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PubMed2004

Cigarette smoking, periodontal disease: and chronic obstructive pulmonary disease.

BACKGROUND: Cigarette smoking is a significant risk factor for both chronic obstructive pulmonary disease (COPD) and periodontal disease. The goal of this study was to better understand the role of smoking in a possible relationship between periodontal disease and COPD. METHODS: The study population consisted of 7,625 participants in the Third National Health and Nutrition Examination Survey (NHANES III) during 1988-1994 who were aged 30 years or older when examined and who received a spirometric examination. The data analysis employed logistic regression models and accounted for the complex sampling design used in NHANES III. RESULTS: After adjustment for potential confounders, there was no statistically significant association between periodontal disease and COPD among former or non-smokers. Current smokers with > or = 4 mm mean loss of attachment had an odds ratio of 3.71 (95% confidence interval: 1.74, 7.89). CONCLUSIONS: These results suggest that cigarette smoking may be a cofactor in the relationship between periodontal disease and chronic obstructive pulmonary disease. The key role played by smoking in the etiology of both periodontal disease and chronic obstructive pulmonary disease suggests that much of the observed increase in risk may actually reflect the exposure to smoking. Additional research into smoking-related effect modification is needed to clarify the role of periodontal disease in the etiology of smoking-related systemic diseases.

Adult↗
PubMed2006

Systematic review of the literature on assessment, feedback and physicians' clinical performance: BEME Guide No. 7.

BACKGROUND AND CONTEXT: There is a basis for the assumption that feedback can be used to enhance physicians' performance. Nevertheless, the findings of empirical studies of the impact of feedback on clinical performance have been equivocal. OBJECTIVES: To summarize evidence related to the impact of assessment and feedback on physicians' clinical performance. SEARCH STRATEGY: The authors searched the literature from 1966 to 2003 using MEDLINE, HealthSTAR, the Science Citation Index and eight other electronic databases. A total of 3702 citations were identified. INCLUSION AND EXCLUSION CRITERIA: Empirical studies were selected involving the baseline measurement of physicians' performance and follow-up measurement after they received summaries of their performance. DATA EXTRACTION: Data were extracted on research design, sample, dependent and independent variables using a written protocol. DATA SYNTHESIS: A group of 220 studies involving primary data collection was identified. However, only 41 met all selection criteria and evaluated the independent effect of feedback on physician performance. Of these, 32 (74%) demonstrated a positive impact. Feedback was more likely to be effective when provided by an authoritative source over an extended period of time. Another subset of 132 studies examined the effect of feedback combined with other interventions such as educational programmes, practice guidelines and reminders. Of these, 106 studies (77%) demonstrated a positive impact. Two additional subsets of 29 feedback studies involving resident physicians in training and 18 studies examining proxy measures of physician performance across clinical sites or groups of patients were reviewed. The majority of these two subsets also reported that feedback had positive effects on performance. HEADLINE RESULTS: Feedback can change physicians' clinical performance when provided systematically over multiple years by an authoritative, credible source. CONCLUSIONS: The effects of formal assessment and feedback on physician performance are influenced by the source and duration of feedback. Other factors, such as physicians' active involvement in the process, the amount of information reported, the timing and amount of feedback, and other concurrent interventions, such as education, guidelines, reminder systems and incentives, also appear to be important. However, the independent contributions of these interventions have not been well documented in controlled studies. It is recommended that the designers of future theoretical as well as practical studies of feedback separate the effects of feedback from other concurrent interventions.

Clinical Competence↗
PubMedDate not supplied

Participation in programs designed to improve employment outcomes for persons with psychiatric disabilities: evidence from the New York WORKS demonstration project.

