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[Some linguistic aspects of thought disorder in non-acute schizophrenia].

Seventy texts, which had been produced spontaneously but in standardized contexts by (non-acute) schizophrenic patients and by non-schizophrenic subjects, were analysed linguistically in order to investigate the various strategies that speakers may use to join different sentences together to form a unified structure by semantic and lexicogrammatical ties. For this purpose we used Halliday's and Hasan's classification of so-called "cohesive ties". This theoretical framework makes it possible to describe the inner coherence of linguistic texts in a quantitative way. In the "schizophrenic texts" the sentences contained significantly fewer such cohesive ties than in those texts produced by normal speakers. An additional longitudinal analysis revealed an increase in the number of cohesive ties per sentence, when the same schizophrenic speakers were asked to produce a second text (in a similar context) after participating in a 3-month psychotherapy programme. The central goal of psychotherapy was to improve the patients' cognitive ability to face and cope with social stress situations. The results of several textual and statistical procedures are discussed, mainly under the aspect of cognitive dysfunctions during periods of non-acute schizophrenia.

Adult↗

Short stature: a common feature in Duchenne muscular dystrophy.

In a retrospective growth evaluation, which included parental height, birth length and a longitudinal analysis of growth and bone maturation, it has been shown that short stature is a common finding in Duchenne muscular dystrophy already in an early or even preclinical stage. Normal length and weight at birth, slow subsequent growth with a curve crossing the centiles in the 1st years of life, and normal bone maturation are characteristic of this type of short stature.

Body Height↗

Patterns of disease activity in multiple sclerosis patients: a study with quantitative gadolinium-enhanced brain MRI and cytokine measurement in different clinical subgroups.

In this study we assessed the subclinical disease activity in 45 patients with primary progressive, secondary progressive or relapsing-remitting multiple sclerosis (MS). The patients had gadolinium-enhanced brain MRI scans, which were analysed using a semiquantitative method both for lesion load and for degree of enhancement. At the same time cerebrospinal fluid (CSF) and serum samples were collected and, from these, cytokine levels were measured in most cases by enzyme-linked immunoassay using commercially available kits. Enhancing lesions on MRI were found in 73% of the patients. The sensitivity of this test was greatly increased by our method of analysis as far as the primary progressive patients are concerned (70% vs 40% for conventional evaluation). CSF interleukin-1 beta (IL-1 beta) levels were above the normal range in 22% and IL-6 levels in 13% of patients, while tumour necrosis factor alpha (TNF-alpha) was undetectable or below the upper normal limits in all the samples tested. Serum IL-1 beta was above the normal limits in 40%, IL-6 in 42% and TNF-alpha in 7% of patients. No significant differences in cytokine profiles were found between the clinical subgroups. This study confirms the high sensitivity of gadolinium-enhanced MRI in detecting MS activity, which was further increased by our method of analysis. Longitudinal studies performed with more sensitive immunological techniques are needed to define better the relationship between cytokine, clinical and MRI data in MS patients.

Adult↗

Change in cohabitation and intrapair similarity of monozygotic (MZ) cotwins for alcohol use, extraversion, and neuroticism.

We have reported cross-sectional evidence that behavioral similarities of adult monozygotic (MZ) cotwins are associated with their age at initial separation and the frequency of their subsequent social interaction (Kaprio et al., 1987; Rose et al., 1988; Rose and Kaprio, 1988). Twins who separated early and twins in infrequent interaction were less alike. Data for those reports came from a 1981 survey of the Finnish Twin Cohort. The Finnish cohort had been surveyed in 1975 with a similar questionnaire, and we now report a longitudinal analysis of the 1975-1981 surveys. All cohabiting MZ cotwins, ages 18-25 at the 1975 baseline, were followed up in 1981, and pairwise similarities at baseline and follow-up were compared for three groups: MZ pairs that remained cohabiting, separated pairs in which the cotwins retained regular contact with one another, and separated cotwins whose social interactions at follow-up were infrequent. For alcohol consumption and EPI Neuroticism scores, relative similarities of the MZ cotwins at follow-up paralleled the relative frequencies of their social contact; baseline differences in resemblance for Extraversion scores preceded follow-up differences in social interaction. These findings clarify the directional nature of associations found in our cross-sectional data and provide new, more compelling evidence of effects of shared experience on sibling resemblance for some dimensions of adult behavior.

Adolescent↗

The Zurich study. VIII. Insomnia: association with depression, anxiety, somatic syndromes, and course of insomnia.

