Illicit drug use by persons with disabilities: insights from the National Household Survey on Drug Abuse

OBJECTIVES: This study sought to evaluate the association of drug use with disability in a representative sample of the US household population. METHODS: The use of illicit drugs and alcohol reported by respondents in the 1991 National Household Survey on Drug Abuse who identified themselves as "disabled, unable to work" was compared with respondents without disabilities. RESULTS: Among younger adults (18-24 years), persons with disabilities were more likely than those without disabilities to report that they had used heroin (adjusted odds ratio [OR] = 6.89; 95% confidence interval [CI] = 1.35, 35.1) or crack cocaine (OR = 6.38; 95% CI = 1.05, 38.6). Among older adults (35 years and older), persons with disabilities were more likely to report the use of sedatives (OR = 2.46; 95% CI = 1.21, 4.94) or tranquilizers (OR = 2.18: 95% CI = 1.08; 4.42) not medically prescribed. CONCLUSIONS: These results suggest that use of illicit drugs is a potentially serious problem among persons with disabilities and requires both research and clinical attention.     

Low prevalence of hearing aid use among older adults with hearing loss: the Epidemiology of Hearing Loss Study

OBJECTIVES: To measure the prevalence of hearing aid use among older adults with hearing loss and to identify factors associated with those currently using hearing aids. DESIGN: Population-based cohort study. SETTING: The south-central Wisconsin community of Beaver Dam. PARTICIPANTS: A total of 1629 adults, aged 48 to 92 years, who have hearing loss and are participating in the Epidemiology of Hearing Loss Study and the Beaver Dam Eye Study. MEASUREMENTS: A hearing-related risk factor and medical history questionnaire, the Hearing Handicap Inventory for the Elderly (screening version), screening tympanometry, pure-tone air- and bone-conduction audiometry, and word recognition tests were administered by trained examiners using standard protocols. RESULTS: The prevalence of current hearing aid use among those with a hearing loss (pure-tone average > 25 decibels hearing level over 500, 1000, 2000, and 4000 Hertz, worse ear) was 14.6%. The prevalence was 55% in a subset of the most severely affected participants. In univariate analyses, current hearing aid use was associated with age, severity of loss, word recognition scores, self-reported hearing loss, self-perceived hearing handicap, and history of noise exposure. Factors associated with current hearing aid use in multivariate logistic regression models were age, severity of loss, education, word recognition scores, Hearing Handicap Inventory for the Elderly (screening version) score, and self-report of a hearing loss. CONCLUSIONS: Few older adults with hearing loss are currently utilizing hearing aids. Improved screening and intervention programs to identify older adults who would benefit from amplification are needed to improve hearing-related quality of life for this large segment of the population.     

Risk factors and clinical presentation of acute primary HIV infection in India

CONTEXT: Most previous studies of clinical presentation and risk factors in early human immunodeficiency virus (HIV) infection have relied on retrospective analyses and referred seroconverters, and thus were subject to possible bias. OBJECTIVES: To apply a method based on measurement of prevalent HIV-1 p24 antigenemia for identification of risk factors for newly acquired HIV infection and to describe the signs and symptoms of acute HIV infection. DESIGN AND SETTING: Nested case-control study in Pune, India. PARTICIPANTS: HIV antibody-negative persons attending 2 sexually transmitted disease (STD) clinics between May 1993 and June 1996. OUTCOME MEASURES: Prevalent p24 antigenemia, risk factors for HIV infection, and clinical symptoms of acute primary HIV infection. RESULTS: Of 3874 HIV antibody-negative persons tested, 58 (1.5%) were p24 antigen positive at initial presentation to the clinics. Unprotected sexual contact with a commercial sex worker (CSW) was reported by 39 (77%) of the 51 p24 antigenemic men, compared with 131 (51 %) of 255 control men (adjusted odds ratio [AOR], 3.4; 95% confidence interval [CI], 1.2-9.6; P=.02). The presence of an active genital ulcer at the time of screening was found in 46 (79%) of the 58 p24 antigenemic men and women, compared with 137 (47%) of the 290 control subjects (AOR, 4.2; 95% CI, 2.0-9.0; P<.001). Signs and symptoms independently associated with p24 antigenemia in HIV antibody-seronegative persons included fever, which was reported by 28 (48%) of the 58 p24 antigenemic subjects, but only 52 (18%) of the 290 control subjects (AOR, 4.7; 95% CI, 2.4-9.0; P<.001). Joint pain was reported by 10% of subjects recently HIV infected, compared with 2% of the control subjects (AOR, 6.5; 95% CI, 1.7-24.8; P=.006). Night sweats were reported by 9% of the p24 antigenemic, but only 1% of the control subjects (AOR, 9.1; 95% CI, 1.7-47.6; P=.009). Overall, fever, joint pain, and/or night sweats were reported in 27 (47%) of the 58 subjects with recent HIV infection. CONCLUSIONS: This systematic case-control study of p24 antigen screening in HIV-seronegative patients attending STD clinics in India identified unprotected sex with a CSW and a genital ulcer as independent risk factors associated with newly acquired HIV infection. In addition, p24 antigen positivity identified recent fever, night sweats, and arthralgias as symptoms that may be predictive of recent HIV infection. In a study of patients attending STD clinics in India, screening for p24 antigen in HIV antibody-negative persons was found to be a reliable and effective research method for determining recent risk behavior and identifying clinical signs of acute primary HIV infection.     