The New York WORKS demonstration project was designed to improve employment outcomes for persons with psychiatric disabilities receiving Supplemental Security Income (SSI) disability payments. This article shows how the individual characteristics of participants were related to outcomes at each stage of the multistage recruitment process used in the project and how those characteristics contributed to enrollment. The findings are important to program administrators who are interested in ensuring that SSI recipients receive equal access to employment-related services and who want to improve recruitment strategies for future demonstration projects. The New York WORKS recruitment process used administrative records from the Social Security Administration (SSA) to identify the population of over 68,000 SSI recipients with a diagnosis of a psychiatric disability in Erie County and New York City. Staff involved in the project documented the results of each stage of the recruitment process. The New York WORKS project included four stages: (1) the provision of information (sending a letter and information packet); (2) demonstrated awareness of the project (response to a letter containing an overview of the project); (3) expression of interest (indication of interest in the project, using a postmarked form returned to New York WORKS project staff); and (4) participation (actual enrollment in the program). The project staff members were also able to identify data from administrative records that described the characteristics of the population, including age, sex, type of psychiatric diagnosis, the number of months that the person collected benefits before the recruitment process, employment experience before the recruitment process, and annual earnings in the year before the recruitment process. The data on outcomes at each stage of the recruitment process and the characteristics of SSI recipients were analyzed using an empirical method recently suggested by Heckman and Smith. The analysis identified the relationship between the characteristics of SSI recipients and the outcomes at each stage of the recruitment process and demonstrated how those characteristics contributed to the overall likelihood of enrollment. Demographic characteristics, information about diagnosis, and characteristics related to work history had different effects on outcomes at different stages of the recruitment process. For example, younger SSI recipients were less likely to reply to the information letter but more likely to express an interest in the project and more likely to enroll, given that interest. This result suggests that there may be an information barrier for the younger group of SSI recipients during the early recruitment stages. There were also interesting differences by psychiatric diagnosis and by recent employment experience at each stage of the process. Most notably, persons with anxiety disorders were less likely to express an interest in the project and less likely to enroll in the project if they expressed an interest. This finding suggests that project administrators may need to examine more effective methods to accommodate persons with an anxiety disorder at the enrollment stage of the recruitment process. Persons with relatively low earnings in the year before the project were more likely to respond, to express interest in the project, and to enroll than were those with no earnings and those with relatively high earnings. This finding suggests that the recruitment strategy used by the New York WORKS project is more effective at enrolling a subset of the population that has some demonstrated work capacity and that, of those with a demonstrated work capacity, New York WORKS is enrolling those who are likely to have the most to gain from the project. This finding has implications for the development of sample designs for other demonstration projects, in particular the SSA-proposed mental health treatment study. A number of strategies may lead to improvements in future evaluations of participation in SSA projects and programs. For example, the New York WORKS data did not contain information for all SSI recipients on race, education, or literacy. These factors have been shown to be important in the Job Training Partnership Act literature and are likely to play a role in participation. The inclusion of these data in future evaluations may provide important information on participation in SSA projects. Another useful strategy for future evaluations includes the identification of random samples of those who choose not to enroll at different stages in the process and the collection of information on the reason for the decision. These additional data may help project administrators to gain a clearer description of the reasons for differences in outcome that occur at each stage of the process, assess the overall performance of the recruitment process, and improve the recruitment processes used in future projects.

Adult↗
PubMedDate not supplied

[The role of epidemiology in mental disorder research].

Mental disorders, including substance abuse, are part of the Mexican epidemiologic scenario and will remain so during several decades. They may even become more prominent as causes of disease, disability, and death in our country. It is thus imperative to frame appropriate management strategies to curb these problems without delay. This paper aims at outlining epidemiology of mental diseases as a field of study, and to identify its limitations. Emphasis is made on common elements shared with other more traditional fields of epidemiology, as well as on the specific contributions made by this particular field to epidemiology and to psychiatry in general. This paper describes the main study designs and problems in this field of epidemiology, its usefulness in prevention actions, and future challenges. A unique characteristic of mental disorder epidemiology is that its target diseases manifest in two levels: behaviorally (for example, compulsive hand-washing) and as an element of the individual's mental life (e.g., obsession with bacteria being a constant, omnipresent health threat). It follows that much of the knowledge currently available on the phenomena of mental disorders in general is based on the self-reported insight of individuals. Trained clinicians have collected such reports by interview or with standardized questionnaires. This field of epidemiology is characterized by having two-sides: a mental disorder is a problem in and of itself, causing suffering and prompting the search for specialized care, as it has peculiar clinical manifestations. On the other hand, mental disorder epidemiology also focuses on determining factors (drug use, abuse, or addiction) and on the way these independent variables result in certain processes and outcomes (such as accidents, homicide, suicide, liver cirrhosis, etc.). Finally, the epidemiology of mental disorders has also been set apart by its focus in series of processes that are not suitably classified as syndromes, but which are germane to public health, for example, violence. The epidemiology of mental disorders faces great challenges in the new millennium, including a complex, changing epidemiologic scenario. Several important issues will influence the future development of mental disorder epidemiology: measurement of mental disorders and risk factors, more efficient sampling design and methods, the relationships among biological research, genetics, social studies, and epidemiology, and the interface between epidemiology and the evaluation of therapies and health services.

