusted for age) and dementia (odds ratio for linear trend per 1,000bp = 0.19; 95% confidence interval, 0.07,0.54; p = 0.002) and less reduction in Mini-Mental State Examination score (p = 0.04, adjusted for baseline score). Interpretation Telomere length is a prognostic marker for poststroke cognitive decline, dementia, and death. Ann Neurol 2006 [source] Time use, parenting practice and conduct problems in four- to five-year-old Australian childrenAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 5 2010Mong-Lin Yu Background:, Conduct problems (CoP) represent one of the most common mental health issues manifesting in childhood, with the potential to influence the developmental trajectory of children negatively. Early identification of children at risk of developing CoP is a key strategy to their effective management. Evidence suggests that parenting practices are important contributors to CoP; however, these practices can also interact with the activities in which children engage and these have not yet been addressed in combination. Method:, A cross-sectional study of a nationally representative sample of 4936 four- to five-year-old children from Wave 1 of the Longitudinal Study of Australian Children was undertaken to examine the relationship between CoP, parenting practices and time use. Results:, All children were at a lower risk of CoP if they were exposed to less hostile and consistent parenting practices and if they did not have sleep problems as reported by their parents. However, boys were more vulnerable if they had fathers who had not undertaken tertiary education, and spent more time in risk-oriented physical activities. Conclusion:, Parenting practices are affirmed as a significant independent predictor of risk for developing CoP. The nature of activities in which children engaged, particularly boys, also has the potential to influence the manifestation of CoP. Occupational therapy services for children with CoP are best provided in the context of family-centred practice and should incorporate an examination of daily time use. [source] Early identification of special educational needs and the definition of ,at risk': The Early Years Transition and Special Educational Needs (EYTSEN) ProjectBRITISH JOURNAL OF SPECIAL EDUCATION, Issue 1 2006Brenda Taggart Education in the early years is a key element in the Government's current strategy. Recently, the Department for Education and Skills (DfES) funded a major study of Effective Provision of Pre-School Education (EPPE). The Early Years Transition and Special Educational Needs (EYTSEN) Project developed from the EPPE research and was also funded by the DfES. The authors of this article, Brenda Taggart, Pam Sammons, Rebecca Smees, Kathy Sylva, Edward Melhuish, Iram Siraj-Blatchford, Karen Elliott and Ingrid Lunt, all worked on the EYTSEN Project, based at the Institute of Education, University of London. In this article, they provide a summary of the findings from the EYTSEN Project, reviewing the impact of pre-school provision on children said to be ,at risk' of developing special educational needs. They suggest that pre-school experience has a positive impact on cognitive attainment and social or behavioural development and that integrated centres (where education and care are fully combined) and nursery schools have the most positive influence among the different f o rms of pre-school provision. This paper also discusses the identification of special educational needs; quality in pre-school centres; parents' perspectives; and future developments. The article closes with a call for improved training for practitioners working in early years settings. [source] Utility of Base Deficit for Identifying Major Injury in Elder Trauma PatientsACADEMIC EMERGENCY MEDICINE, Issue 9 2007Shahriar Zehtabchi MD Background: Early identification of serious injuries is especially important in elders. Base deficit (BD) is an indicator of serious injury in trauma patients. There are limited data to support the utility of BD in elders who have sustained trauma. Objectives: To assess the diagnostic performance of BD in identifying major injury in elders. Methods: This was a prospective, observational, preliminary study. Elder (age 65 years and older) patients with significant injury mechanisms had BD analyzed during initial emergency department resuscitation. Major injury was defined by an Injury Severity Score ,15, a decrease in hematocrit of more than ten points, or blood transfusion. Patients were stratified into two groups of minor and major injuries. Data were reported as means (±SD). Receiver operating characteristic (ROC) curves tested the diagnostic ability of BD to identify major injury. Results: Seventy-four patients were enrolled; the mean (±SD) age was 75 (±7) years, and 57% were male. Twenty-four patients (32%) had major