Neonatal hyperbilirubinemia and long-term outcome: another look at the Collaborative Perinatal Project

OBJECTIVE: To examine the association between neonatal bilirubin levels and subsequent neurodevelopmental outcome. DESIGN: Prospective cohort study. SETTING: 12 US medical centers from 1959 (first births) to 1974 (last follow-up). PARTICIPANTS: 41,324 singleton white or black infants with birth weight > or = 2500 g who had neonatal bilirubin measurements recorded and survived at least 1 year. MAIN OUTCOME MEASURES: Wechsler Intelligence Scale for Children Intelligence Quotient (IQ) at age 7 years, blinded neurologic examination at age 7 years, and sensorineural hearing loss at age 8 years. RESULTS: There was no association between IQ and bilirubin. For example, comparing children who had maximum bilirubin levels > or = 342 mumol/L (20 mg/dL) with those who had lower bilirubin levels, adjusted mean IQs were 105.0 and 103.4 in whites (difference + 1.6; 95% confidence interval [CI]: -0.4 to +3.5) and 91.0 and 93.3 in blacks (difference -2.3; 95% CI: -4.8 to +0.2). Abnormal neurologic examination results were reported in 12 of 268 children (4.5%) with bilirubin > or = 342 mumol/L (20 mg/dL) compared with 1249 of 33,004 children (3.8%) with lower levels (relative risk [RR] = 1.2; 95% CI: 0.7 to 2.1). The frequency of abnormal or suspicious neurologic examination results increased in a stepwise fashion with increasing bilirubin level (P < .001), from 4346/29,258 (14.9%) of those with bilirubin levels < 171 mumol/L (10 mg/dL) to 60/268 (22.4%) of those with bilirubin levels. > or = 342 mumol/L (20 mg/dL), apparently due to increasing minor motor abnormalities at higher bilirubin levels. Sensorineural hearing loss was not associated with high bilirubin levels (RR = 1.0; 95% CI: 0.3 to 3.0). CONCLUSIONS: Neonatal bilirubin levels seem to have little effect on IQ, definite neurologic abnormalities, or hearing loss. Higher bilirubin levels are associated with minor motor abnormalities, but the clinical importance of this finding is limited by the weakness of the association, the mild nature of the abnormalities, and the lack of evidence that they are prevented by treatment.     

The associations between cervicovaginal HIV shedding, sexually transmitted diseases and immunosuppression in female sex workers in Abidjan, C?te d'Ivoire