Biomedical Research↗
PubMed1996

An intravascular microdialysis sampling system suitable for application in continuous biochemical monitoring of glucose and lactate.

Direct sensor implantation for continuous biochemical monitoring has proved disappointing, but microdialysis sampling devices can serve as a biocompatible patient-sensor interface. We propose a novel "MiniShunt" extracorporeal microdialysis sampling circuit designed to sample core blood, and report the performance of different microdialysis probe membrane types and sizes with pumped and non-pumped blood flow in anaesthetised dogs. Discrete microdialysate and plasma samples collected during glucose and lactate monitoring were analysed with a YSI analyzer and showed microdialysis efficiency (% relative recovery) in excess of 95% for both analytes using fibres of greater than 70 mm2 internal surface area. Pumped veno-venous extracorporeal blood microdialysis sampling of this type could provide a suitable interface for future multi-analyte on-line biosensor applications in critically ill patients.

Animals↗
PubMed2000

Lifetime prevalence of and risk factors for psychiatric disorders among Mexican migrant farmworkers in California.

OBJECTIVES: In this study, the prevalence of and risk factors for 12 psychiatric disorders were examined by sex and ethnicity (Indian vs non-Indian) among Mexican migrant farm-workers working in Fresno County, California. METHODS: Subjects aged 18 through 59 years were selected under a cluster sampling design (n = 1001). A modified version of the Composite International Diagnostic Interview was used for case ascertainment. The effects of sociodemographic and acculturation factors on lifetime psychiatric disorders were tested. RESULTS: Lifetime rates of any psychiatric disorder were as follows: men, 26.7% (SE = 1.9); women, 16.8% (SE = 1.7); Indians, 26.0% (SE = 4.5); non-Indians, 20.1% (SE = 1.3). Total lifetime rates were as follows: affective disorders, 5.7%; anxiety disorders, 12.5%; any substance abuse or dependence, 8.7%; antisocial personality, 0.2%. Lifetime prevalence of any psychiatric disorder was lower for migrants than for Mexican Americans and for the US population as a whole. High acculturation and primary US residence increased the likelihood of lifetime psychiatric disorders. CONCLUSIONS: The results underscore the risk posed by cultural adjustment problems, the potential for progressive deterioration of this population's mental health, and the need for culturally appropriate mental health services.

Adolescent↗
PubMed1995

Comorbidity between DSM-IV drug use disorders and major depression: results of a national survey of adults.

This study describes detailed patterns of comorbidity between Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) drug use disorders and major depression in the United States for 1992. Data were derived from the National Longitudinal Alcohol Epidemiologic Survey (NLAES), a national probability survey consisting of 42,862 respondents, 18 years old and older, residing in the contiguous United States. The sampling design included oversampling of Blacks and young adults (18-29 years old). Comorbidity rates and associations between DSM-IV drug use disorders (i.e., prescription drugs, sedatives, tranquilizers, amphetamines, cannabis, cocaine, and hallucinogens) and major depression were expressed as odds ratios with confidence intervals adjusted for the complex design characteristics of the NLAES. Comorbidity analyses were presented by gender, ethnicity, and age for past-year, prior-to-past-year, and lifetime diagnoses. The results showed that virtually all odds ratios were significantly greater than 1, demonstrating that comorbidity of a variety of drug use disorders and major depression is pervasive in the general population. Diagnostic and subgroup variations in comorbidity were noted. As expected, the association between drug dependence and major depression was greater than the association between abuse and major depression. The association between abuse and major depression was greater for women than men for prescription drugs, sedatives, tranquilizers, and amphetamines, but not for cocaine or hallucinogens. Men generally demonstrated stronger relations between drug dependence and major depression. Implications of the results are discussed in terms of professional help seeking, the self-medication hypothesis, and differential social-control theory.

