A measure of physician mental work load in internal medicine ambulatory care clinics

Physician mental work load is an important variable intervening between work demands imposed on physicians and physician performance. A brief instrument was developed to measure the mental work load experienced during a clinic session in internal medicine ambulatory care hospital clinics. The instrument covered six dimensions of mental work load: performance, time load, mental effort, physical effort, psychologic stress, and difficulty. Cronbach's alpha reliability coefficient for the instrument was 0.83. The instrument exhibited construct validity. As hypothesized, mental work load was found to be positively associated with number of patients seen and with fatigue, and mental work load was inversely associated with physician satisfaction with the patient care they provided and with their self-rating of the quality of care they provided. The importance of measuring physician mental work load is discussed.     

Assessing physicians' interpersonal skills: do patients and physicians see eye-to-eye?

OBJECTIVE: To determine the level of agreement between standardized patient ratings and resident physician self-ratings of physician interpersonal skills and the level of agreement between faculty observer and standardized patient ratings of resident physicians' interpersonal skills. DESIGN: Structured clinical evaluation. A total of 25 resident physicians in physical medicine and rehabilitation conducted a 10-min interview of a standardized patient to obtain a history. A resident physician, a standardized patient, and a faculty observer rated the resident physician's interpersonal skills immediately after the interview. The main outcome measure was a modification of the patient assessment measure from the American Board of Internal Medicine, a 9-item rating scale assessing communication (score range, 9-45). RESULTS: There was a low level of agreement between standardized patient ratings and the resident physicians' self-ratings of interpersonal skills (Lin's concordance coefficient, rc = 0.11, P = 0.58). Conversely, there was a statistically significant degree of agreement between the standardized patient and faculty observer ratings of resident physician interpersonal skills (rc = 0.50, P = 0.006). CONCLUSIONS: Some resident physicians have significant difficulty accurately assessing how well they communicate with patients. Physicians in training rarely get feedback regarding their interpersonal skills and may have difficulty using social comparison. Conversely, standardized patients and faculty observers may have insight into interpersonal skills about which resident physicians are unaware.     

脑静息态功能磁共振局部一致性分析在轻度认知障碍患者中的初步研究

目的利用局部一致性(regional homogeneity,ReHo)分析方法来探讨轻度认知障碍(mild cognitive impairment,MCI)患者局部自发脑活动特点,并进一步探讨相应脑区ReHo值改变与认知功能及临床生理指标的相关性。材料与方法39例被试入组,其中临床诊断的MCI患者17例,年龄、性别及受教育年限相匹配的健康志愿者22例,所有受试者均行静息态功能磁共振成像(resting-state fMRI,rs-fMRI)扫描,采用rs-fMRI的ReHo分析方法,比较静息状态下MCI患者与健康志愿者ReHo值存在差异的脑区,对存在显著差异脑区的ReHo值与认知评估量表及临床生理指标进行相关分析。结果与正常对照比较,MCI组右侧岛叶、左侧小脑半球、旁扣带回、颞下回、左右梭状回ReHo值升高;而左侧颞上回、右侧背外侧额上回ReHo值降低。所有被试蒙特利尔认知评估量表(montreal cognitive assessment scale,MoCA)评分与右侧脑岛区(r=-0.487,P=0.002)ReHo值呈负相关,与左侧颞上回(r=0.610,P<0.001)及右侧背外侧额上回(r=0.475,P=0.002)呈正相关。所有被试简易智能状态检查量表(mini mental status examination,MMSE)评分与左侧小脑上回(r=-0.407,P=0.010)呈负相关,与左侧颞上回(r=0.466,P=0.003)呈正相关。MCI组右侧岛叶ReHo值与血浆果糖胺浓度呈负相关(r=-0.630,P=0.007),左侧小脑半球ReHo值与血清肌酐浓度呈负相关(r=-0.579,P=0.015)。结论轻度认知障碍患者rs-fMRI的ReHo值有明显改变,并与认知功能改变及临床生理指标存在一定的相关性。     

Measuring "humanism" in medical residents

The American Board of Internal Medicine (ABIM) has charged directors of residency programs with evaluating "humanistic attributes" in residents seeking certification. To investigate whether traditional measures of residents' performance assess humanistic attributes, 38 second- and third-year medical residents completed the Totalitarian-Authoritarian-Dogmatism (TAD) and Rokeach tests for attitudinal assessment. Five primary sources were used to measure performance. When the measures of performance and attitude were correlated, two negative correlations with "antipathy toward patients" were found: professional maturity (r = -.43, P less than .01) and compassion and concern for patients (r = -.35, P less than .04). The TAD Opinionnaire and the special performance evaluation detect "nonhumanistic dimensions" that routine faculty assessments do not. Since the new Likert scale distributed by ABIM does not differ materially from the rating form used at Baylor for 2 1/2 years, it is unlikely that "humanistic attributes" will be measured by the ABIM's new scale.     