OBJECTIVE: To measure the frequency and associated factors of cervicovaginal HIV shedding and to determine the impact of sexually transmitted disease (STD) treatment on HIV shedding. DESIGN: Cross-sectional study with 1-week follow-up. SETTING: Confidential clinic for female sex workers in Abidjan, C?te d'Ivoire. PARTICIPANTS: A total of 1201 female sex workers. INTERVENTIONS: STD treatment based on clinical signs. MAIN OUTCOME MEASURES: HIV serostatus; cervicovaginal HIV shedding at enrollment and at 1-week follow-up; STD status at enrollment and at 1-week follow-up. RESULTS: Cervicovaginal shedding of HIV-1 in HIV-1-seropositive women was more frequent (96 out of 404, 24%) than shedding of HIV-2 in HIV-2-seropositive women [one out of 21, 5%; odds ratio (OR), 6.2; 95% confidence interval (CI), 1.0-261]. Among 609 HIV-1-seropositive or dually seroreactive women, HIV-1 shedding was significantly more frequent in immunosuppressed women [adjusted OR (AOR), 6.3; 95% CI, 3.4-11.9; and AOR, 2.9; 95% CI, 1.6-5.0 for CD4 < 14% and CD4 14-28%, respectively, versus CD4 > 28%], and in women with Neisseria gonorrhoeae (AOR, 1.9; 95% CI, 1.2-3.0), those with Chlamydia trachomatis (AOR, 2.5; 95% CI, 1.1-5.8), and with a cervical or vaginal ulcer (AOR, 3.9; 95% CI, 2.1-7.4). HIV-1 shedding decreased from 42 to 21% (P < 0.005) in women whose STD were cured. CONCLUSIONS: These data help to explain the difference in transmissibility between HIV-1 and HIV-2 and the increased infectiousness of HIV in the presence of immunosuppression and STD. In addition, they lend biological plausibility to arguments for making STD control an integral part of HIV prevention strategies in Africa.     

Breastfeeding, maternal smoking and lower respiratory tract infections

The objective of the study was to assess the relationship between breastfeeding and lower respiratory tract infections (LRTIs) during the first year of life, with special reference to maternal smoking. A cohort of 3,754 children born in 1992-1993 in the City of Oslo, Norway was recruited and data were collected at birth, 6 and 12 months of age. Complete information was obtained from 3,238 children (follow-up rate 86%). The main outcome was an episode of a LRTI, such as pneumonia, bronchitis or bronchiolitis, based on a self-administered questionnaire addressed to parents when the child was 6 and 12 months old. The outcome was specified as physician-diagnosed. In logistic regression analysis adjusting for confounding, maternal smoking increased the risk of LRTIs in children breastfed for 0-6 months (odds ratio (AOR) 1.7; 95% confidence interval (95% CI) 1.2-2.4), but not essentially when the child was breastfed for more than 6 months (AOR 1.1; 95% CI 0.7-1.6). Short-term breastfeeding (0-6 months) and no maternal smoking was related to an adjusted AOR of LRTIs of 1.3 (95% CI 1.0-1.7), and short-term breastfeeding combined with maternal smoking was related to an adjusted AOR of 2.2 (95% CI 1.6-3.1), as compared with long-term breastfeeding and no maternal smoking. The present study indicates a protective effect of long-term breastfeeding on the risk of lower respiratory tract infection during the first year of life. The results suggest that the protective effect is strongest in children exposed to environmental tobacco smoke.     

Effects of depressive symptoms on health behavior practices among older adults with vision loss.

Objective: The authors examined the interface between visual impairment and depressive symptoms on health behaviors, self-care, and social participation among adults ages 65 and older. Method: The authors analyzed data from the 1997–2004 National Health Interview Survey on visual impairment and depressive symptoms for 49,278 adults ages 65 and older, comparing visually impaired adults (n = 8,787) with and without depressive symptoms with a reference group of adults with neither condition (n = 3,136) for outcome measures: physical health, health behaviors, and difficulties with self-care and social participation. Results: Adults with visual impairment and severe depressive symptoms were more likely than adults with neither condition to smoke (14.9%, adjusted odds ratio [AOR] = 1.6), be obese (28.2%, AOR = 1.9), be physically inactive (80.5%, AOR = 3.0), have fair–poor health (76.0%, AOR = 26.5), and have difficulties with self-care (27.9%, AOR = 11.8) and social participation (52.1%, AOR = 10.9). Discussion and Conclusions: Older visually impaired adults with depressive symptoms are vulnerable to health decline and further disablement without timely interventions that target smoking cessation, healthy eating, and increased physical activity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cigarette smoking and hearing loss: the epidemiology of hearing loss study