Adolescent↗
PubMed1996

Periodontal status in the United States, 1988-1991: prevalence, extent, and demographic variation.

This paper reports estimates of the periodontal status of US population derived from data from Phase 1 of the Third National Health and Nutrition Examination Survey conducted by the National Institute of Dental Research from 1988-1991. A total of 7,447 dentate individuals 13 years of age and older, representing approximately 160.3 million civilian non-institutionalized Americans, received a periodontal assessment. Measurements of gingival bleeding, gingival recession level, periodontal pocket depth, and calculus were made by dental examiners. Assessments were made at the mesiobuccal and mid-buccal sites of all fully erupted permanent teeth present in two randomly selected quadrants, one maxillary and one mandibular. All data were weighted and standard errors calculated by special software to adjust for the effect of sample design. Although over 90% of persons 13 years of age or older had experienced some clinical loss of attachment (LA), only 15% exhibited more severe destruction (LA > or = 5 mm). Prevalence of moderate and severe LA and gingival recession increased with age, while prevalence of pockets > or = 4 mm or > or = 6 mm did not. These data suggest that the increasing prevalence of LA with age is more associated with increasing prevalence of recession than with changes in the prevalence of pockets or age. The extent or number of affected sites with advanced conditions for loss of attachment, pocket depth, or recession was not large for any age group. Differences in prevalence of moderate and severe loss of attachment, moderate and deep pockets, and recession were found among gender and race-ethnicity groups. Females exhibited better periodontal health than males, and non-Hispanic whites exhibited better periodontal health than either non-Hispanic blacks or Mexican-Americans.

Adolescent↗
PubMedDate not supplied

The evaluation of mechanical devices for lateral transfers on perceived exertion and patient comfort.

PURPOSE: The purpose of this study was to compare the perceived physical stress felt by subjects (nursing and other hospital personnel), time spent, number of personnel required, and patient comfort using various methods to transfer patients laterally in the supine position. DESIGN: Descriptive comparative design. SAMPLE: One hundred ninety-two transfer ratings (132 using manual methods and 60 using a mechanical device) were compared. Thirty-two transfers (18 manual and 14 mechanical device) were timed, and 39 patients (12 having manual transfer and 27 with a mechanical device) provided comfort ratings. FINDINGS: Perceived exertion was significantly less for subjects performing lateral transfers with a mechanical device than with manual methods. Fewer personnel were needed for transfers with mechanical devices. Approximately 5 minutes less per transfer was needed when using mechanical devices, and patients felt significantly more comfortable and secure when a mechanical transfer device was used. DISCUSSION: The use of a mechanical device for transfer provided lower exertion ratings, used less personnel and time, and was more comfortable for patients. There are barriers to use, however, because of resistance to change, perceived increase in time needed for transfer, and the limitation of storing and retrieving the devices. Provision of equipment does not ensure use; institution of teaching and no-lift policies can facilitate use of lifting/transferring equipment.

Air↗
PubMed2005

The 2010 challenge: data availability, information needs and extraterrestrial insights.

At the 2002 Johannesburg World Summit on Sustainable Development, 190 countries endorsed a commitment to achieve, by 2010, a significant reduction of the current rate of biodiversity loss at the global, regional and national levels. A wide range of approaches is available to the monitoring of progress towards this objective. The strengths and weaknesses of many of these approaches are considered, with special attention being given to the proposed and existing indicators described in the other papers in this issue. Recommendations are made about the development of indicators. Most existing and proposed indicators use data collected for other purposes, which may be unrepresentative. In the short term, much remains to be done in expanding the databases and improving the statistical techniques that underpin these indicators to minimize potential biases. In the longer term, indicators based on unrepresentative data should be replaced with equivalents based on carefully designed sampling programmes. Many proposed and existing indicators do not connect clearly with human welfare and they are unlikely to engage the interest of governments, businesses and the public until they do so. The extent to which the indicators already proposed by parties to the Convention on Biological Diversity are sufficient is explored by reference to the advice an imaginary scientific consultant from another planet might give. This exercise reveals that the range of taxa and biomes covered by existing indicators is incomplete compared with the knowledge we need to protect our interests. More fundamentally, our understanding of the mechanisms linking together the status of biodiversity, Earth system processes, human decisions and actions, and ecosystem services impacting human welfare is still too crude to allow us to infer reliably that actions taken to conserve biodiversity and protect ecosystem services are well chosen and effectively implemented. The involvement of social and Earth system scientists, as well as biologists, in collaborative research programmes to build and parameterize models of the Earth system to elucidate these mechanisms is a high priority.

