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This cross-sectional study aimed to evaluate the prevalence and predictive factors associated with late HIV diagnoses in Houston, Texas using surveillance data. Study subjects were Houston/Harris County residents, 13 years or older, diagnosed with HIV and reported to the Houston Department of Health and Human Services. Late HIV diagnosis was defined as an AIDS diagnosis within three months of an HIV diagnosis. Logistic regression was used to investigate the association between late HIV diagnoses and predictive factors. We found 31% of the study population had late HIV diagnoses. The Hispanic population, men, older individuals, heterosexuals, and those diagnosed in private facilities were more likely to receive late HIV diagnoses. Sensitivity analysis was conducted to evaluate the effect of time from HIV to AIDS diagnosis on the prevalence of a late diagnosis, and on the predictors of late diagnosis. The sensitivity analysis showed time affects prevalence, but not the odds ratios of the risk factors for late diagnosis. This finding suggests HIV prevention programs should specifically target these populations at risk for late HIV diagnosis to encourage frequent HIV testing.

Background: Injection drug is the second most frequent HIV/AIDS exposure in the United States. Social support and depression may mediate risky behaviors among drug injectors., Objectives: To describe differences in perceived social support and depressive symptoms between male and female injection drug users, and to describe factors associated with depressive symptoms., Methods: Using respondent-driven sampling, we recruited and interviewed injection drug users in Houston, Texas. Data were from the Centers for Disease Control and Prevention's National HIV Behavioral Surveillance Program. We used the short Center for Epidemiologic Studies Depression Scale (CES-D 10) and scales for perceived social support from family, friends, and significant others from the Multidimensional Scale of Perceived Social Support. Four-hundred seventy-one participants had complete data and were included in this analysis., Results: Seventy-five percent of male and female participants had CES-D scores indicating depressive symptoms. In a multivariate logistic regression, depressive symptoms among men were positively associated with frequent use of speedballs (injecting heroin and cocaine together) and never having tested for HIV, and negatively associated with perceived social support from a special person. Among women, depressive symptoms were positively associated with currently smoking cigarettes, having no health insurance, and more years of injection drug use, and negatively associated with perceived social support from a special person., Conclusions: Lack of social support from a special person or significant other was associated with depressive symptoms in both males and females. Our findings suggest that depression and social support should be addressed when developing HIV prevention programs among injection drug users.

Objectives: To identify and analyze trends in bullous disease mortality from 1979 through 2002 in the United States., Design: Retrospective population-based analysis., Setting: Mortality records from the Centers for Disease Control and Prevention mortality database., Participants: Mortality records from 1979 through 2002 for persons who died of bullous disease., Main Outcome Measures: Age-adjusted mortality rates and trends for 4 bullous disease subgroups: toxic epidermal necrolysis, pemphigoid, pemphigus, and epidermolysis bullosa., Results: The overall age-adjusted (to the 2000 US standard population) annual mortality rate from bullous diseases of the skin was 0.103 death per 100 000. The average mortality from bullous disorders was 0.098 per 100 000 in 1979 through 1982 and remained stable at 0.099 per 100 000 during the final 4 years of the study, 1999 through 2002. Pemphigoid had a significant increase in mortality from 1979 through 2002, while pemphigus demonstrated a significant decrease in mortality. The mortality rate for toxic epidermal necrolysis was much higher among blacks (0.192 death per 100 000) than whites (0.025 per 100 000) (P < .001), with a mortality rate ratio of 7.57 (95% confidence interval, 6.97-8.21)., Conclusions: Overall mortality from bullous diseases remained stable from 1979 through 2002, although an increasing mortality from pemphigoid and a decreasing mortality from pemphigus occurred during this period. A very large racial disparity in mortality from toxic epidermal necrolysis was observed.

Imipramine-induced hyperpigmentation is rare with only 13 cases reported in the literature to date. We report a 64-year-old female who presented with blue-gray discoloration on her face present for 4-5 years. The patient's medications included imipramine for depression for approximately 23 years. Physical examination revealed slate-gray hyperpigmented discrete and coalescing macules of the malar cheeks and the bilateral temples and periorbitally. She also had diffuse gray pigmentation of the bilateral dorsal hands. Histologic examination revealed an unremarkable epidermis with golden-brown round globules clustered in the superficial dermis, which stained strongly positive with a Fontana-Masson stain. Prussian blue stain for hemosiderin was negative. A diagnosis of imipramine-induced hyperpigmentation was made. Imipramine-induced hyperpigmentation as well as a detailed review of drug-induced hyperpigmentation is discussed., ((c) 2008 John Wiley & Sons A/S.)