The association of three subtypes of insomnia with psychic and functional syndromes, and the course of insomnia over 7 years were examined in a Swiss cohort of young adults interviewed three times. Specific associations were found between repeated brief insomnia (RBI) and recurrent brief depression (RBD). Continued insomnia (CI) was associated with major depression. All three subtypes of insomnia were associated with anxiety disorders; 52% of insomniacs were free of concurrent anxiety and depression. Insomnia--especially RBI and CI--was also associated with a number of functional complaints, but not with the consumption of alcohol, medicine, or illegal drugs. Insomniacs with RBI and occasional insomnia (OI) experienced more life events and interpersonal conflicts than controls. These findings support the subdivision of insomnia into different subtypes. The longitudinal analysis showed that insomnia tends to reoccur. For subjects with insomnia either at age 21 or 23 years, there was a higher risk of further insomnia at follow-ups. The specific subtype of insomnia at the first occurrence was not predictive for the outcome: all subtypes of insomnia enhance the risk of relapses in a similar way. Insomnia at age 21 is no precursor of the first onset of a depressive or anxiety disorder within a 2-year follow-up. With respect to the course of insomnia over 7 years, the subtypes did not differentiate.

Adult↗

Social contact, social attitudes, and twin similarity.

The nature of the relationship between social contact and attitude similarly between twins was investigated using longitudinal data from a sample of Australian twins. Earlier research has suggested that social attitudes are not explained solely by shared environment; rather there are both genetic and environmental components that explain variance in social attitudes. Using three types of analyses we investigated the magnitude of the relationship and the direction of causation between attitude similarity and social contact. Longitudinal analysis of within-pair variance by level of contact suggests that attitude similarity leads to contact among the females and that similarity is both genetically and environmentally based. Analyses using a crosslag regression model suggest that similarity causes contact among MZ females. Biometrical analyses indicate differences in direction of causation for males and females. Among females, both genetic and shared environmental parameter estimates could be equated across contact groups, suggesting little relationship between contact and similarity. Among males, findings of smaller estimated heritability in the high-contact group suggest that similarity causes contact. However, an increased estimate of the contribution of shared environmental variance in the high-contact males could additionally suggest that contact leads to similarity.

Adolescent↗

Factors contributing to frequent use of psychiatric inpatient services by schizophrenia patients.

BACKGROUND: Although present findings about frequent users of psychiatric inpatient services vary from study to study, some potentially important predictors of frequent use were extracted. The purpose of this study was to examine the potentially contributory factors of frequent use of psychiatric inpatient services by schizophrenia patients and to test the influence single factors have in an overall model. METHODS: A total of 307 schizophrenia patients were interviewed five times with intervals of 6 months. Data were collected about service receipt and health care costs, strength of primary diagnosis and comorbidities, as well as about patients' needs for care and satisfaction with care. Patients with three or more psychiatric admissions within a 30-month period were defined as frequent users. RESULTS: According to this criterion, 12% of the study population were frequent users. Compared with ordinary users, these patients accounted for significantly higher costs in hospital- and community-based care. Important predictors for frequent use of psychiatric inpatient services were the number of previous hospitalizations and current scores of psychopathology. In addition, a longitudinal analysis showed the importance of social factors for the use of psychiatric inpatient care. Therefore, a number of the frequent users' multiple admissions could also be caused by social problems. CONCLUSIONS: The mental health system should, thus, provide well-directed community-based resources, which give frequent users support to solve their social problems.

Adolescent↗

Hospital comorbidity bias and the concept of schizophrenia.

BACKGROUND: The comorbidity bias predicts that if disease definition is based on observations of patients in the hospital, spurious comorbidity of psychopathological dimensions that increase the probability of hospital admission will be included in the disease concept, whereas comorbid dimensions that are not associated with admission will be excluded. The direction of any dimensional comorbidity bias in psychotic illness was assessed in a longitudinal analysis of the psychopathology of patients assessed both inside and outside the hospital. METHOD: Four hundred and eighty patients with broadly defined psychotic disorders were assessed between one and nine times (median two times) over a 5-year period with, amongst others, the Brief Psychiatric Rating Scale. Dimensional comorbidities between positive symptoms, negative symptoms, depression/anxiety, and manic excitement were compared, in addition to their associations with current and future admission status. RESULTS: Higher levels of psychopathology in all symptom domains were associated with both current and future hospital admissions. Associations between the positive, negative, and manic symptom domains were higher for patients in the hospital than for patients outside the hospital, in particular, between positive symptoms and manic excitement (beta=0.28, p<0.001). However, associations between depression and other symptom domains were higher in out-patients as compared to in-patients (positive symptoms and depression, beta=-0.26; p<0.002). CONCLUSION: The current analyses suggest that, to the extent that disease concepts of psychosis do not take into account effects of dimensional comorbidity biases occasioned by differential psychopathology according to treatment setting, "florid" psychotic psychopathology may be overrepresented, whereas depressive symptoms may be spuriously excluded.

