Cognitive-linguistic subgroups in closed-head injury

This study examined variability in the interrelationship between language skill and neuropsychological function within a group of 25 severe closed head injury (CHI) subjects and 23 matched controls. All subjects underwent a battery of standardized language and neuropsychological tests. Cluster analyses were conducted to determine whether the CHI sample was universally or differentially impaired. Further subgroup analysis using a Q type factor analysis outlined the differences in performance profiles within the group of CHI subjects. Results support the hypothesis that while some deficits were common to all CHI subjects, impairments delinated by whole group analysis do not necessarily represent universal impairments. In particular, ability to perform tasks involving auditory comprehen sion, naming, verbal memory, visual memory and visuospatial skills appeared to be important com ponents in group differentiation. The cognitive linguistic impairments which were common to all CHI subjects and considered to be the lcardinal cognitive-linguistic deficits following severe CHI were deficits in lexical-semantic and sentential semantic skills, verbal fluency, complex auditory comprehension, and attentional operations. Profile analysis revealed the existence of a double dissocia tion between performances on naming and verbal memory tasks and performances on visually related cognitive tasks. Results are discussed with reference to findings on previous studies of subgroups in the CHI population.     

Predictors of renal recovery in Australian and New Zealand end-stage renal failure patients treated with peritoneal dialysis.

OBJECTIVES: The aim of this study was to investigate the factors affecting recovery and durability of dialysis-independent renal function following commencement of peritoneal dialysis (PD). DESIGN: Retrospective, observational cohort study of the Australian and New Zealand PD patient population. SETTING: Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. PARTICIPANTS: The study reviewed all patients in Australia and New Zealand who commenced PD for treatment of end-stage renal failure between 15 May 1963 and 31 December 2004. MAIN OUTCOME MEASURES: The primary outcomes examined were recovery of dialysis-independent renal function and time from PD commencement to recovery of renal function. A secondary outcome measure was time to renal death (patient death or recommencement of renal replacement therapy) following recovery of dialysis-independent renal function. RESULTS: 24663 patients commenced PD during the study period. Of these, 253 (1%) recovered dialysis-independent renal function. An increased likelihood of recovery was predicted by autoimmune renal disease, hemolytic-uremic syndrome, paraproteinemia, cortical necrosis, renovascular disease, and treatment in New Zealand. A reduced likelihood of recovery was associated with polycystic kidney disease and indigenous race. Analysis of a contemporary subset of 14743 patients in whom complete data were available for body mass index, smoking, and comorbidities yielded comparable results, except that increasing age was additionally associated with a decreased likelihood of recovery. Of the 253 patients who recovered renal function, 151 (60%) recommenced renal replacement therapy and 49 (19%) died within a median period of 226 days (interquartile range 110-581 days). The only significant predictors of continued renal survival after renal recovery were autoimmune renal disease and cortical necrosis. CONCLUSIONS: Recovery of renal function in patients treated with PD is rare and determined mainly by renal disease type and race. In the majority of cases, recovery is short term. The apparently high rate of early patient death or return to dialysis after recovery of renal function on PD raises questions about the appropriateness of discontinuing PD therapy under such circumstances.     

Play space: historical and socio-cultural reflections on drugs, licensed leisure locations, commercialisation and control

This paper will consider legal and illicit drug use in relation to changing leisure spaces, reflecting on different types of leisure space from the formal, controlled and purpose built licensed leisure locations of the modern urban landscape to the illicit, unregulated and wild zones beyond. Drawing on a range of literature, as well as empirical studies by the author, the historical and socio-cultural development of leisure space in relation to dance clubs, public houses and café bars in the UK will be considered. The relationship between spatiality, consumption, commercialisation and control is analysed through a consideration of changes in licensed leisure spaces; changes in the use of legal and illicit drugs within them; and state and commercial responses to these changes at local and national level. After pub and club space, the third and final consideration is the notion of head space, utilised and commodified in the pursuit of pleasure in late modern consumer society.     

Correlation between hospital anxiety depression (HAD) scale and other measures of anxiety and depression in geriatric inpatients

Ninety-four patients on geriatric wards were examined as part of a study of prevalence of psychiatric disorders in elderly inpatients. A good correlation was found between depression measured on the HAD and on the Montgomery–Asberg scale. Lower, but still highly significant correlations were found between anxiety measured on the HAD and on the brief anxiety scale (BRAS), between anxiety on the self-rating anxiety scale (SRAS) and the BRAS, and between anxiety on the HAD and the SRAS.     

Diet and gender moderate clozapine-related weight gain

This study examined patients with schizophrenic disorders treated with clozapine in a state hospital setting. Gender and diet affected weight gain over a six-month period. Pre-treatment weight status also related to eventual weight gain. There were no significant effects of dosage. Weight gain was most pronounced in non-dieting women. This has implications for management of patients on clozapine.     

Relationship between Chemosensitivity, Obesity and Blood Pressure in Obstructive Sleep Apnoea

It has previously been documented that patients with obstructive sleep apnoea (OSA) have an abnormal blood pressure (pressor) response to acute hypoxia when awake. The relationship between hypoxic chemosensitivity and 24 h blood pressure in OSA is not known. Twenty-four hour ambulatory BP (ABP) was measured at 15 min intervals for 24 h using a non-invasive device (Oxford Medilog ABP or Spacelabs 90207 recorder) in 49 men (mean age 51 ± 9 years), with OSA. The BP response to acute hypoxia was measured either directly (radial arterial line) or indirectly (Finapress) during wakefulness. The pressor response to hypoxia (expressed as the slope of the regression line of mean BP on % fall in arterial oxygen saturation) was compared with the results of the ABP recording, sleep study data and clinical variables. A pressor response to acute hypoxia was present in all patients (mean 1.4 ± 1.1 mmHg/% δSaO₂, range 0.1-4.5). There was a relationship between the magnitude of the pressor response to hypoxia, severity of sleep apnoea (RDI and minimum SaO₂) and central obesity (waist measurement). In contrast, there was no relationship between BP response to hypoxia during wakefulness and 24-h BP. However, increasing obesity and severity of OSA were associated with loss of the normal fall in BP at night. We conclude that enhanced chemosensitivity is common in OSA but there is no demonstrable link between chemosensitivity and mean daytime or night-time ABP.