综合性心理干预对精神分裂症病人家属应对方式、情绪及生活质量的影响

目的探讨心理干预对精神分裂症病人家属应对方式、情绪及生活质量的影响。方法对精神分裂症病人家属进行为期12周的心理干预,在干预前后应用应对方式问卷、焦虑自评量表（SAS）、抑郁自评量表（SDS）、生活质量量表（SF-36）进行心理测评。结果干预后病人家属消极应对、SAS、SDS得分减少,积极应对和部分SF-36得分增加,与干预前和对照组相比差异有显著性（t=2.02～4.15,P〈0.05）。病人家属的精神健康和角色情绪得分与积极应对得分呈正相关（r=1.12、0.21,P〈0.05）,与消极应对、SAS、SDS得分呈负相关（r=-0.13～-0.37,P〈0.05）;病人家属的活力得分与积极应对得分呈正相关（r=0.13,P〈0.05）,与SDS得分呈负相关（r=-0.13,P〈0.05）。结论心理干预可有效改善精神分裂症病人家属的应对方式、情绪和生活质量。     

The Hopkins Rehabilitation Engagement Rating Scale: development and psychometric properties

OBJECTIVE: To conduct an initial investigation of the psychometric properties of the Hopkins Rehabilitation Engagement Rating Scale (HRERS), a 5-item, clinician-rated measure developed to quantify engagement in acute rehabilitation services. DESIGN: We used a cross-sectional design to conduct correlational and multivariate analyses to establish the measure's internal consistency, interrater reliability, construct validity, and criterion validity. SETTING: Acute inpatient rehabilitation in 3 metropolitan hospitals. PARTICIPANTS: A total of 206 subjects with spinal cord injury, ischemic or hemorrhagic stroke, amputation, or hip or knee replacement. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The HRERS, Positive and Negative Affect Schedule, Brief Symptom Inventory, Levine's Denial of Illness Scale, Craig Handicap Assessment and Reporting Technique, and FIM instrument. RESULTS: The HRERS has good internal consistency (alpha=.91) and interrater reliability (intraclass correlation coefficient, .73) and represents a unidimensional construct. It correlated negatively with symptoms of depression (r=-.24, P<.01), higher ratings of denial of illness (r=-.30, P<.001), and self-rated negative affect (r=-.23, P<.01), and correlated positively with self-rated positive affect (r=.36, P<.001) and level of functioning 3 months postdischarge (r=.22, P<.01). CONCLUSIONS: The HRERS is a valid and reliable measure of rehabilitation engagement that relates to intermediate-term functional outcomes.     

Developing a Valid Evaluation for Interpersonal and Communication Skills

Objectives The Accreditation Council for Graduate Medical Education requires that residency programs evaluate the acquisition of six general competencies, including Interpersonal and Communication Skills (ICS). To develop a 360-degree method for accomplishing this, a semantic-differentiation matrix for various communication traits for nurses to evaluate physician ICS was developed. The authors sought to determine whether this evaluation method could discriminate between more experienced medical communicators (faculty) and less experienced medical communicators (residents).
Methods A 98-item questionnaire measured several communication dimensions by using an eight-element semantic-differentiation scale. In addition, global assessment ratings assessed nursing perceptions of physician ICS skills. This process was repeated for various clinical scenarios.
Results There were 26 nurse evaluators, 19 emergency medicine (EM) residents (EM2 and EM3), and 30 EM faculty. Each physician received five independent evaluations (total, 245 evaluations). All EM residents (EM2 and EM3) were compared with the EM faculty. All eight items on the semantic-differentiation scale were compared. Likewise, the global assessment scores were compared. In every category, the faculty scored higher (Mann-Whitney U: p < 0.001).
Conclusions An evaluation process integrating a semantic-differentiation matrix was applied to various clinical scenarios (as well as global assessment items) and demonstrated discriminatory results. Faculty physicians scored significantly higher than resident physicians. The ability to provide discriminatory results is a requisite in the development of a valid evaluation process. The described semantic-differentiation matrix and global assessment questions may be valid measurements of ICS.     