CONTEXT: Clinical studies have suggested that cigarette smoking may be associated with hearing loss, a common condition affecting older adults. OBJECTIVE: To evaluate the association between smoking and hearing loss. DESIGN: Population-based, cross-sectional study. SETTING: Community of Beaver Dam, Wis. PARTICIPANTS: Adults aged 48 to 92 years. Of 4541 eligible subjects, 3753 (83%) participated in the hearing study. MAIN OUTCOME MEASURES: The examination included otoscopy, screening tympanometry, and pure-tone air-conduction and bone-conduction audiometry. Smoking history was ascertained by self-report. Hearing loss was defined as a pure-tone average (0.5, 1, 2, and 4 kHz) greater than 25-dB hearing level in the worse ear. RESULTS: After adjusting for other factors, current smokers were 1.69 times as likely to have a hearing loss as nonsmokers (95% confidence interval, 1.31-2.17). This relationship remained for those without a history of occupational noise exposure and in analyses excluding those with non-age-related hearing loss. There was weak evidence of a dose-response effect. Nonsmoking participants who lived with a smoker were more likely to have a hearing loss than those who were not exposed to a household member who smoked (odds ratio, 1.94; 95% confidence interval, 1.01-3.74). CONCLUSIONS: These data suggest that environmental exposures may play a role in age-related hearing loss. If longitudinal studies confirm these findings, modification of smoking habits may prevent or delay age-related declines in hearing sensitivity.     

Differential responses in anterior pituitary luteinizing hormone (LH) content and LH beta- and alpha-subunit mRNA, and plasma concentrations of LH and testosterone, in bulls treated with the LH-releasing hormone agonist deslorelin

Tooth loss diminishes oral function and quality of life, and national health targets aim to reduce population levels of tooth loss. OBJECTIVES: The purpose of this study was to determine tooth loss incidence and predictors of tooth loss among older adults in South Australia. METHODS: Data were obtained from a cohort study of a stratified random sample of community-dwelling dentate people aged 60+ years. Interviews and oral examinations were conducted among 911 individuals at baseline and among 693 of them (76.1%) 2 years later. Incidence rates and relative risks were calculated for population subgroups and multivariate logistic regression was used to construct risk prediction models. A method was developed to calculate 95% confidence intervals (95% CI) for relative risks (RR) from logistic regression models using a Taylor series approximation. RESULTS: Some 19.5% (95% CI = 15.4-23.6%) of people lost one or more teeth during the 2 years. Men, people with a recent extraction, people who brushed their teeth infrequently, smokers and people born outside Australia had significantly (P < 0.05) greater risk of tooth loss. Baseline clinical predictors of tooth loss included more missing teeth, retained roots, decayed root surfaces, periodontal pockets and periodontal recession. In a multivariate model that controlled for baseline clinical predictors, former smokers (RR = 2.55, 95% CI = 1.48-4.40) and current smokers (RR = 2.06, 95% CI = 0.92-4.62) had similarly elevated risks of tooth loss compared with non-smokers. CONCLUSIONS: The findings from this population suggest that a history of smoking contributes to tooth loss through mechanisms in addition to clinical disease processes alone.     

Occupational injuries among workers with disabilities: the National Health Interview Survey, 1985-1994

CONTEXT: As the baby boom generation ages, more people will be working with disabilities, but we have little information regarding how disabilities affect risk for occupational injury. OBJECTIVE: To test the hypothesis that work-limiting disabilities in general and hearing and visual impairments in particular are risk factors for occupational injuries. DESIGN: Retrospective cohort study. SETTING: The National Health Interview Survey (NHIS), 1985 to 1994. PARTICIPANTS: The 459827 participants in the NHIS from 1985 to 1994 who listed "working" as their primary activity, who were not farmers, and who were between 18 and 65 years of age. MAIN OUTCOME MEASURE: Occupational injuries in the year preceding the interview causing a residual impairment at the time of interview. RESULTS: After adjusting for occupation, self-employment, and age, occupational injury was associated with preceding work disability (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.19-1.56); blindness (OR, 3.21; 95% CI, 1.32-7.85); deafness (OR, 2.19; 95% CI, 1.17-4.12); hearing impairment (OR,1.55; 95% CI, 1.29-1.87); upper extremity impairment (OR, 1.46; 95% CI, 1.05-2.05); and arthritis (OR, 1.34; 95% CI, 1.07-1.68). Visual impairment was not associated with a significantly increased risk (OR, 1.37; 95% CI, 0.87-2.17). CONCLUSIONS: Workers with disabilities, especially sensory impairments, appear to have an elevated risk for occupational injury. Further research in the design and evaluation of improved workplace accommodations for workers with these disabilities is needed.     