Adult↗

CD64 surface expression on neutrophils is transiently upregulated in patients with septic shock.

OBJECTIVE: To clarify the changes in total leukocyte counts, CD64 neutrophil receptor expression and serum granulocyte colony-stimulating factor (G-CSF) concentrations in critically ill patients without infection and sepsis and in patients with septic shock. DESIGN: Prospective study. SETTING: Intensive care unit (ICU) and research laboratory of a university hospital. PATIENTS: Eleven critically ill patients without infections and 22 patients with proven infections in septic shock for the first time and of at least 3 days' duration. MEASUREMENTS AND RESULTS: Over a 6month period, a longitudinal analysis of expression of the monomeric Fc receptor type I (CD64, FcgammaRI) on neutrophils was performed by flow cytometric analysis on a daily basis in all postoperative/post-traumatic patients admitted to the ICU until discharge from the ICU or death. Out of 273 patients, 11 patients without sepsis had organ failure and 22 patients with proven infections had septic shock for the first time and of at least 3 days' duration. Ten out of the 22 patients survived, 12 died. CD64 expression was greater in patients with septic shock than in patients without sepsis. Moreover, CD64 expression was only initially and transiently elevated in most survivors (9/10) and non-survivors (8/12) of septic shock. In survivors, G-CSF serum concentrations were markedly decreased in the 2nd week. CONCLUSIONS: Decreased neutrophil CD64 expression in an acutely ill population with septic shock may reflect the development of a non-responsive state as well as the early downregulation of neutrophil activation prior to the resolution of an ongoing infection.

Aged↗

Bone sialoprotein is a specific biochemical marker of bone metabolism in postmenopausal women: a randomized 1-year study.

Accelerated bone remodeling after the menopause is associated with increased bone loss that can be abolished using hormone replacement therapy (HRT). Biochemical markers of bone metabolism are known to correlate closely with changes in bone histomorphometry and osteodensitometry. Bone sialoprotein (BSP), a major constituent of bone matrix, is almost exclusively found in mineralized tissues and therefore considered a potential marker of bone metabolism. In 82 postmenopausal women, randomly allocated to either low-dose sequential HRT or no HRT, serum BSP was measured and compared with established specific biochemical markers of bone resorption [urinary deoxypyridinoline (DPD), pyridinoline (PYD) and amino-terminal telopeptide (NTx)] and markers of bone formation [serum osteocalcin (Oc) and bone-specific alkaline phosphatase (bALP)]. Longitudinal analysis showed a marked response of BSP levels following commencement of HRT, resulting in a 52% reduction after 12 months compared with initial values. The changes of BSP levels over time were at least as strong as in conventional markers of bone formation and resorption and paralleled their changes. A moderate to close correlation was found between BSP and both markers of bone resorption (r = 0.57 for NTx; r = 0.38 for DPD) and formation (r = 0.55 for Oc; r = 0.39 for bALP; p < 0.0001, respectively). Our data demonstrate a cause and effect relationship between commencement of HRT and a change in serum BSP. In conclusion, serum BSP circumvents some of the limitations of urinary measurements and appears valuable for the quantitative monitoring of the skeletal response to HRT in healthy postmenopausal women.

Aged↗

Trends in the use of inhaled corticosteroids for childhood asthma in New Zealand.

OBJECTIVE: To compare the dispensed volumes and prescribed doses for inhaled corticosteroids (ICS) for children in New Zealand. DESIGN: Longitudinal analysis of prescribing trends using the Royal New Zealand College of General Practitioners Research Unit database and the Pharm Warehouse database of the New Zealand Health Information System. SETTING: New Zealand from 1993 to 2001. SUBJECTS: Children aged 0-5 years and 6-17 years. MAIN OUTCOME MEASURES: The ratio of potency-adjusted mean daily dose of fluticasone propionate (FP) to beclomethasone (BDP) and dispensed volumes of FP, BDP and budesonide. RESULTS: The ratio of potency-adjusted mean daily dose of FP to BDP prescribed to children aged 0-17 years ranged from 1.22 to 1.91. With the introduction of FP, the total amount of ICS dispensed to children aged 0-5 years in New Zealand nearly doubled, when adjusted for potency. CONCLUSIONS: The introduction of FP into New Zealand corresponds with an increase in the total amount of ICS dispensed and an increase in the adjusted daily dose prescribed.

Administration, Inhalation↗

Skin tumors among employees of a tar refinery: the current data and their implications.