Substance abuse and symptoms of mental illness among HIV-positive persons in the Southeast

OBJECTIVES: Mental illness and substance abuse have been consistently associated with poor HIV-medication adherence and other negative health outcomes. METHODS: A brief mental health and substance use screening instrument was administered to 1,362 HIV-infected individuals receiving care at two academic medical center Infectious Diseases Clinics in North Carolina. RESULTS: Study results indicated high frequencies of symptoms of mental illness (60%), substance abuse (32%), and co-occurring symptoms of mental illness and substance abuse (23%). Younger age (P = 0.03), male sex (P < 0.001), and higher viral load (P < 0.001) were associated with substance use problems. White race (P = 0.001), younger age (P = 0.023), and higher viral load (P = 0.042) were associated with symptoms of mental illness. CONCLUSIONS: In the Southeast, mental health and substance abuse services are sparse and stigma is high; thus, innovative treatment strategies are needed to address the high levels of co-occurring mental illness and substance abuse. Antiretroviral therapies will not reach their potential for slowing the HIV/AIDS epidemic and prolonging survival if comorbidities that influence patient behavior are not addressed.     

Students’ and residents’ ratings of teaching effectiveness in a department of pediatrics

We analyzed an instrument for measuring overall teaching effectiveness in the Department of Pediatrics at the Medical College of Wisconsin.

Over 18 months, we prospectively collected 2,101 teacher evaluations from medical students and residents using a Likert scale evaluating overall teaching effectiveness and nine component traits.

The mean rating (5.62, SD = 1.13) for overall teaching effectiveness (OTE) correlated most highly (r = .83) with the average scores across traits (M = 5.61, SD = .95), although Pearson correlation coefficients of OTE with all traits were all significant (p < .001). Multiple regression showed that being clear/organized, demonstrating enthusiasm, and developing rapport accounted for 71% of the variance (p < .001). Although the inpatient ward rotation had lower OTE mean ratings (p < .0001), individual's OTE ratings in different settings did not differ significantly. OTE mean ratings were positively associated with longer duration of interaction (p < .0001) but not by the evaluator's level of training. The form had the necessary internal consistency (a = .94).

Based on student/resident evaluations, the OTE rating was the best single indicator summarizing global teaching effectiveness. Our form was shown to be reliable and useful for faculty development and administrative decisions, and teaching ability was not influenced by the setting.     

Global self-rated mental health: associations with other mental health measures and with role functioning

BACKGROUND: A large body of research shows that global self-rated health is related to important outcome variables. Increasingly, studies also obtain a single global self-rating of mental health, but understanding of what this item measures is limited. OBJECTIVE: To clarify interpretation of self-reported mental health, we examine its associations with other validated measures of mental health and role functioning. RESEARCH DESIGN: We conducted cross-sectional analyses of nationally representative data from the Medical Expenditure Panel Survey. MEASURES: In-person household interviews obtained data on global self-reported mental health and any limitations in work, school, or housekeeping activities. Adult respondents (N = 11,109) completed the SF-12 health status survey, the K6 scale of nonspecific psychologic distress, and the Patient Health Questionnaire (PHQ-2) depression screener in a self-administered questionnaire. We used the SF-12 Mental Component Summary and the mental health subscale. Analyses examined associations among mental health measures and regressed activity limitations, and the SF-12 physical and emotional role functioning scales on mental health measures, controlling for demographics and selected chronic conditions. RESULTS: The 4 multi-item mental health measures were strongly correlated with each other (r > 0.69), but correlated less strongly with the self-reported mental health item (r approximately 0.4). In an exploratory factor analysis, self-reported mental health loaded on both mental and physical health factors. In multivariate analyses, each mental health variable was significantly associated with activity limitations and with role functioning, but the association of self-reported mental health with emotional role functioning was relatively weak. CONCLUSIONS: Although global self-rated mental health is related to symptoms of psychologic distress, it cannot be considered to be a substitute for them.     

Effects of olanzapine alone and olanzapine/fluoxetine combination on health-related quality of life in patients with bipolar depression: secondary analyses of a double-blind, placebo-controlled, randomized clinical trial