Objectives: Patient literacy affects many aspects of medication use and may influence the measurement of adherence. The aim of the study is to design and evaluate a medication adherence scale suitable for use across levels of patient literacy., Methods: The Adherence to Refills and Medications scale (ARMS) was developed, pilot tested, and administered to 435 patients with coronary heart disease in an inner-city primary care clinic. Psychometric evaluation performed overall and by literacy level, included an assessment of internal consistency, test-retest reliability, and factor analysis. Criterion-related validity was evaluated by comparing scores with Morisky's self-reported measure of adherence, medication refill adherence, and blood pressure measurements. Lexile analysis was performed to assess the reading difficulty of the instrument., Results: The final 12-item scale had high internal consistency overall (Cronbach's alpha = 0.814) and among patients with inadequate (alpha = 0.792) or marginal/adequate literacy skills (alpha = 0.828). Factor analysis yielded two subscales, which pertained to taking medications as prescribed and refilling medications on schedule. The ARMS correlated significantly with the Morisky adherence scale (Spearman's rho = -0.651, P < 0.01), and it correlated more strongly with measures of refill adherence than did the Morisky scale. Patients with low ARMS scores (which indicated better adherence) were significantly more likely to have controlled diastolic blood pressure (P < 0.05), and tended to have better systolic blood pressure control. Lexile analysis demonstrated that the instrument had a favorable reading difficulty level below the eight grade., Conclusion: The ARMS is a valid and reliable medication adherence scale when used in a chronic disease population, with good performance characteristics even among low-literacy patients.

Background: Total body cutaneous photography is increasingly being used by dermatologists to monitor patients at risk for the development of melanoma, but limited evidence exists regarding the impact of such photography on melanoma and melanoma-related outcomes., Objective: We sought to compare biopsy number in patients with multiple atypical nevi in their first year of care at our pigmented lesion clinic (PLC) between those who received total body skin examination alone and those who received total body skin examination and total body digital photography (TBDP). We sought to identify predictors of biopsy number and number of dysplastic nevi diagnosed in patients with multiple atypical nevi., Methods: A chart review was performed of patients attending the PLC during the years 1998 to 2003 to identify the number of biopsies performed in the first year of care. Patient demographics, melanoma risk factors, and melanoma outcome events were also abstracted from the charts., Results: The mean number of biopsies performed in patients in their first year of care at the PLC in those who did not receive TBDP was equal to the mean number of biopsies performed in patients who did receive TBDP (0.82 and 0.8, respectively). Linear regression analysis revealed that the interaction term between a lack of both personal history of melanoma and severe dysplastic nevi (-0.930, P = .005) has a significant protective effect on the number of biopsies. Similar regression analysis also showed that the interaction term between a lack of both personal history of melanoma and of severe dysplastic nevi (-1.209, P < .0001), increasing provider experience (-0.047, P = .029), and increased number of biopsies before the initial PLC (-0.028, P = .050) have a statistically significant protective effect on the number of dysplastic nevi diagnosed in the first year of PLC. TBDP did not have an effect on the number of biopsies or on the number of dysplastic nevi diagnosed in the first year of care at the PLC., Limitations: This study is limited by being retrospective in nature, having a small sample size, and having a short follow-up period., Conclusion: Overall, this small retrospective study does not provide evidence that would suggest that TBDP changes provider behavior in caring for patients at high risk for melanoma. Rather, our study supports the fact that a patient's positive history of melanoma and a history of severe dysplastic nevi have the most significant impact on provider biopsy behavior, resulting in a lower threshold to biopsy suggestive lesions.

Purpose: We determined the incidence of Fitz-Hugh-Curtis syndrome (FHCS) in adolescents who had mild to moderately severe pelvic inflammatory disease (PID)., Design: Prospective cohort study., Setting: Harris County Juvenile Detention Center, April 2000-April 2006., Participants: Incarcerated female adolescents., Intervention: In patients who met accepted criteria for the diagnosis of PID, we determined the proportion that had right upper quadrant pain that responded to therapy for PID. They were diagnosed as having FHCS., Results: The 117 subjects' mean age (SD) was 15.6 (1.8) years; 37% were Hispanic, 34% black, and 26% white. 5/117 (4.3%, 95% confidence interval 1.4-9.7%) had symptomatic FHCS. Fifteen (13%) of all subjects, including 1 with FHCS, had fever and/or nausea and vomiting (moderately severe PID): none had generalized peritonitis or tubo-ovarian abscess (severe PID). Thirty-four had chlamydial, 4 gonorrheal, and 9 combined infections. All improved with standard outpatient PID therapy., Conclusion: FHCS was uncommon (4%) in adolescents who had mild to moderate PID and chlamydia as the most common pathogen.

This study investigated the social and behavioral predictors of consistent condom use among female commercial sex workers (FCSWs) in Ghana. Four hundred fifty street commercial sex workers were interviewed in Accra, Kumasi and Techiman. The level of condom education was very low (14%); however consistent condom use (all the time) with clients was relatively high (49.6%). Two hundred seventy-seven of the participants did not use condoms all the time.