OBJECTIVE: Skin tumors and their preliminary stages may be recognized and compensated as an occupational disease only after exposure to soot, raw paraffin, tar, anthracene, pitch or similar substances. The presented study was carried out in one of the world's largest tar refineries and special attention was paid to the dermatological long-term effects and today's relevance of tar-induced skin lesions. METHODS: The data were generated by means of a standardized questionnaire based on occupational disease records and dermatological reports that have been carried out on a regular basis retrospectively. Among other things, the localization, the number and type of skin tumor, the date of diagnosis and the histological evaluation, where available, were taken into account. RESULTS: In a longitudinal analysis from 1946 to 2002, a total of n = 618 employees were examined. Squamous cell carcinomas n = 393, basal cell carcinomas n = 298, keratoacanthomas n = 194 and melanomas n = 6 were diagnosed. Latency periods for keratoacanthomas (median 29.5 years) and squamous cell carcinomas (median 28.0 years) were almost identical and could possibly imply that the pathomechanisms for both types of skin tumor might be comparable. Of the persons diagnosed, the skin tumors were mainly localized in the head region (n = 1,662). A remarkable divergence in the localization and distribution of the lesions was found when compared to the general population, for example the relative susceptibility of the upper lip (n = 67) compared to the lower lip (n = 31) as well as the less sun-exposed forearms (n = 381) compared to the back of the hand (n = 331), being typically preferred sites of squamous cell carcinomas. Furthermore, a discrepancy between the distribution of premalignant nonmelanoma skin tumors and carcinomas on the back of the nose, which is more exposed to the sun (n = 56) and those in the nostrils (n = 89), which are less exposed to the sun, but are in the act of breathing more exposed to tar, could be found. CONCLUSIONS: Tar-induced skin lesions are still of importance nowadays, which is reflected in the incidence of new cases and in the relapses of skin tumors. As a consequence, intensified measures are necessary, in the form of primary and secondary prevention. In view of the high incidence of malignant skin tumors in the general public, it is urgently necessary to take occupational hazards into consideration as well.

Adult↗

Growth and bone mineral density in long-lasting idiopathic hypercalciuria.

Growth retardation and osteopenia have been reported in some children with idiopathic hypercalciuria (IHC), particularly in those with nephrocalcinosis. The duration of hypercalciuria might be a risk factor for osteopenia. A retrospective longitudinal analysis of statural growth and a cross-sectional evaluation of bone mineral density (BMD) was carried out in 26 IHC children followed for 4-13 years. None of the patients had nephrocalcinosis. Growth, including pubertal growth spurt, was normal in all subjects. BMD Z score less than -1 was recorded in 3 subjects with hyperuricosuria. BMD Z score averaged -0.68+/-0.99 in the 9 subjects with associated hyperuricosuria and 0.21+/-0.64 in the 17 with occasional or no hyperuricosuria ( P=0.018). Our analysis shows that children with long-lasting IHC without nephrocalcinosis have normal growth, but those with associated hyperuricosuria may be at risk for osteopenia.

Bone Density↗

Persistence of invertebrate iridescent virus 6 in tropical artificial aquatic environments. Brief report.

The rate of loss of activity of invertebrate iridescent virus 6 (IIV-6, family Iridoviridae) was determined in two artificial aquatic habitats in southern Mexico, using a sensitive insect bioassay technique. IIV-6 placed in trays of water in direct sunlight suffered rapid loss of activity (99.99% reduction) over a period of 36 h, during which water temperatures fluctuated between 24 and 41 degrees C. No significant deactivation occurred during the hours of darkness. In contrast, IIV-6 placed in trays of water in the shade lost 97% of original activity over a 60 h period, during which water temperatures fluctuated from 24 to 31 degrees C. Longitudinal analysis involving mixed effects models of time (shade) and cumulative exposure to ultraviolet radiation (sunlight) indicated that the rate of deactivation was best described by third order polynomial equations in both cases. We conclude that the likelihood of transmission of IIVs in aquatic habitats will be mediated by the intensity of UV radiation and water temperature.

Animals↗

The role of emission tomography in dementia.