Clinically significant hearing loss in renal allograft recipients treated with intravenous erythromycin

BACKGROUND: Hearing loss is generally regarded as a rare side effect of erythromycin therapy. However, our own clinical experiences in erythromycin-treated patients led us to suspect that this complication may be more common among renal allograft recipients. The purpose of this study was to evaluate the incidence, predisposing factors, clinical characteristics, and outcomes of erythromycin-induced hearing loss among renal allograft recipients. METHODS: We reviewed medical records of renal transplant patients treated for pneumonia with intravenous erythromycin lactobionate. Patients were evaluated for the occurrence of clinically significant hearing loss (including onset, duration, and reversibility), other signs and symptoms of ototoxicity (vertigo and tinnitus), daily erythromycin dose and duration of treatment, concurrent ototoxic drug therapy, renal and hepatic function, and history of previous otic disease. RESULTS: Eleven (32%) of 34 courses of intravenous erythromycin therapy resulted in hearing loss. The incidence of hearing loss was 53% (eight of 15 courses) in patients treated with 4 g of erythromycin daily compared with 16% (three of 19 courses) among those receiving 2 g/d (P = .05). In addition, courses of erythromycin were longer in those suffering auditory toxicity (9.6 +/- 4.7 days) than in nontoxic patients (5.7 +/- 3.6 days) (P < .05). Hepatic and renal function did not differ between toxic and nontoxic patients. All episodes of erythromycin-induced hearing loss were reversible. CONCLUSIONS: We conclude that clinically significant hearing loss occurs in more than 30% of renal allograft recipients treated for pneumonia with intravenous erythromycin lactobionate. Patients who require prolonged courses of erythromycin and those treated with 4 g/d are at particular risk for the development of auditory toxicity. With prompt recognition and modification of therapy, erythromycin-induced hearing loss appears to be completely reversible.     

Prevalence and relevant background characteristics of deafness and severe hearing loss in the Netherlands

OBJECTIVE: To determine the prevalence of deafness and severe hardness of hearing among the Dutch population and of some relevant background characteristics. DESIGN: Study of documents. SETTING: Dutch schools for deaf and hard-of-hearing children. METHOD: The number of deaf and severely hard-of-hearing children of 6-12 years who received education or ambulatory supervision at schools for deaf and hard-of-hearing children was counted in the period November 1996-April 1997, and a number of relevant background characteristics were collected. By means of consultation with experts, this number was corrected for children who could not be retrieved by means of the inventory at these schools. To estimate the total number of deaf and severely hard-of-hearing people in the Dutch population, this adjusted number was extrapolated to older and younger year cohorts. RESULTS: The number of deaf and hard-of-hearing children of 6-12 years, after correction for missing groups, was 0.74 (95% confidence interval (95% CI): 0.69-0.78) per 1000 persons. In 9% the age of onset of the handicap was postlingual; they more often received ambulatory supervision and more often received education at a school for hard-of-hearing children than those with a prelingual auditive handicap. Of the children 29% had a non-Western origin; they less often received ambulatory supervision, and more often received education from a school for deaf children than indigenous pupils. Among the total Dutch population, the number of deaf and hard-of-hearing persons in 1996 was estimated to be 11,400 persons (95% CI: 10,690-12,110). CONCLUSION: The prevalence of deafness and severe hardness of hearing in the Netherlands (15,490,000 inhabitants in 1996) was 11,400 persons (95% CI: 10,690-12,110).     

Neurology and psychiatry

This study examined 4,547 workers' compensation claims accepted for hearing-related conditions in Washington state between 1984 and 1991; 80% resulted in disability compensation (n = 3,660). Acute hearing-related conditions comprised 11% of accepted conditions (95% confidence interval [CI], 2-15%); most claims were for chronic noise-related hearing loss. Tinnitus was reported in 64% of accepted claims (95% CI, 54-75%). The median binaural-equivalent hearing loss in compensated claims was 12.5% (inter-quartile interval, 5-22%; 90th percentile, 34%), although it declined by 30% during the study period. The number of claims and associated impairment increased with claimant age, but the number of claims dropped dramatically after age 65. Annual total disability settlements almost tripled in 8 years, totaling $22.8 million. This study indicates that occupational hearing-related conditions: 1) are manifested by mild to moderate hearing loss, accompanied by tinnitus in a majority of cases; 2) may be under-recognized in older, formerly noise-exposed individuals; and 3) were associated with substantial increases in compensation and medical costs over time, through 1991.     