injury. The mean (±SD) for BD in the major injury group (,2.9 [±6] mmol/L) was significantly different from that in the minor injury group (0.8 [±3] mmol/L), with a mean difference of 3.7 (95% confidence interval = 1.4 to 5.9). ROC curves revealed that BD was able to identify major injury in elder patients (area under the ROC curve, 0.72; 95% confidence interval = 0.60 to 0.85; p = 0.0003). Conclusions: The preliminary data from this study indicate that in trauma patients aged 65 years and older, increased BD at emergency department arrival can predict life-threatening injury. [source] Prevalence of the metabolic syndrome in secondary school adolescents in Beijing, ChinaACTA PAEDIATRICA, Issue 3 2008XU Yi-Qun Abstract Aim: To estimate the prevalence and distribution of the metabolic syndrome and to determine the risk factors associated with the metabolic syndrome in secondary school adolescents. Methods: In 2006, we conducted a school-based survey in Beijing, China. Questionnaire data, anthropometric, blood pressure, and biochemical measurements were available for 2020 adolescents aged 14,16 years. The metabolic syndrome was assessed using the National Cholesterol Education Program's (NCEP) Adult Treatment Panel (ATP) criteria modified for age. Results: The overall prevalence of the metabolic syndrome among adolescents was 3.3%. In Beijing, 4.2% of boys and 2.5% of girls were affected (p < 0.05). The syndrome was present in 28.1% of obese adolescents compared with 6.0% of overweight and 0.2% of normal status (p < 0.001). Abdominal obesity and elevated blood pressure were the most common components of the metabolic syndrome in boys, and elevated triglyceride (TG) and abdominal obesity were the most common in girls. The prevalence of the metabolic syndrome was influenced by body mass index (BMI) status, father's educational degree and pubertal development. Conclusion: The metabolic syndrome and its components are frequent in overweight and obese adolescents in Beijing. Early identification and treatment of these risk factors may help target intervention to improve future cardiovascular health. [source] Cardiac troponin T Arg92Trp mutation and progression from hypertrophic to dilated cardiomyopathyCLINICAL CARDIOLOGY, Issue 5 2001Noboru Fujino M.D. Abstract Background: Mutations in the cardiac troponin T gene causing familial hypertrophic cardiomyopathy (HCM) are associated with a very poor prognosis but only mild hypertrophy. To date, the serial morphologic changes in patients with HCM linked to cardiac troponin T gene mutations have not been reported. Hypothesis: The aim of this study was to determine the long-term course of patients with familial HCM caused by the cardiac troponin T gene mutation, Arg92Trp. Results: The Arg92Trp missense mutation was present in 10 individuals from two unrelated pedigrees. They exhibited different cardiac morphologies: three had dilated cardiomyopathy-like features, five had asymmetric septal hypertrophy with normal left ventricular systolic function, one had electrocardiographic abnormalities without hypertrophy, and one had the disease-causing mutation but did not fulfill the clinical criteria for the disease. The mean maximum wall thickness was 14.1 ± 6.0 mm. The three patients with dilated cardiomyopathy-like features had progressive left ventricular dilation. Three individuals underwent right ventricular endomyocardial biopsy. There was a modest degree of myocardial hypertrophy (myocyte diameter: 18.9 ± 5.2 m,m), and minimal myocardial disarray and mild fibrosis were noted. Conclusion: The Arg92Trp substitution in the cardiac troponin T gene shows a high degree of penetrance, moderate hypertrophy, and early progression to dilated cardiomyopathy in Japanese patients. Early identification of individuals with this mutation may provide the opportunity to evaluate the efficacy of early therapeutic interventions. [source] Is it time to reconsider initial antibiotic treatment strategies for severe urinary tract infections in Europe?CLINICAL MICROBIOLOGY AND INFECTION, Issue 3 2007J. R. Zahar Abstract Until recently, most reported cases of bacteraemia caused by multidrug-resistant strains of Enterobacteriacae producing an extended-spectrum ,-lactamase (ESBL) in Europe have been nosocomial in origin. However, increasing numbers of reports of community-acquired bacteraemia and urinary tract infection caused by ESBL-producing microorganisms suggest that the geographical origin of patients should be taken into account as a risk-factor for possible ESBL production. Early identification of patients at high-risk of infection with ESBL-producing microorganisms, based on their geographical origin and travel history, should help to optimise initial antibiotic treatment strategies for severe urinary tract infections in Europe. [source] Changes in left ventricular