Medication nonadherence remains a significant obstacle to achieving improved health outcomes in patients with chronic disease. Self-efficacy, the confidence in one's ability to perform a given task such as taking one's medications, is an important determinant of medication adherence, indicating the need for reliable and valid tools for measuring this construct. This study sought to develop a self-efficacy scale for medication adherence in chronic disease management that can be used in patients with a broad range of literacy skills. The Self-efficacy for Appropriate Medication Use (SEAMS) was developed by a multidisciplinary team with expertise in medication adherence and health literacy. Its psychometric properties were evaluated among 436 patients with coronary heart disease and other comorbid conditions. Reliability was evaluated by measuring internal consistency and test-retest reliability. Principal component factor analysis was performed to evaluate the validity of the SEAMS. Reliability and validity analyses were also performed separately among patients with low and higher literacy levels. The final 13-item scale had good internal consistency reliability (Cronbach's alpha = 0.89). A two-factor solution was found, explaining 52.3% of the scale's variance. The scale performed similarly across literacy levels. The SEAMS is a reliable and valid instrument that may provide a valuable assessment of medication self-efficacy in chronic disease management, and appears appropriate for use in patients with low literacy skills.

There has been speculation that trends in syphilis have been fueled by crack cocaine use. This study examined the data on syphilis notifications and arrestee drug abuse monitoring (ADAM) to ascertain the relationships between syphilis and cocaine use trends in three racial/ethnic groups. Syphilis notifications and data from the ADAM project were compared in Houston/Harris County, Texas, from 1991-1998 using a linear regression equation. Data indicated significant relationships between the data for cocaine use and syphilis in African Americans but not Hispanics or non-Hispanic whites. For African Americans, 58% of the variance between cocaine use and syphilis was explained. When data limited to jail syphilis notifications and ADAM cocaine in African Americans were examined, the association was stronger for males than for females. For African Americans, cocaine (probably crack cocaine) use trends were significantly associated with syphilis trends in this population. These data suggest that control of crack cocaine may have an impact on syphilis rates and that there may be close relationships between some STDs and drug abuse.

Hurricane Katrina made landfall along the Gulf Coast as a Category 3 storm on August 29, 2005. Many residents were evacuated to neighboring cities owing to massive destruction. Working with the City of Houston Health Department, researchers conducted a medical and psychological needs assessment of 124 Hurricane Katrina evacuees in Houston shelters from September 4-12, 2005. Among those willing to talk about their experiences, 41% were afraid they would die, 16% saw someone close to them injured or die, 17% saw violence, and 6% directly experienced physical violence. When using a version of the Impact of Stress Experiences scale, the majority of evacuees scored as experiencing moderate (38.6%) to severe (23.9%) post-traumatic stress disorder (PTSD) symptoms. These data suggest that in addition to challenges in finding loved ones, housing, and jobs, many Katrina survivors have experienced significant psychological trauma that may lead to future PTSD.

Study Objective: The Centers for Disease Control and Prevention (CDC) recently changed the recommended criteria for the clinical diagnosis of pelvic inflammatory disease (PID). The purpose of this study was to assess the impact of this change on the frequency with which we made a diagnosis of PID., Design: prospective cohort study., Setting: juvenile detention center., Participants: adolescent females., Interventions: We used the new diagnostic criteria to determine the prevalence and incidence of PID. We then compared these values to those in a previous study of a similar cohort of youth who were evaluated with the CDC's old, more stringent clinical criteria., Main Outcome Measures: Prevalence and incidence of PID. INCIDENCE MEASURES: Incidence density and cumulative incidence, using the Kaplan-Meier method. Results between studies were compared using prevalence and incidence ratios., Results: In sexually active adolescents (N=315), the prevalence of PID (95% confidence interval) at admission was 8.6% (5.7-12.2%). During the first 31 days of incarceration, the cumulative incidence was 7.9% (5.0-12.3%) and the incidence density was 11.1 cases/100 person-months (6.5-16.4). Comparison of these results with those of our previous study that used old diagnostic criteria yielded a prevalence ratio of 2.0 (1.0-4.2), a risk ratio (comparing cumulative incidence) of 3.6, and a rate ratio (comparing incidence density) of 3.4 (1.2-11.2). All differences were statistically significant (P<0.05)., Conclusion: The new diagnostic criteria for PID doubled the prevalence and more than tripled the incidence of this disease in this high risk population of incarcerated adolescents.

