Detection of increased pallor over time. Computerized image analysis in untreated ocular hypertension

Computerized image analysis was used to measure changes in percent area of pallor of the optic disc in a retrospective study of a group of 16 normals and 39 untreated ocular hypertensives. The optic discs of the subjects were photographed on at least two visits at least one year apart (mean, 2 years). No significant changes in area of pallor for the normal group were observed between visits, except in the inferior quadrant of the left eye. The ocular hypertensive group showed a significant increase in area of pallor between visits for the total disc and for most quadrants of both eyes. Multiple regression analysis revealed that, in addition to ocular hypertension, the significant factors associated with a change in optic disc pallor were change of ocular pressure, standard deviation of the ocular pressures, presence of vascular hypertension, and standard deviation of vascular pulse pressures. Clinical implications of early detection of disc changes for follow-up and treatment of ocular hypertensives are discussed.     

Intervention Model for Contaminated Consumer Products: A Multifaceted Tool for Protecting Public Health

Lead-based paint and occupational lead hazards remain the primary exposure sources of lead in New York City (NYC) children and men, respectively. Lead poisoning has also been associated with the use of certain consumer products in NYC.The NYC Department of Health and Mental Hygiene developed the Intervention Model for Contaminated Consumer Products, a comprehensive approach to identify and reduce exposure to lead and other hazards in consumer products. The model identifies hazardous consumer products, determines their availability in NYC, enforces on these products, and provides risk communication and public education.Implementation of the model has resulted in removal of thousands of contaminated products from local businesses and continues to raise awareness of these hazardous products.Although lead poisoning has declined dramatically in New York City (NYC) and across the United States, lead poisonings continue to occur.1 In NYC, most identified cases of lead poisoning are among young children, pregnant women, and occupationally exposed adults. The primary exposure source for lead in NYC children remains lead-based paint from older, poorly maintained homes. However, in 2009, 24% of the lead-poisoned children interviewed by the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) did not have an identified lead-based paint hazard. During the same year, 15% of men and 89% of women reported potential nonoccupational sources of lead exposure. Examples of such sources include consumer products containing lead, such as certain spices, cosmetics, supplements or remedies, and glazed ceramic foodware.1–6NYC is a highly heterogeneous city; its residents come from a broad spectrum of ethnic, cultural, and religious backgrounds. Many residents maintain close ties with their birth and ancestral countries and exchange goods through the domestic marketplace, travel, and contacts abroad. Some of these imported goods may contain lead or other heavy metals at levels exceeding reference limits. Lead may be intentionally added to certain products (e.g., for perceived therapeutic benefits, as a coloring agent, to add weight to products sold by weight), or inadvertently added along the supply chain (e.g., lead contamination of soil where raw ingredients are grown, poor processing equipment).The NYC Health Code defines lead poisoning as a blood lead level (BLL) of 10 micrograms per deciliter or higher. Effects in adults can include increased risk of hypertension, kidney disease, cognitive dysfunction, and reproductive risks.7 Lead poisoning in children can affect neurocognitive development and result in learning and behavior problems.8 Adverse health effects may occur even at BLLs lower than 10 micrograms per deciliter.9,10 Preventing lead exposure is the only effective way to protect adults and children from lead poisoning.     

An evaluation of microcrystalline cellulose and lactose excipients using an instrumented single station tablet press