ejection time and pulse transit time derived from finger photoplethysmogram and electrocardiogram during moderate haemorrhageCLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 3 2009Paul M. Middleton Summary Objectives:, Early identification of haemorrhage is difficult when a bleeding site is not apparent. This study explored the potential use of the finger photoplethysmographic (PPG) waveform derived left ventricular ejection time (LVETp) and pulse transit time (PTT) for detecting blood loss, by using blood donation as a model of controlled mild to moderate haemorrhage. Methods:, This was a prospective, observational study carried out in a convenience sample of blood donors. LVETp, PTT and R-R interval (RRi) were computed from simultaneous measurement of the electrocardiogram (ECG) and the finger infrared photoplethysmogram obtained from 43 healthy volunteers during blood donation. The blood donation process was divided into four stages: (i) Pre-donation (PRE), (ii) first half of donation (FIRST), (iii) second half of donation (SECOND), (iv) post-donation (POST). Results and conclusions:, Shortening of LVETp from 303+/,2 to 293+/,3 ms (mean+/,SEM; P<0·01) and prolongation of PTT from 177+/,3 to 186+/,4 ms (P<0·01) were observed in 81% and 91% of subjects respectively when comparing PRE and POST. During blood donation, progressive blood loss produced falling trends in LVETp (P<0·01) and rising trends in PTT (P<0·01) in FIRST and SECOND, but a falling trend in RRi (P<0·01) was only observed in SECOND. Monitoring trends in timing variables derived from non-invasive ECG and finger PPG signals may facilitate detection of blood loss in the early phase. [source] Severe personality disorder emerging in childhood: a proposal for a new developmental disorderCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 1 2004Eileen Vizard Background The concept of ,severe personality disorder' is currently applied to adults with a history of serious antisocial and offending behaviour. There is, however, no similar classification that can be applied to the sub-group of children and adolescents who display persistent and serious offending from an early age. This omission from diagnostic nomenclature prevents the appropriate early identification, assessment and management of these young people. Method This paper therefore proposes a new developmental disorder: ,severe personality disorder emerging in childhood'. The existing evidence base strongly supports the presence of a developmental trajectory from childhood to adult life for the small number of children who show early signs of severe personality disorder (SPD). Based on a review of the literature and the experience of working in a specialist, forensic Child and Adolescent Mental Health Service (CAMHS), a multi-factorial model is proposed that outlines the developmental trajectory of SPD. This model includes neurobiological, psychosocial, environmental and systemic factors, within a developmental framework, and contributes to a more developmentally appropriate understanding of the genesis of severe personality disorder. Copyright © 2004 Whurr Publishers Ltd. [source] The targets of violence committed by young offenders with alcohol dependence, marijuana dependence and schizophrenia-spectrum disorders: findings from a birth cohortCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 2 2002Louise Arseneault Background: Estimates of who is most at risk from violence by people with mental illness rest mainly on identified patient samples. This study, without such selection bias, examined the targets of violence committed by young adults with as-yet untreated alcohol dependence, marijuana dependence, or schizophrenia-spectrum disorders, to determine the extent to which their victims were co-residents or non-household members. Methods: In a total birth cohort of 21-year-olds (n = 956), past-year prevalence of alcohol dependence, marijuana dependence and schizophrenia-spectrum disorders were diagnosed using standardized DSM-III-R interviews. None of the people with schizophrenia-spectrum disorder has been hospitalized in the past year. Past-year violence and victim targets were measured using self-reports. Results: Compared with controls, cohort members with substance dependence or schizophrenia-spectrum disorders had higher prevalence and frequency rates of assault against co-residents, against non-household members, and also robbery and gang fights. Out of 39, five individuals with schizophrenia-spectrum disorder committed violent street crimes. Persons with substance dependence had similar proportions of violence against co-resident and non-household members, but persons with schizophrenia-spectrum disorders tended to victimize co-residents more than others. Conclusions: At the age when they are most likely to contribute to the