Purpose: (a) To compare weight change at 1 year between adolescents 13-19 years old who were using either depot medroxyprogesterone acetate (DMPA) or oral contraceptives (OC), and (b) to determine if age, baseline body mass index (BMI), race/ethnicity, or weight gain at 3 months predicted which subjects would gain excessive weight., Method: The setting was a Planned Parenthood Teen Clinic with chart review of variables of interest. Excessive weight was defined as weight gain > 10%., Results: Baseline variables were similar in the two groups, except that DMPA users (n = 44) had a greater mean BMI (t test, p = .05) than OC users (n = 86). Mean (standard deviation) and median weight gains at 1 year were 3.0 (4.5) and 2.4 kg in the DMPA users and 1.3 (3.9) and 1.5 kg in the OC users (difference in medians not significant, Wilcoxon rank sum test, p = .10). Fifty-six percent of DMPA and 70% of OC users lost weight or gained < 5% of their baseline weight (p = .17, Fisher exact test); 25% of DMPA users and 7% of OC users gained > 10% of their baseline weight (p = .006). Age, baseline BMI, or race/ethnicity did not affect the likelihood that either group would gain > 5% or > 10% of their baseline weight. Of adolescents who gained > 5% of baseline weight at 3 months, 13 of 14 (93%) gained even more weight at 12 months., Conclusions: The majority of adolescents who used hormonal contraception for 1 year lost weight or gained < 5% of baseline weight. DMPA users were more likely than OC users to gain > 10%. Subjects who gained > 5% of baseline weight at 3 months were at high risk (93%) of gaining even more weight by 1 year.

Background: National and local syphilis rates have fallen since 1990. Accurate epidemiologic information about the distribution of syphilis during the waning years of an epidemic are important to health care organizations so that they can specifically target screening and intervention programs., Goals: To describe the epidemiology of syphilis in Houston, Texas, from 1991 through 1997., Study Design: Descriptive evaluation of morbidity surveillance data from the Houston Department of Health and Human Services., Results: Between 1991 and 1997, rates for syphilis fell 61%. Rates for primary and secondary syphilis fell 90% among men and women in all race/ethnicity groups; early latent rates fell 81% among blacks, 57% among Hispanics, and 50% among whites. Late latent rates were stable among blacks and whites and increased among Hispanics. The proportion of total cases identified as late latent disease increased from 16% in 1991 to 63% in 1997. Congenital syphilis rates have remained at approximately 2 per 1,000 live births since 1993., Conclusion: Syphilis continues to be a problem in Houston. The medical community and HIV/STD prevention programs need to be vigilant in actively screening high-risk individuals to identify syphilis at earlier stages of the disease and to prevent congenital syphilis.

Objective: To evaluate the effects of nutrition counseling with or without oral supplementation in malnourished patients infected with the human immunodeficiency virus (HIV)., Design: Randomized controlled trial., Subjects: HIV-infected men (n=118) who were less than 90% of usual weight for height or who had lost more than 10% of body weight., Intervention: Nutrition counseling alone (control group) vs nutrition counseling plus enteral supplementation (supplement group) for 6 weeks. All patients were instructed to consume a diet that exceeded estimated total energy expenditure by 960 kcal/day., Main Outcome Measures: Weight, skinfold thickness, fat-free mass, grip strength, quality of life, and cognitive function (Buschke test)., Statistical Analyses: Differences in baseline variables and outcomes were evaluated using analysis of variance or the Wilcoxon rank sum test., Results: Ninety-nine men completed at least 4 weeks of treatment, 49 in the supplement group and 50 in the control group. Half the patients in each treatment group achieved at least 80% of their energy target. No differences in weight, skinfold thickness measurements, or quality of life were observed. Compared with the control group, the supplement group had larger increases in fat-free mass and grip strength, although the differences did not reach statistical significance., Applications: In the short term, nutrition counseling with or without oral supplementation can achieve a substantial increase in energy intake in about 50% of malnourished HIV-infected patients. Although further study is needed to evaluate long-term effects, these findings suggest that nutrition counseling has an important role in the management of malnourished HIV-infected patients.

The purpose of this study was to determine the influence of the D1-selective partial agonist SKF 38393 on the odor detection performance of rats using high precision olfactometry and a go/no-go operant task. Previous studies have found that the D2 receptor partial agonist quinpirole decreases such performance, but the influences of D1 receptor activation are unknown. In experiment 1, such detection performance to the odorant ethyl acetate was enhanced by SKF 38393, relative to saline, in male rats at 7.5 and 10.0 mg/kg i.p. dose levels, but not at the lower doses of 1.0, 2.5, and 5.0 mg/kg. In experiment 2, this enhancement was replicated at the 7.5 and 10.0 mg/kg doses and was shown to occur at the 12.5 mg/kg dose as well. In experiment 3, similar enhancement was shown for the odorant eugenol in female rats at the 7.5, 10.0 and 12.5 mg/kg doses, suggesting this effect is neither sex-specific nor confined to the odorant ethyl acetate. In experiment 4, a 0.025 mg/kg dose of the D1 receptor antagonist SCH 23390 depressed the enhancement produced to ethyl acetate by 7.5 mg/kg SKF 38393 to control levels. Overall, these data demonstrate that, in contrast to quinpirole, SKF 38393 improves odor detection performance in the rat and that this phenomenon can be attenuated by the D1 receptor blocker SCH 23390.