Biodiversity↗
PubMed2001

Dietary fats and asthma in teenagers: analyses of the first Nutrition and Health Survey in Taiwan (NAHSIT).

BACKGROUND: The occurrence of asthma may be associated with dietary factors. OBJECTIVE: To examine the association between nutrient intake and physician-diagnosed asthma and allergic rhinitis. METHODS: A stratified, multiple-staged sampling design was used to select study areas, in which household interviews were carried out to gather information on health status and 24-h food recall. Data from 1166 adolescents, 13-17 years of age, were analysed. RESULTS: In univariate analysis, total calorie and energy-adjusted fat intake were associated with the prevalence of asthma, whereas vitamin A and vitamin C intake showed negative association with asthma. Multivariate logistic regression was used to adjust for sex and levels of urbanization; intake of saturated fats was associated with increased risk (OR = 2.02 for an increase of one SD, 95%CI 1.40-2.90), while monounsaturated fats were inversely related to asthma (OR = 0.65 for an increase of one SD, 95%CI 0.43-0.99). Vitamin C intake in the lowest quartile was associated with elevated risk for asthma with marginal significance (OR = 1.81, 95%CI 0.88-3.71, P = 0.10). None of the nutritional factors was associated with allergic rhinitis. CONCLUSION: Results from this cross-sectional survey suggest that saturated and monounsaturated fats may have different effects on airway inflammation.

Adolescent↗
PubMed1997

Correlates of drinking during the third trimester of pregnancy in Alaska.

OBJECTIVES: To examine characteristics related to drinking during pregnancy among a population-based sample of women. METHOD: We analyzed data related to third-trimester drinking collected from the Alaska Pregnancy Risk Assessment Monitoring System (PRAMS). PRAMS used a population-based, stratified sampling design to survey 9733 of the approximately 44,000 live births to Alaska-resident women during 1991-1994. We defined regular drinking as one or more drinks per week on average during the third trimester. Analyses included bivariate and multivariate associations with any and regular drinking. RESULTS: Of women mailed a survey, 6973 responded and answered the questions related to alcohol consumption. Nine percent reported any drinking during the third trimester and 2.5% were regular third-trimester drinkers. The strongest risk factors for both any and regular third-trimester drinking were older age and marijuana or cocaine use. Other risk factors for any third-trimester drinking included prenatal cigarette smoking, greater education, non-Alaska Native race, the experience of significant life stressors, and residence in a community that did not restrict the sale of alcohol. Other risk factors for regular third-trimester drinking included prenatal cigarette smoking and the experience of domestic violence. Prenatal counseling regarding the effects of alcohol consumption during pregnancy and adequacy of prenatal care were not significantly associated with either outcome variable. CONCLUSIONS: Efforts to decrease prenatal alcohol consumption should be directed at older women and should address social determinants of health, such as education, domestic violence, drug use, and the availability of alcohol. In the absence of these efforts, prenatal alcohol education by health care providers may have little impact on pregnancy-related drinking.

Adolescent↗
PubMed2003

Social marginalization of overweight children.