community's violence burden, young untreated offenders with alcohol or marijuana dependence or with schizophrenia-spectrum disorders assault not only co-residents, but others as well, and commit violent street crimes. Families, schoolteachers and primary care physicians have an important potentially preventive role in early identification and treatment of the disorders. Copyright © 2002 Whurr Publishers Ltd. [source] AN ASSESSMENT OF RECENT TRENDS IN GIRLS' VIOLENCE USING DIVERSE LONGITUDINAL SOURCES: IS THE GENDER GAP CLOSING?CRIMINOLOGY, Issue 2 2005DARRELL STEFFENSMEIER Applying Dickey-Fuller time series techniques in tandem with intuitive plot-displays, we examine recent trends in girls' violence and the gender gap as reported in four major sources of longitudinal data on youth violence. These sources are arrest statistics of the Uniform Crime Reports, victimization data of the National Crime Victimization Survey (where the victim identifies sex of offender) and self-reported violent behavior of Monitoring the Future and National Youth Risk Behavior Survey. We find that the rise in girls' violence over the past one to two decades as counted in police arrest data from the Uniform Crime Reports is not borne out in unofficial longitudinal sources. Several net-widening policy shifts have apparently escalated girls' arrest-proneness: first, stretching definitions of violence to include more minor incidents that girls in relative terms are more likely to commit; second, increased policing of violence between intimates and in private settings (for example, home, school) where girls' violence is more widespread; and, third, less tolerant family and societal attitudes toward juvenile females. These developments reflect both a growing intolerance of violence in the law and among the citizenry and an expanded application of preventive punishment and risk management strategies that emphasize early identification and enhanced formal control of problem individuals or groups, particularly problem youth. [source] Effects of alcohol and smoking during pregnancy on infant autonomic controlDEVELOPMENTAL PSYCHOBIOLOGY, Issue 3 2009William P. Fifer Abstract Prenatal exposure to smoking and alcohol increases the risk for Sudden Infant Death Syndrome (SIDS). Physiological changes associated with these exposures are not well studied. Full-term infants were tested within the first 3 days of life. We hypothesized that maternal alcohol consumption and/or smoking during pregnancy would alter autonomic nervous system function. Newborns whose mothers smoked during pregnancy had lower beat-to-beat heart rate variability in quiet sleep. Infants whose mothers consumed alcohol had lower global heart rate variability, but only in active sleep. Unexposed infants demonstrated increases in heart rate with head-up tilt and decreases in heart rate with head-down tilt, but smoking and alcohol-exposed infants showed no significant responses. These results indicate that autonomic function is altered by prenatal exposure to alcohol and smoking. Such markers may provide early identification of infants at greatest risk for SIDS. © 2009 Wiley Periodicals, Inc. Dev Psychobiol 51: 234,242, 2009 [source] ,Lipoproteins, glycoxidation and diabetic angiopathy'DIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 5 2004Alicia J. Jenkins Abstract The chronic vascular complications of diabetes (nephropathy, retinopathy and accelerated atherosclerosis) are a major cause of morbidity and premature mortality. In spite of the more widespread availability of intensive diabetes management, approximately one in three people with diabetes develop aggressive complications and over 70% die of atherosclerosis-related diseases. Genetic and acquired factors are likely to be contributory. Potential mediators of vascular damage may include the interrelated processes of lipoprotein abnormalities, glycation, oxidation and endothelial dysfunction. Lipoprotein abnormalities encompass alterations in lipid concentrations, lipoprotein composition and subclass distribution and lipoprotein-related enzymes. Nonenzymatic glycation and oxidative damage to lipoproteins, other proteins and to vascular structures may also be deleterious. As atherosclerosis is a chronic condition commencing in youth, and because clinical events may be silent in diabetes, surrogate measures of vascular disease are important for early identification of diabetic patients with or at high risk of vascular damage, and for monitoring efficacy of interventions. The increasing array of biochemical assays for markers and mediators of vascular damage, noninvasive measures of vascular health, and therapeutic options should enable a reduction in the excessive personal and economic burden of vascular disease in type 1 and type 2 diabetes. Copyright © 2004 John Wiley & Sons, Ltd. [source] |