Objectives: To compare grating visual acuity of eyes with varying severity of retinal residua of retinopathy of prematurity to grating visual acuity of eyes that did not have acute-phase retinopathy of prematurity, showed no ocular abnormalities on follow-up, and were from patients who passed neurodevelopmental screening questions., Design: Monocular grating visual acuity was measured by means of the Teller acuity card procedure when children reached 1, 2, 3 1/2, and 4 1/2 years of age., Patients: A total of 1398 children with birth weights less than 1251 g whose acute-phase retinopathy of prematurity was documented as part of the Multicenter Cryotherapy for Retinopathy of Prematurity Study and who participated in follow-up visual acuity testing., Results: Eyes with no or mild residua of retinopathy of prematurity showed a mean visual acuity similar to that of the comparison group. Eyes in a subgroup with abnormally straightened temporal retinal vessels showed a mean visual acuity approximately 1 octave below that of the comparison group. Mean visual acuity scores from eyes with macular heterotopia ranged from 1 octave (at 1 year) to more than 2 octaves (at 4 1/2 years) below the mean visual acuity of the comparison group. Mean visual acuity scores for the few eyes in the retinal fold or partial detachment group that had quantifiable visual acuity were well below the means for the comparison group., Conclusions: Acute-phase retinopathy of prematurity that regresses without retinal residua produces no deficit in grating visual acuity between 1 and 4 1/2 years of age. In contrast, eyes with macular heterotopia show a visual acuity deficit, and the deficit is greater at older than at younger ages. Eyes with retinal fold or partial detachment that have measurable visual acuity show large visual acuity deficits at all ages.

Background: Loss of lean-body mass has been found to be predictive of death from wasting in HIV-infected individuals. Several clinically applicable, noninvasive methods for estimating body wasting are available, but the comparability of these methods is not known. The objective of this study was to assess the agreement between estimates of lean-body mass in HIV-infected men., Methods: Lean-body mass was measured by bioelectrical impedance assessment, by prediction equations that used anthropometric measurements, and by total body electrical conductivity as the comparison method in 27 outpatient HIV-infected men seen at the Houston Veterans Affairs Special Medicine Clinic. Agreement was assessed by comparing the difference between two methods (the bias) with the mean of those two methods. This statistical approach evaluates whether two methods are similar enough that measurements from one might accurately replace those of the other., Results: The mean +/- SE for lean-body mass were 55.98 +/- 1.96 kg for total body electrical conductivity and 55.18 +/- 1.27 kg for bioelectrical impedance assessment; they ranged from 55.18 +/- 1.27 to 63.71 +/- 1.89 kg for the prediction equations., Conclusions: In individual subjects, no alternate method gave estimates of lean-body mass that were the same as estimates from total body electrical conductivity. One prediction equation (Brozek) gave estimates that might be useful for following changes in fat-free mass over time because the bias did not change substantially for increasing values of lean-body mass. On the other hand, because there were no statistically significant differences between the mean lean-body mass estimates by total body electrical conductivity and those measured by bioelectrical impedance assessment or a prediction equation on the basis of body mass index, the latter two methods might be useful in assessing lean-body mass in groups.

Objective: To develop a simple clinical staging system based on CD4 count and clinical variables that predicts progression to AIDS in HIV-infected non-AIDS patients., Design: Retrospective cohort study., Setting: A primary care outpatient clinic for HIV-infected patients at a VA Medical Center., Patients: One hundred seventy-six HIV-infected non-AIDS patients seen at the Houston VA Special Medicine Clinic between January 1986 and December 1990 and followed for a mean of 22 months. Fifty-four patients (31%) progressed to AIDS during follow-up., Measurements: The medical records were reviewed, and data corresponding to the initial (baseline) clinic visit and subsequent six-month visits were extracted., Main Results: "Predictive" baseline variables (i.e., those associated with progression to AIDS) were first identified and then examined in Cox proportional hazards modeling. In the final model, CD4 category, oral thrush, and night sweats made significant independent contributions. A three-stage prognostic system was constructed by assigning points to the three variables: CD4 > 500 cells/mm3 = 0; 500 > or = CD4 > or = 200 = 1; CD4 < 200 = 2; presence of oral thrush = 1; presence of night sweats = 1. Stages were assigned as follows: stage I = 0 points, stage II = 1-2 points, and stage III = 3-4 points. The proportions of patients who progressed to AIDS were: stage I, 6/39 (15%); stage II, 31/106 (29%); and stage III, 17/31 (55%)., Conclusions: These results demonstrate that simple, clinically sensible prognostic staging systems that predict progression to AIDS can be constructed using CD4 count and clinical variables.