The objective of this study was to evaluate the effects of microcrystalline cellulose of two particle sizes from two suppliers at two concentration levels, in combination with anhydrous lactose or Fast-Flo lactose on various properties of hydrochlorothiazide tablets. The powder blends before compression were evaluated for flow, density and compressibility. Tablets were compressed at three hardnesses and evaluated for friability, disintegration and hydrochlorothiazide dissolution. Powder blends containing Fast-Flo lactose exhibited a flow rate predicted to be sufficient for high-speed tableting whereas only when anhydrous lactose was used with the larger particle size microcrystalline cellulose was the same degree of flowability obtained. Density was affected by the concentration of microcrystalline cellulose. Fast-Flo lactose markedly increased density at the lower level of microcrystalline cellulose concentration. No difference was found in blend compressibility as a result of microcrystalline cellulose particle size or supplier source at medium to high tablet hardness levels, however, anhydrous lactose blends were more compressible than Fast-Flo lactose blends. At all hardness levels, tablets from all blends exhibited excellent friability. In most instances, tablet disintegration seemed to be more rapid when Fast-Flo lactose was present. Hydrochlorothiazide dissolution from all tablets easily met USP specifications. The microcrystalline cellulose from the two sources are interchangeable within particle size classification. Anhydrous lactose is more compressible than Fast-Flo lactose but Fast-Flo lactose is more flowable and its use results in more rapid drug dissolution at the higher microcrystalline cellulose levels.     

Heart rate response to alcohol and intoxicated aggressive behavior

BACKGROUND: This study examined the elevated heart rate (HR) response to alcohol intoxication, thought to reflect an increased sensitivity to alcohol-induced reward, as a potential factor in the increased likelihood of alcohol-induced aggression. METHODS: Three groups, intoxicated high (n=37) and low (n=37) HR responders and sober controls (n=73), participated in a laboratory measure of physical aggression, the Taylor Aggression Paradigm. RESULTS: Results revealed that intoxicated high HR responders were more aggressive than the intoxicated low HR responders and sober controls. CONCLUSIONS: These findings are interpreted within a hypothetical model relating increased alcohol-induced aggression to a dysregulation in the motivational system responding to rewards.     

A longitudinal-experimental approach to testing theories of antisocial behavior development

A longitudinal study with a nested preventive intervention was used to test five hypotheses generated from developmental theories of antisocial behavior. The longitudinal study followed 909 boys from their kindergarten year up to 17 years of age. The randomized multimodal preventive intervention targeted a subsample of boys who were rated disruptive by their kindergarten teacher. Semiparametric analyses of developmental trajectories for self-reported physical aggression, vandalism, and theft identified more types of trajectories than expected from recent theoretical models. Also, these trajectories did not confirm theoretical models, which suggest a general increase of antisocial behavior during adolescence. The majority of boys were on either a low-level antisocial behavior trajectory or a declining trajectory. Less than 6% appeared to follow a trajectory of chronic antisocial behavior. Comparisons between disruptive and nondisruptive kindergarten boys confirmed the hypothesis that disruptive preschool children are at higher risk of following trajectories of frequent antisocial behavior. Comparisons between treated and untreated disruptive boys confirmed that an intensive preventive intervention between 7 and 9 years of age, which included parent training and social skills training, could change the long-term developmental trajectories of physical aggression, vandalism, and theft for disruptive kindergarten boys in low socioeconomic areas. The results suggest that trajectories of violent behavior can be deflected by interventions that do not specifically target the physiological deficits that are often hypothesized to be a causal factor. The value of longitudinal-experimental studies from early childhood onward is discussed.     

Developmental trajectories of physical aggression from school entry to late adolescence

The developmental perspective applied to psychopathology has led to the concept of early- and late-onset disorders. This study explores the application of the early- and late-onset concepts of antisocial behavior to physical aggression. Are there two categories of chronically physically violent adolescents: those who are physically aggressive throughout childhood and those who start being physically aggressive during adolescence? The estimation of developmental trajectories for repeated measures of two different response variables physical aggression in childhood as measured by teacher reports and physical aggression in adolescence as measured by self-reported violent delinquency is achieved with a semi-parametric, group-based method. This new method is applied to a large sample of males from Montreal who have been assessed repeatedly since kindergarten. Several salient findings emerge from the analysis. First, we find considerable change in the levels of childhood and adolescent physical aggression. Thus, there is little evidence of stability of behavior in an absolute sense. A second key finding concerns the connection of childhood aggression to adolescent aggression. Boys with higher childhood physical aggression trajectories are far more likely to transition to a higher-level adolescent aggression trajectory than boys from lower childhood physical aggression trajectories. However, for all childhood physical aggression trajectory levels the modal transition is to a relatively low-level adolescent aggression trajectory. Third, we find little evidence of "late onset" of high-level physical aggression. Specifically, the joint trajectory analysis finds no evidence of transition from a low physical aggression trajectory in childhood to a high trajectory in adolescence.     