Depression without sadness: functional outcomes of nondysphoric depression in later life

OBJECTIVES: We hypothesized that depressive symptoms not meeting full standard criteria for Major Depression would be associated with significant functional impairment among older adults over the course of a 13-year follow-up interval. Specifically, we developed criteria for a form of depression whose core symptoms did not include sadness or dysphoria. DESIGN: Population-based 13-year follow-up survey. SETTING: Community-dwelling adults living in East Baltimore in 1981. PARTICIPANTS: Subjects were the 1612 participants of the Baltimore sample of the Epidemiologic Catchment Area Program aged 50 years and older at the initial interview in 1981. MEASUREMENTS: The subjects were sorted into four categories based on their responses at baseline: (1) persons meeting standard criteria for Major Depression; (2) persons meeting alternative criteria for depression with dysphoria or (3) without dysphoria; and (4) a comparison category of persons not meeting any criteria for depression ("noncases"). The mortality and functional status of each group were compared after a 13-year follow-up interval. RESULTS: Compared with non-cases, participants aged 50 years and older who reported depressive symptoms but who denied sadness or dysphoria (nondysphoric depression) were at increased risk for death (relative risk (RR) = 1.70; 95% confidence interval (CI) (1.09, 2.67)), impairment in activities of daily living (RR = 3.76; 95% CI (1.73, 8.14)), impairment in instrumental activities of daily living (RR = 5.07; 95% CI (2.24, 11.44)), psychologic distress (RR = 3.68; 95% CI (1.47, 9.21)), and cognitive impairment (RR = 3.00; 95% CI (1.31, 6.89)) after a 13-year follow-up interval. The findings were not wholly explained by potentially influential baseline characteristics such as age, education, selected comorbid medical conditions, and functional status. CONCLUSION: Among adults aged 50 years and older, nondysphoric depression may be as important as Major Depression in relation to the development of functional disability and other long-term outcomes.     

Hearing loss and cognition in the Baltimore Longitudinal Study of Aging.

Objective: To determine the relationship between hearing loss and cognitive function as assessed with a standardized neurocognitive battery. We hypothesized a priori that greater hearing loss is associated with lower cognitive test scores on tests of memory and executive function. Method: A cross-sectional cohort of 347 participants ≥55 years in the Baltimore Longitudinal Study of Aging without mild cognitive impairment or dementia had audiometric and cognitive testing performed in 1990–1994. Hearing loss was defined by an average of hearing thresholds at 0.5, 1, 2, and 4 kHz in the better-hearing ear. Cognitive testing consisted of a standardized neurocognitive battery incorporating tests of mental status, memory, executive function, processing speed, and verbal function. Regression models were used to examine the association between hearing loss and cognition while adjusting for confounders. Results: Greater hearing loss was significantly associated with lower scores on measures of mental status (Mini-Mental State Exam), memory (Free Recall), and executive function (Stroop Mixed, Trail Making B). These results were robust to analyses accounting for potential confounders, nonlinear effects of age, and exclusion of individuals with severe hearing loss. The reduction in cognitive performance associated with a 25 dB hearing loss was equivalent to the reduction associated with an age difference of 6.8 years. Conclusion: Hearing loss is independently associated with lower scores on tests of memory and executive function. Further research examining the longitudinal association of hearing loss with cognitive functioning is needed to confirm these cross-sectional findings. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Sexual segregation in infant mice: behavioural and neuroendocrine responses to d-amphetamine administration