Taste detection performance for representatives of the four taste qualities as a function of stimulus volume (5 x 10(-4) to 1 x 1(-1) ml) was examined in rats using high-precision gustometry, computer-controlled operant procedures, nonparametric signal detection measures of sensitivity and responsivity, and blind control procedures. The overall sensitivity index was positively related to stimulus volume (rs = .60), with optimal detection performance attained with a 5 x 10(-3) ml stimulus volume for salty tastants and a 1 x 10(-2) ml stimulus volume for the other taste qualities. The overall responsivity index was inversely related to stimulus volume (rs = -.47), especially for sour and bitter tastants. These results are consistent with prior observations and demonstrate that operant methods using small tastant samples produce sensitive estimates of the rat's taste detection performance and response bias.

The influence of adrenalectomy (ADX) on the odor detection performance of male Long-Evans rats was assessed using high-precision olfactometry and a go/no-go operant signal detection task. Nonparametric signal detection measures of sensitivity and responsivity, as well as measures of S+ response latency, the number of aborted trials, and session time, were obtained in daily 250-trial test sessions prior to and after adrenalectomy. Four ADX animals were tested using the odorant pyridine, three using the odorant eugenol, and two using the odorant ethyl acetate. Nine other rats served as sham-operated controls. Neither odor detection nor related nonsensory performance measures were influenced by adrenalectomy or sham-operation procedures. These results imply that adrenalectomy has little or no influence on the odor detection performance of the rat.

In brief After childhood, iron deficiency is mainly a problem in females, but it also occurs in males aged 11 to 14 years. Inadequate dietary intake of iron is the major cause of iron deficiency, but factors such as gastrointestinal (GI) blood loss may contribute to this problem. Mild anemia may impair sports performance, and some research suggests that iron deficiency without anemia also has an adverse effect. The diagnosis of iron deficiency should be based on the patient's serum ferritin and hemoglobin concentrations. Treatment requires therapeutic doses of oral ferrous iron for several months.

Rats with posterior transection of the lateral olfactory tract (LOT), lesions of the mediodorsal thalamic nucleus (MD), or with combined lesions of these structures were tested for retention of a preoperatively learned multiple odor discrimination task, acquisition of 3 simple 2-odor discrimination problems, and reversal of the last problem of the series. Compared to controls, rats with transection of the LOT had no deficits in any task. Those with MD lesions had no deficits in retention but moderate deficits in acquisition of novel odor discriminations and a severe deficit in reversal learning. Rats with combined LOT and MD lesions had no retention of the preoperatively learned task but their performance on the remaining problems was similar to that of rats with only MD lesions. These results suggest that neither the olfactory thalamocortical projections nor those to the periamygdaloid or entorhinal cortex are essential for storage and/or recall of an olfactory procedural memory task. Performance on the postoperative acquisition tests indicate that the thalamocortical but not the limbic olfactory projections play an important role in olfactory discrimination learning.

Information is limited on the effect of exercise on bone density in young eumenorrheic athletes. We studied 12 Caucasian intercollegiate volleyball players (V), nine basketball players (B), ten swimmers (S), and 13 non-athletes (N) with bone density measurements by photon absorptiometry of their calcaneus and lumbar spine (L2-L4). The effect of athletic status on bone density was analyzed by multivariate analysis of covariance, with height and weight as covariates. The bone densities reported below are mean +/- SE, adjusted for the covariates; units = g.cm-2, P less than 0.005. The swimmers had a significantly lower mean density in the lumbar spine than all other groups; the non-athletes' mean density was also lower than that of volleyball players (V = 1.31 +/- 0.03, B = 1.26 +/- 0.04, N = 1.18 +/- 0.03, S = 1.05 +/- 0.03). The volleyball and basketball players' mean calcaneal densities were greater than those of the swimmers and non-athletes (V = 0.530 +/- 0.017, B = 0.564 +/- 0.023, N = 0.438 +/- 0.018, S = 0.375 +/- 0.019). The higher bone densities for athletes in vertical weight-bearing activities are consistent with some but not all published data. The swimmers' low bone density in the lumbar spine, less than published values for amenorrheic runners, was unexpected.

We studied the incidence of injury caused by weight training in junior and senior high school football players. Three hundred fifty-four subjects completed a retrospective injury questionnaire; histories were confirmed for high school athletes. Cumulative incidence and incidence rates were determined for injuries causing more than 7 days of missed participation. The cumulative incidences of injuries were as follows: all athletes, 7.6% (27/354); junior high school athletes, 7.1% (7/98); high school freshman/junior varsity athletes, 9.4% (15/159); and high school varsity athletes, 5.2% (5/97). The total incidence rate was 0.082 injuries per person-year, with 0.11 injuries per person-year in junior high school athletes, 0.091 injuries per person-year in high school freshman/junior varsity players, and 0.051 injuries per person-year in high school varsity players. Differences in the incidence measures among groups were not statistically significant. The most common injury type was a strain (74.1%), and the most common site was the back (59.3%). Certain exercise apparently caused more back injuries in older athletes.

The authors present several cases of gunshot injury to the foot. Classification of wounds according to weapon type and caliber is discussed, as well as treatment rationale. Emphasis is placed on the need for detailed wound history and classification as precursors to adequate therapy. The low-velocity, high-energy wound type is introduced, and its variation from the current low- and high-velocity classifications discussed.