BACKGROUND: Overweight is the most common health problem that faces children and adolescents. Although the correlation among overweight, low self-esteem, and depression is well known, social isolation among overweight children and adolescents has not been studied. OBJECTIVE: To investigate social networks of overweight and normal-weight adolescents in a large, nationally representative sample. DESIGN: Cross-sectional, nationally representative cohort study. Population A total of 90 118 adolescents aged 13 to 18 years who were enrolled in the National Longitudinal Study of Adolescent Health, of which a 1:5 subsample was selected for detailed in-home assessment, including height and weight measurements (n = 17 557). Overweight was defined according to body mass index (>95th percentile for age and sex). MAIN OUTCOME MEASURES: This analysis focuses on the number of friendship nominations each adolescent received from other adolescents. The number of friendship nominations and other social network measures were calculated using statistical software. RESULTS: Overweight adolescents were more likely to be socially isolated and to be peripheral to social networks than were normal-weight adolescents. Although overweight adolescents listed similar numbers of friends as normal-weight adolescents, overweight adolescents received significantly fewer friendship nominations from others than were received by normal-weight adolescents (mean [SE] number of friendship nominations, 3.39 [0.08] vs 4.79 [0.04]; P<.001). Overweight adolescents were also more likely to receive no friendship nominations than were normal-weight adolescents (odds ratio, 1.71; 95% confidence interval, 1.39-2.20). Decreased television viewing (P<.001), increased levels of sports participation (P<.001), and increased participation in school clubs (P<.001) were associated with significantly more friendship nominations and higher network centrality scores among both overweight and normal-weight adolescents. CONCLUSIONS: Many overweight adolescents are socially marginalized. Such isolation may aggravate the social and emotional consequences of overweight in this age group.

Adolescent↗
PubMed1990

The design and analysis of case-control studies with biased sampling.

A design is proposed for case-control studies in which selection of subjects for full variable ascertainment is based jointly on disease status and on easily obtained "screening" variables that may be related to the disease. Recruitment of subjects follows an independent Bernoulli sampling scheme, with recruitment probabilities set by the investigator in advance. In particular, the sampling can be set up to achieve, on average, frequency matching, provided prior estimates of the disease rates or odds ratios associated with screening variables such as age and sex are available. Alternatively--for example, when studying a rare exposure--one can enrich the sample with certain categories of subject. Following such a design, there are two valid approaches to logistic regression analysis, both of which allow for efficient estimation of effects associated with the screening variables that were allowed to bias the recruitment. The statistical properties of the estimators are compared, both for large samples, based on asymptotics, and for small samples, based on simulations.

Case-Control Studies↗
PubMed1998

Human herpesvirus 8 in Italian HIV-seronegative patients with Kaposi sarcoma.

OBJECTIVE: To evaluate the prevalence of human herpesvirus 8 (HHV-8) DNA detection in a large series of human immunodeficiency virus-seronegative patients with and without Kaposi sarcoma (KS) from the central and southern regions of Italy where classic KS is prevalent. DESIGN: Samples of lesional, peripheral unaffected, and distant normal skin and peripheral blood mononuclear cells (PBMCs) from 33 patients with KS and PBMCs from 42 control subjects were analyzed using single and nested polymerase chain reaction techniques for the presence of HHV-8 DNA. PATIENTS: A total of 33 patients with KS not related to acquired immunodeficiency syndrome (26 patients with classic KS and 7 patients with iatrogenic KS) were studied. Furthermore, 2 control groups were enrolled. The first group consisted of 13 healthy volunteers, the second of 29 patients affected by different dermatological diseases. RESULTS: Human herpesvirus 8 sequences were found in 100% of lesional and perilesional specimens, in 33% of the distant normal skin samples, and in 69.6% of the PBMCs from patients with KS. A possible correlation between HHV-8 DNA in PBMCs and the clinical stage of the disease was observed. Moreover, the prevalence of viral DNA in PBMCs from the total control group was 23.8%. No viral DNA was detected in tissue biopsy specimens taken from the control group. CONCLUSIONS: Our data suggest that HHV-8 could be a widespread virus, at least in Mediterranean regions where KS is more prevalent, such as southern and central Italy. As with other herpesviruses, it may be present lifelong in latent form somewhere in the body and may contribute to the pathogenesis of KS when other predisposing conditions are present.

Aged↗
PubMed2002

Skin colonization by Malassezia species in neonates: a prospective study and relationship with neonatal cephalic pustulosis.