An epidemiologic survey (n = 466) was conducted in an area of subtropical rainforest in north-west Ecuador with the following objectives: (1) to determine the prevalence of cutaneous leishmaniasis (CL), (2) to identify the Leishmania species causing human disease, (3) to investigate the major clinical manifestations of leishmaniasis, (4) to study cellular and humoral immune response indicators associated with disease status and (5) to identify risk factors for CL. Fourteen percent of subjects had parasitologically confirmed CL; 33% had evidence of prior disease. However, 17.2% of subjects with a negative CL clinical history presented with a positive Montenegro skin test (MST), indicating the possibility of subclinical infection. The species isolated from subject lesions were L. guyanensis (63%), L. panamensis (33%), and L. brazilensis (4%). Mean specific anti-Leishmania IgG and IgM OD serum levels were highest in subjects diagnosed with current CL, followed by those with prior CL, and were lowest in healthy subjects, respectively (0.56 +/- 0.27 vs 0.33 +/- 0.2 vs 0.22 +/- 0.14; F-ratio = 74; P < 0.00001) and (665 +/- 270 vs 481 +/- 220 vs 301 +/- 128.5; F-ratio = 37; P < 0.00001). Likewise, subjects with present CL had measurably higher MST reactions (13 +/- 6.7 mm) than those with prior CL (10.9 +/- 7.8 mm) or healthy individuals (2.4 +/- 2.5 mm; F-ratio = 106; P < 0.00001). Serum concentrations of IgG were predicted by lesion number (t = 2.5; P = 0.018), size (t = 3.7; P = 0.0006), and duration (t = 3.5; P = 0.0013). Furthermore, the MST induration size increased as a function of lesion number (t = 3.0; P = 0.005) and size (t = 3.4; P = 0.022). Subject age and sex did not predict serum IgG or IgM concentrations or MST reactions in the 3 disease groups. Although no sex differences were found with respect to clinical characteristics, children < or = 12 years of age were almost 3 times more likely to have CL lesions or scars located on the face and head area compared to adults (OR = 2.75; 95% CI = 1.4-5.6, P = 0.004). The risk factors associated with disease included age under 5 years (AOR = 1.5; 95% CI = 0.48-2.35), male gender in adults (AOR = 2.8; 95% CI = 1.1-7.8), and wood and/or cane exterior house walls (AOR = 1.8; 95% CI = 1.4-2.5). In contrast, electric home lighting was associated with decreased risk (AOR = 0.7; 95% CI = 0.4-2.3). The results suggest that it may be possible to modify a portion of the risk of CL by making changes in the housing environment which may help to reduce the amount of human-vector contact.     

Magnesium isotopic abundance measurement in humans: comparison of two mass spectrometric methods

OBJECTIVE: A population of children having bilateral moderate to profound hearing impairment was investigated to find out the number who passed (false negatives) and who failed (true positives) a screening test based on the auditory brain stem response (ABR). DESIGN: This study of the ABR is a parallel report to Lutman, Davis, Fortnum, and Wood (1997), where the transient evoked otoacoustic emission was examined on a similar but not identical population of at-risk neonates. Hearing screening was undertaken in at-risk neonates (targeted screening) at seven hospitals in the UK using the Nottingham ABR Screener. During the period from January 1988 to December 1993, a total of 6983 neonates had been tested. Assessment of audiological records from the participating centers ascertained that 201 children born between January 1988 and December 1993 had hearing threshold levels in both ears of 50 dB or more, averaged over the speech frequencies 0.5, 1, 2, and 4 kHz. Of these, 51 had completed the ABR screening test. Examination of the ABR records, which included both machine and visual scoring, indicated whether they had passed or failed the screening test. RESULTS: Forty-six of the 51 hearing impaired babies failed the neonatal ABR screen either on one or both ears (five false negatives), and 42 failed the test on both ears (nine false negatives). This resulted in field sensitivities of 90% and 82%, respectively. Two cases of suspected progressive hearing loss have been included in the numbers of false negative results. The percentage of babies passing the screen on both ears and subsequently having normal hearing (specificity) is typically 93%. CONCLUSIONS: Neonatal hearing screening in an at-risk population using a highly automated ABR test is a viable and effective tool for identification of hearing impairment. Although the field sensitivity of the test is high, it is unable to identify all babies with a criterion level of hearing loss. There are a number of possible explanations as to the origin of false negative results: configuration of the pure-tone audiogram, a progressive hearing loss, acquired sensorineural or conductive loss, retrocochlear deafness, or an incorrect interpretation of the screening test. Passing a neonatal screening test, therefore, does not exclude the possibility of subsequent hearing impairment and highlights the need for further surveillance.     