Fluprazine hydrochloride (DU 27716) decreases copulatory and offensive attack behaviors of male rats and increases their latency to locate buried food in an open field. Since such behaviors are mediated to some degree by the olfactory system, several investigators have hypothesized that this drug may produce an overall impairment in olfactory sensitivity. To test this hypothesis, the influences of five doses of fluprazine hydrochloride (1.0, 2.5, 5.0, 7.5 and 10.0 mg/kg IP) on the odor detection performance of 12 adult male Long Evans rats was assessed, relative to saline, using high precision olfactometry and a go/no-go operant odor detection task. Treatments were administered every 3rd day in counterbalanced order, with the drug or saline injections occurring 30 minutes before the 260-trial test sessions. No significant influence of fluprazine was observed on odor detection performance, as measured by the nonparametric signal detection sensitivity index SI and the percentage of correct trials. These results indicate that fluprazine does not induce generalized olfactory impairment.

Because adolescents avoid bringing sensitive issues, such as substance abuse, suicide, and sexual activity, to pediatricians, and may fail to realize that they need health education or services, a computer program was designed to facilitate reporting of high-risk psychosocial and health behaviors and to provide specific health advice and referral for timely professional intervention. Computer printouts done anonymously by a random sample of 265 adolescents after a physical examination were compared with those of a matched group of 294 who were predirected to share the printout with the clinician at their examinations. The former elicited more positive responses to sensitive health problems, but both computer groups responded significantly more often about most high-risk issues than a matched written questionnaire group of 251. Almost all adolescents said that they reported true information to the computer and read all the information it printed. Experience with 3327 teenagers demonstrated that 89% preferred the computer over a questionnaire or personal interview, but nearly all were willing to share the printout with the pediatrician, which should facilitate clinical evaluation. The nonjudgmental computer can identify problem areas and deliver automated medical advice and referral. Automated health assessment and education may become a useful adjunct for addressing adolescent health issues.

Shape discrimination learning by four groups of 150-day-old Sprague-Dawley rats was studied. The groups were the offspring of mothers on the following schedules: (1) prenatal and postnatal methadone, (2) prenatal methadone and postnatal saline, (3) prenatal and postnatal methadone, and (4) prenatal and postnatal saline. The hypothesis investigated was that the methadone groups would show a deficit in learning when compared to the saline-control group. This hypothesis was upheld for the prenatal methadone group and the postnatal methadone group.

Immobility in intravenous digital angiography (ANIV) plays a leading part for high-quality results. Three hundred forty children (mean age 30 months, mean weight 12 kg) had an intravenous digital angiography in day-hospital's conditions. Intravenous general anesthesia with or without short neuromuscular blockade is able to help immobility in children. Method described requires a perfect synchronization with the radiologist. Anesthesia mean life was 6 minutes. No incident or fatal accident was observed. Many observations either confirmed the diagnosis or decided a surgical intervention. Determinant character of obtained investigations incite us to accept risks inherent in the technique.

The foregoing long term follow-up examinations of 8 cases demonstrate that the increase of the scoliotic deformity can be prevented by spinal fusion. Correction can be maintained by fusion. One of the best methods of correction is a combination of traction and lateral bend. Spinal pain can be eliminated by fusion. Corrective holding casts can prevent increasing deformity during during the period of vertebral growth and may maintain some correction of the deformity.

A review of the literature shows that some loss of correction after seemingly adequate fusion, with or without spinal instrumentation, is considered inevitable and, in general, accepted. A critical study of case series reveals that occult silent pseudoarthrosis is the commonest cause of this loss. It is suggested that the use of corrective roentgenography is a valuable aid in the diagnosis of these lesions.

Occut pseudarthrosis is the most likely cause of loss of correction of scoliosis. Prompt detection by serial roentgenograms and treatment of occult pseudarthrosis can prevent deformities which could develop with further spinal growth.

A follow-up study of 34 cases shows that scoliosis after termination of vertebral growth is commonly a progressive condition. In the increase of scoliosis disc degeneration is the most important single factor. Further increase may result from lateral subluxation of the vertebra. Once disc degeneration is initiated further increase is inevitable. The results of the study also suggest that change in the disc is possibly more closely related to the nutritional and metabolic condition of the individual than to any other factor.

The influence of adrenalectomy on the taste sensitivity and responsivity of Long-Evans rats to sodium chloride and sucrose tastants presented separately and in mixtures was examined using high precision gustometry, computer-controlled go/no-go operant procedures, and nonparametric signal detection measures. Relative to baseline levels, adrenalectomized rats' plasma corticosterone levels decreased by 328% while sodium chloride and water consumption increased by 548% and 165%, respectively. The same measures remained unchanged in sham-operated animals. Taste sensitivity and responsivity to sodium chloride and sucrose did not differ between adrenalectomized and sham-operated animals and discrimination performance remained the same between the groups as well. The present results support and extend previous findings that adrenalectomy and the resultant corticosteroid deficiency does not influence taste sensitivity or responsivity in the rat.