OBJECTIVES: To assess skin colonization by Malassezia species in full-term healthy newborns, to investigate factors associated with colonization, and to look at acnelike cephalic pustulosis associated with this carriage. DESIGN: Samples were obtained from neonates and their mothers 0 to 5 days after birth and again 3 weeks later. Clinical patterns of common acnelike pustulosis were reported as mild (<10 papulopustules), moderate (> or =10 papulopustules), or absent. Direct examination and culture of sample. Identification of yeasts was based on microscopic and physiologic criteria. SETTING: A maternity hospital and the pediatric dermatology unit of a university hospital. PARTICIPANTS: Consecutive series of 102 neonates and their mothers. MAIN OUTCOME MEASURES: Incidence of skin colonization and type of Malassezia species found in neonates and correlation with neonatal cephalic pustulosis (neonatal acne). RESULTS: At the first visit, 11 neonates and 36 mothers had cultures positive for Malassezia. Malassezia sympodialis and Malassezia globosa were preferentially cultured. At 3 weeks, 29 (52%) of 56 neonates and 18 (32%) of 56 mothers had cultures positive for only M sympodialis and M globosa. Breastfeeding was not associated with a higher prevalence of Malassezia carriage in neonates. Malassezia colonization was higher when pustulosis was more severe and M sympodialis was found in pustules. CONCLUSIONS: Malassezia colonization begins at birth and increases in the first weeks of life. A high prevalence of M sympodialis in neonates is noted from birth. Its association with neonatal acne is confirmed. Further investigation is needed to study the role of sebum secretion rate and quality in the neonatal period.

Acne Vulgaris↗
PubMed2004

Homocysteine and the brain in midadult life: evidence for an increased risk of leukoaraiosis in men.

BACKGROUND: High serum homocysteine (HCY) levels have been associated with thromboembolic cerebrovascular disease, but their relationship to microvascular disease is uncertain. Homocysteine also has a direct neurotoxic effect and has been linked to brain atrophy and an increased risk of Alzheimer disease. OBJECTIVE: To examine the relationship of HCY levels to brain and cognitive measures in a healthy community sample. DESIGN: Cross-sectional study. SETTING: Individuals residing in Canberra and Queanbeyan, Australia, who were participating in the longitudinal PATH Through Life Project. PARTICIPANTS: Individuals aged 60 to 64 years selected randomly from the community, 196 men and 189 women. MAIN OUTCOME MEASURES: Regression coefficients with HCY level as the putative determinant and various magnetic resonance imaging measures (brain atrophy index, ventricle-brain ratios, volume of periventricular and deep white matter hyperintensities) and cognitive measures (information processing speed, verbal memory, fine motor speed) as dependent measures. RESULTS: Homocysteine levels did not have a significant relationship with brain atrophy index or ventricle-brain ratios. High HCY levels were related to increased deep white matter hyperintensities but not periventricular white matter hyperintensities, after correcting for levels of folate, vitamin B(12), creatinine, and thyrotropin; hypertension; smoking; and diabetes, the relationship being significant only in men. Homocysteine levels were related to impairment in verbal memory and fine motor speed but not after the previously mentioned correction. CONCLUSIONS: Total HCY level is independently related to leukoaraiosis in middle-aged men, and this may be functionally relevant in the form of mild cognitive impairment. The remediation of hyperhomocysteinemia should begin early in life if its deleterious effects on the brain are to be prevented.

Brain↗
PubMed1993

An international study of psychological problems in primary care. Preliminary report from the World Health Organization Collaborative Project on 'Psychological Problems in General Health Care'.

This article describes a large longitudinal multicenter collaborative study that investigated the form, frequency, course, and outcome of psychological problems that were seen in primary health care settings in 15 different sites around the world. The research employed a two-stage sampling design in which the 12-item General Health Questionnaire was administered to 26,422 persons aged 18 to 65 years who were consulting health care services. Of these persons, 5604 were selected for detailed examinations using standardized instruments and were followed up at 3 months and 1 year to provide information on course and outcome. All assessment instruments have been translated into 13 different languages. The project has produced a database that allows for the exploration of the nature of psychological disorders experienced by patients in general medical care and their association with physical illness, illness behavior, and disability over time.

Adolescent↗