Depression, family environment, and adolescent suicidal behavior

OBJECTIVE: To assess the specific influence of family relationship difficulties, over and above the effect of depression, on the risk of adolescent suicidal behavior. METHOD: The study was based on the clinical data summaries, "item sheets," of children and adolescents who attended the Maudsley Hospital during the 1970s and 1980s. Two hundred eighty-four cases of suicidal behavior, defined as suicidal ideas, attempts, or threats (mean age 13.9 years, SD 2.6), were compared with 3,054 nonsuicidal controls, using stepwise logistic regression controlling for age and sex. RESULTS: The following variables were each independently associated with suicidal behavior: an operationally defined depressive syndrome, odds ratio (OR) = 4.4 (95% CI 3.1 to 6.3); family discord, OR = 1.5 (95% CI 1.1 to 2.0); disturbed mother-child relationship, OR = 1.5 (95% CI 1.1 to 2.0); and familial lack of warmth, OR = 1.6 (95% CI 1.1 to 2.3). Twenty-seven percent of the suicidal cases met operational criteria for depression. In a separate analysis of nondepressed cases (n = 198), female gender, OR = 2.4 (95% CI 1.7 to 3.2), and conduct symptoms, OR = 1.4 (95% CI 1.02 to 1.95), were independent risk factors for suicidal behavior. Among the depressed cases (n = 73), gender and conduct symptoms did not affect the risk of suicidal behavior. CONCLUSIONS: Although depression is the largest single risk factor for teenage suicidal behavior, family relationship difficulties make a significant independent contribution to this risk. Depression also interacts with gender, so that the excess risk of suicidal behavior in females is confined to nondepressed cases.     

Factors associated with cognitive impairment among older Italian inpatients. Gruppo Italiano di Farmacovigilanza nell'Anziano (G.I.F.A.)

OBJECTIVE: To examine the association of cognitive impairment with educational, demographic, and nutritional variables in older hospitalized people. DESIGN: Survey of older patients admitted consecutively to a hospital during two 2-month periods in 1993. SETTING: Patients admitted for general medical care at 35 hospitals participating in the GIFA study throughout Italy. PARTICIPANTS: A total of 3628 patients aged 65 or older were studied. MEASUREMENTS: The Hodkinson Abbreviated Mental Test (HAMT) was used as a screening method to assess the patients' basic cognitive function. Multiple logistic regression was used to examine the association between cognitive impairment and demographic, educational or nutritional variables. RESULTS: Twenty-nine percent of older inpatients were classified as having cognitive impairment, with similar distribution of HAMT score found in both genders. Educational attainment has a highly significant inverse relationship with cognitive impairment (highest education: OR 0.32; 95% CI 0.20-0.52). Moreover, cognitive impairment decreased with increasing body mass index (3rd tertile: OR 0.69; 95% CI: 0.51-0.93), cholesterol serum level (highest values: OR 0.59; 95% CI 0.37-0.93), circulating lymphocytes (highest values: OR 0.55; 95% CI 0.45-0.69), and serum albumin (highest values: OR 0.60; 95% CI 0.47-0.76), with a gradient of influence for each variable. CONCLUSIONS: Educational attainment affects cognitive function in older inpatients. The strong association between cognitive impairment and nutritional variables suggests that every effort to improve nutritional status is needed in approaching cognitive impairment in older patients.     

An implantable hearing aid for inner ear hearing loss. Short-term implantation of microphone and transducer

A microphone constructed for implantation in the posterior wall of the auditory canal and a piezoelectric transducer serving as the main components of an implantable hearing aid were temporally implanted in five patients during middle ear surgery under local anesthesia. The microphone was positioned beneath the skin of the auditory canal such that it completely covered the microphone membrane. The vibratory element of the transducer was coupled to the malleus in four patients with normal ossicular chains and directly to the stapes in one patient with missing incus. The microphone and transducer were electrically connected with an external battery-driven signal amplifier. Speech material and music were presented in the operation room at a sound level of 65 dB SPL under free-field conditions. The patients had to estimate the quality of speech, music, and their own voice as well as the effects of bone-conducting noises. All patients were able to hear with the system. An intraoperative talk without vision contact was possible without any problems, as was understanding of numerals ("Freiburger Zahlentest"). Perception of music was judged as "clear and undistorted with all broadband component." The estimation was also valid for one patient with a sensorineural hearing loss. One patient declared the music to be "a little of unnatural." Bone-conducted sound was estimated as normal in two patients, better than without an implant in one patient with sensorineural hearing loss, and "somewhat metallic" in another patient. Hearing the own voice was considered "normal" in two cases "monotonous" in one case, and "a little bit roaring" in another case. An amplification factor that can be technically realized in an implantable hearing aid was necessary for one of the patients with sensorineural hearing loss to perceive music at a pleasant volume. On the basis of this study, essential requirements for the construction of a fully implantable hearing aid are fulfilled.