Positron emission tomography (PET) and single photon emission tomography (SPET) offer the opportunity to improve a diagnosis of dementia by providing regional functional measurements, which can be used to substantiate the clinical judgement. Further progress in the differential diagnosis among degenerative dementias is expected from pathological confirmation in the follow-up of patients evaluated with neuroimaging methods. A prospective multi-center cohort study of patients with possible or probable Alzheimer's disease mostly with presenile onset, showed impairment of brain glucose metabolism in temporoparietal or frontal association areas, as measured with PET. This was associated significantly with dementia severity, clinical classification, presence of multiple cognitive deficits, and history of progression. In addition, prospective longitudinal analysis showed a significant association between initial metabolic impairment (metabolic ratio = 0.80) and subsequent clinical deterioration. In patients with mild cognitive deficits at entry, the risk of deterioration was up to 4.7-times higher if metabolism was severely impaired than with mild or absent metabolic impairment. In the future, it might be possible to use different tracers to measure neurotransmitter release or receptor function. It may also be possible to scan the patient while performing cognitive tasks to examine changes in functional brain activity during pharmacological treatments.

Alzheimer Disease↗

Seventeen-year experience with bilateral internal mammary artery grafts.

The internal mammary artery (IMA) is being recognized as the conduit of choice for myocardial revascularization. From January 1972 through June 1988, 1,087 patients received bilateral IMA and supplemental vein grafts. There were 917 men (84.4%) and 170 women (15.6%) with a mean age of 62.4 years (range, 29 to 84 years). Three hundred ninety-four patients (36.2%) had unstable angina, and 194 (17.8%) had left main coronary artery stenosis greater than 50%. In all, 3,741 coronary grafts were performed, with a mean of 3.4 per patient. Hospital mortality was 2.7% (29 patients). Hospital complications included reoperation for bleeding, 19 patients (1.7%); sternal infection, 16 patients (1.5%); respiratory failure, 35 patients (3.2%); perioperative myocardial infarction, 22 patients (2.0%); and stroke, 20 patients (1.8%). Post-operative arteriography in 53 patients (mean postoperative time, 53.0 months) showed that 92.1% (58/63) of the left IMA and 84.9% (45/53) of the right IMA grafts were patent. Follow-up was completed on 1,058 hospital survivors. There were 82 late deaths (7.8%). The actuarial survival for patients discharged from the hospital was 80.0 +/- 3.2% (plus or minus standard error of the mean) at 10 years and 60.0% +/- 5.0% at 15 years. At follow-up, 866 patients (90.3%) were asymptomatic and in New York Heart Association class I and 68 (7.1%) were in class II. This longitudinal analysis demonstrates that bilateral IMA grafting has a low operative risk and provides excellent long-term functional improvement and survival.

Adult↗

Proliferative heterogeneity of vascular smooth muscle cells and its alteration by injury.

This study was designed to explore the question of whether the population of morphologically similar smooth muscle cells (SMC) in the vessel wall is functionally homogeneous or heterogeneous with respect to their proliferative response to injury. Using time-lapse video recording we measured interdivision times (IDT) of primary SMC clones, sibling pairs, and mother/daughter pairs. SMC from in vivo undisturbed vessels displayed an interclonal and intraclonal heterogeneity with a wide range in IDT. In vivo balloon injury resulted in a population with homogeneously short IDT. While 80% of IDT of SMC from injured vessels were shorter than 14 h, only slightly more than half of IDT of cells from undisturbed vessels fell into this category. Longitudinal analysis of mother/daughter pairs confirmed the presence of a heterogeneous population of SMC in the undisturbed vessel wall. In vivo balloon injury not only shortened the IDT of the majority of cells, but the shorter IDT persisted much longer than in the case of the undisturbed vessel. We suggest that a morphologically homogeneous SMC population in the aorta can now be subdivided into several groups of functionally different SMC with respect to their proliferative response to injury.

Angioplasty, Balloon↗

Evaluation of growth in anorexia nervosa from serial measurements.

Measured longitudinal growth data in a sample of 66 patients with anorexia nervosa (AN) (58 females and 8 males) is compared to expected growth from normative standards. The data was subject to cross-sectional as well as longitudinal analysis. Females had a normal growth rate and pattern, in particular a normal sequence and timing of pubertal events. Distribution of weight for age indicated a slight (non-significant) overweight before onset of anorexia nervosa. Weight by height was significantly above the expected before onset of AN. Mean age at Peak Height Velocity (PHV) was 11.5 yr. Mean size of PHV 8.03 cm/yr. A subsample of females (those with onset of AN after menarche) had a mean age of menarche of 12.88 yr. Mean distance in time from age at PHV to age at menarche was 1.34 yr. These results are normal for Scandinavian girls. Male anorexics were tall for age, heavy for age and, where a PHV could be seen (5 out of 8 cases), had signs of early puberty. Mean age at PHV was 11.8 yr, a highly significant difference from the normal mean age at PHV which is 14.06 yr for Scandinavian boys. Weight by height was distributed as in the reference population, that is, with no indication of pre-morbid obesity for male probands.

Adolescent↗