Parental and early childhood predictors of persistent physical aggression in boys from kindergarten to high school

BACKGROUND: In a prior study, we identified 4 groups following distinct developmental courses, or trajectories, of physical aggression in 1037 boys from 6 to 15 years of age in a high-risk population sample from Montréal, Québec. Two were trajectories of high aggression, a persistently high group and a high but declining group. The other 2 trajectories were a low group and a moderate declining group. This study identified early predictors of physical aggression trajectories from ages 6 to 15 years. METHODS: In this study, logistic regression analysis was used to identify parental and child characteristics that distinguished trajectory group membership. RESULTS: For boys displaying high hyperactivity and high opposition in kindergarten, the odds of membership in the 2 high aggression groups were increased by factors of 3.0 (95% confidence interval [CI], 2.0-4.3) and 2.7 (95% CI, 1.9-3.8), respectively, compared with boys without these risks. Counterpart odds ratios for the risk factors of mothers' teen-onset of parenthood and low educational attainment were 1.6 (95% CI, 1.1-2.2) and 1.8 (95% CI, 1.3-2.4), respectively. Only the maternal characteristics distinguished between the trajectory of persistently physical high aggression and the trajectory starting high but subsequently declining. For the 2 maternal risk factors combined, the odds ratio of persisting in high level physical aggression was 9.4 (95% CI, 2.9-30.4). CONCLUSIONS: Kindergarten boys displaying high levels of opposition and hyperactivity are at high risk of persistent physical aggression. However, among kindergarten boys who display high levels of physical aggression, only mothers' low educational level and teenage onset of childbearing distinguish those who persist in high levels of physical aggression.     

Asbestos disease screening by non-specialists: results of an evaluation.

We performed a medical audit of an asbestos disease screening program offered to New York City sheet metal workers by a corporate medical service. The screening program purported to evaluate the health status of workers exposed to asbestos in the past and present during construction and renovation of commercial buildings. Using current Occupational Safety and Health Administration (OSHA) regulations as a benchmark, medical records for more than 800 workers who took the examination between 1982-83 were reviewed; x-ray interpretations of the staff radiologist were compared with the interpretations of specialists in occupational lung diseases. The audit found inadequate record-keeping procedures, a lack of a comprehensive occupational history, poor notification and absence of any form of health education. Further, there was an extreme lack of concordance between the staff radiologist and the specialist readers in the interpretation of x-rays (kappa = .14 for pleural disease and .26 for asbestosis). To an increasing extent, occupational clinical services are being provided by corporate medical groups; such groups may not be familiar with occupational health problems.     

Salivary cortisol and aggression in a population-based longitudinal study of adolescent males

Summary. Chronic antisocial behaviour in youth has been associated with cortisol, a measure of stress reactivity. However, some studies have found low cortisol levels, while others have found elevated cortisol levels. The present study compared variously defined aggressive subgroups for differences in salivary cortisol. A population-based sample of boys was followed longitudinally from childhood to adolescence. Assessments of different forms of antisocial behaviour were obtained from various informants at several points in time, and cortisol was collected at age 13. Higher cortisol levels were found in boys with conduct disorder (CD) than in boys without CD. In addition, boys with an aggressive form of CD had higher cortisol levels than boys who showed a covert form of CD. Furthermore, reactive aggression was strongly correlated with elevated cortisol. Adolescent boys with chronic reactive aggression and those who scored high on aggressive CD symptoms seem to have a more active hypothalamic-pituitary-adrenal system.