Seven-day-old sham operated rats and those with lesions of the rostral medial, lateral, or posterior medial olfactory bulbs were tested postoperatively for nipple attachment behavior and weighed daily. The posterior medial lesions included the area of the modified glomerular complex (MGC), a region of the bulb that has been implicated in suckling behavior. There were no significant differences among groups in nipple attachment latency or weight gain. These results do not support the notion that the MGC is essential for suckling in neonatal rats.

Undergraduate students in social science and architecture did not differ in their accuracy of adjusting the vertical lines of L and inverted-T figures to be equal to a 1-in. horizontal line (the adjustment task) or in producing a 1 in. long line in the vertical or horizontal plane on a blank sheet of paper (the production task). In the adjustment task vertical lines were made significantly shorter than the horizontal comparison line and the shortening of the vertical line was significantly greater for the inverted-T than for the L-figure. In the production task lines drawn in the horizontal plane did not differ significantly from 1 inch but those drawn in the vertical plane were significantly shorter than 1 inch. Further, the magnitude of this error was equal to that obtained with the inverted-T figure. These results demonstrate that, while line bisection (the bisection of the horizontal by the vertical in the inverted-T figure) contributes to the horizontal-vertical illusion, the illusion clearly exists in the absence of a comparison line and can be accounted for as an overestimation of the vertical line.

The prevalence of iron deficiency and its impact on performance have not been adequately investigated in non-endurance athletes. This study evaluated these factors in 100 female intercollegiate athletes in various sports, and in 66 non-athletes. All subjects had determinations of hemoglobin, ferritin, and transferrin saturation. Athletes reported on diet, menses, and symptoms. Athletes and coaches described mood and performance. Iron-deficient athletes were treated with iron; others received placebo. The same data were collected at season's end. Initially 31/100 (31%) athletes had iron deficiency (ferritin less than 12 ng.ml-1; transferrin saturation less than 16%, or both) compared to 30/66 (45.5%) controls (not statistically significant). Compared to normal athletes, iron-deficient athletes did not have more symptoms of iron deficiency or differences in mood state, but they considered their performance to be worse (P less than 0.05). Their total iron intakes were similar, as were menstrual blood losses. At re-evaluation, 7/45 (15.6%) initially normal athletes were iron-deficient; 14/22 (63.6%) initially iron-deficient athletes were normal. Athletes receiving an iron supplement and their coaches did not report a greater improvement in performance or mood than athletes receiving a placebo. Female college athletes frequently had iron deficiency that could be successfully treated during the season, while some untreated normal athletes became iron-deficient. Iron deficiency and its treatment had no significant impact on symptoms or mood, but affected subjective assessment of performance.

The influence of five doses of the D-2 receptor agonist quinpirole (0.025, 0.05, 0.075, 0.10, and 0.20 mg/kg IP) on the odor detection performance of 21 adult male Long Evans rats was assessed using high precision olfactometry and a go/no-go operant task. Additionally, ten rats were pre-treated with the D-2 receptor antagonist spiperone (0.62 mg/kg IP) and their performance monitored following quinpirole administration. Treatments were administered every third day in a counterbalanced order, with the quinpirole injections occurring 15 min before, and the spiperone injections 35 min before, the 260-trial test sessions. Quinpirole injection resulted in a dose-dependent decrease in odor detection performance, as measured by the percentage of correct trials and by the non-parametric signal detection sensitivity index SI. Prior treatment with spiperone eliminated these effects. Dose-related influences of quinpirole on (a) the average latency to initiate a detection response (i.e., the S + response latency), (b) the total session duration, and (c) the number of aborted trials were also eliminated or greatly attenuated by prior spiperone injection. These results suggest that D-2 receptors may be involved in the modulation of odor detection performance and related behaviors.

Seven-day-old rat pups were olfactory bulbectomized, cortical lesioned, or sham lesioned, tested for nipple attachment 24 hr after surgery, then housed with their dam and weighed daily for the next 7 days. On the basis of histological findings the bulbectomized animals were divided into two subgroups: Those with removal of all olfactory bulb tissue (n = 9) and those in which some cellular elements remained in the lesioned area (n = 7). There were no differences between sham and cortical lesioned groups for nipple attachment behavior or weight gain. The completely bulbectomized pups did not show nipple attachment, lost weight each day, became moribund and had to be sacrificed by the fifth postoperative day. Deficits in incompletely bulbectomized pups were somewhat less severe and each of these survived and maintained or gained weight in the latter part of the test period. These results suggest that suckling may be critically dependent upon olfaction in 8 day or older pups and that significant savings in this behavior may be mediated by small remnants of olfactory bulb tissue.