BACKGROUND: Improving patients' health-related quality of life (HRQOL) could be a treatment goal for bipolar depression. OBJECTIVES: The objectives of these secondary analyses of a previous report were to determine the benefits of olanzapine alone and olanzapine-fluoxetine combination (OFC) for improving HRQOL in patients with bipolar depression using both a generic and a depression-specific HRQOL instrument, and to examine the association between the 2 HRQOL instruments and the construct validity of the depression-specific HRQOL instrument. METHODS: This was a double-blind, placebo-controlled, 83-site, international, randomized trial. Adults with bipolar I disorder, most recent episode depressed (according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), were randomly assigned to receive olanzapine (6-20 mg/d), OFC (6/25, 12/25, or 12/50 mg/d), or placebo for 8 weeks. HRQOL improvement was calculated as last-observation-carried-forward changes in dimension and component summary scores on Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and total score on the Quality of Life in Depression Scale (QLDS). Results: Patients were assigned to receive olanzapine (n = 370), [corrected] OFC (n = 86), or placebo (n = 377) [corrected] for 8 weeks. Of 833 enrolled patients, 454 discontinued (olanzapine, 191/370 [51.6%] [corrected]OFC, 31/86 [36.0%]; and placebo, 232/377 [61.6%]) [corrected] Compared with placebo, olanzapine-treated patients exhibited greater improvements on SF-36 mental component summary (MCS) score ( P=0.002) and 3 of 8 SF-36 dimension scores (mental health [P=0.015], role-emotional [P=0.046], and social functioning [P=0.006). OFC-treated patients exhibited greater improvements on MCS score ( P<0.001) vs both placebo and olanzapine), 5 SF-36 dimension scores (general health perception (P<0.001) vs placebo; (P<0.001) vs olanzapinel, mental health [ P=0.001] vs both placebo and olanzapine], role-emotional [ P<0.001] vs placebo; [P=0.007] vs olanzapine], social functioning [ P=0.001] vs placebo; [P=0.032] vs olanzapine], and vitality [P=0.002] vs placebo; [P=0.011] vs olanzapine]), and QLDS total score ( P<0.001] vs both placebo and olanzapine). Changes in SF-36 scores of mental health, social functioning, role-emotional, and vitality were highly correlated to changes in the QLDS total score (all p < -0.5). CONCLUSIONS: Based on these analyses, patients with bipolar depression receiving olanzapine or OFC for 8 weeks had greater improvement in HRQOL than those receiving placebo. OFC treatment was associated with greater improvement in HRQOL than olanzapine alone. The correlation results support the construct validity of the QLDS.     

The concentration of adiponectin in breast milk is related to maternal hormonal and inflammatory status during 6 months of lactation

Abstract Background: Varying concentrations of adiponectin are present in human breast milk. This study aimed to determine the relationship between milk adiponectin concentration and the hormonal and inflammatory status of breast-feeding women. Methods: Blood and breast milk samples were collected from 157 breast-feeding women enrolled at 1-180 post-partum lactation days. The milk and serum adiponectin concentrations were measured by radioimmunoassays. The serum oestradiol, prolactin, thyroxine, triiodothyronine, cortisol and insulin concentrations were measured by the chemiluminescent immunometric method. The leptin, resistin and ghrelin concentrations were measured by the immunometric methods. Results: The milk, but not serum, adiponectin concentration increased during the 180-day lactation period and displayed a positive correlation (r=0.748; p<0.001) to the lactation day. The milk adiponectin concentration was positively correlated to the maternal serum ghrelin concentration (r=0.299; p<0.001) and inversely to the maternal serum oestradiol (r=-0.366; p<0.001), prolactin (r=-0.444; p<0.001), thyroxine (r=-0.355; p<0.001), triiodothyronine (r=-0.291; p<0.001), cortisol (r=-0.537; p<0.001), and C-reactive protein (r=-0.483; p<0.001) concentrations. The milk adiponectin concentration was positively correlated to the milk leptin (r=0.344; p<0.001) and ghrelin (r=0.458; p<0.001) concentrations, and inversely to milk resistin concentration (r=-0.518; p<0.001). The serum adiponectin concentration in breastfed infants was positively correlated (r=0.711; p<0.001) to the adiponectin concentration in the consumed breast milk. Conclusions: The adiponectin concentration in breast milk increases over time during lactation and is affected by the maternal hormonal and inflammatory status.     

护理专业男生心理健康状况及与人格特征的相关性研究

目的了解医科大学护理专业男生心理健康状况及与人格特征的相关性。方法采用症状自评量表(SCL-90)、艾森克个性问卷(EPQ)对广州某医科大学105名护理专业男生进行测评。结果①护理专业男生SCL-90各因子得分均显著低于大学生常模(P0.01或P0.001),强迫和精神病性2个因子得分高于国内成人常模(P0.01或P0.001),与护理专业女生得分相比差异无统计学意义(P0.05)。②护理专业本、专科男生SCL-90各因子得分仅在躯体化因子上差异有统计学意义(P0.05)。本科护理专业男、女生SCL-90各因子得分差异均无统计学意义(P0.05)。专科护理专业男、女生仅在人际敏感、恐怖2个因子得分上差异有统计学意义(P0.05)。③护理专业男生SCL-90总分及各因子分与人格问卷的内外向维度分呈负相关(P0.05或P0.01)(除敌意因子外),与神经质维度分呈正相关(P0.05或P0.01),其中SCL-90均分与神经质维度相关最为密切(r=0.687)。结论护理专业男生心理健康状况好于普通大学生,情绪稳定、外向等人格特征有利于提高护理专业男生的心理健康水平。     

Determinants of hypertension and left ventricular function in end stage renal failure: a pilot study using cardiovascular magnetic resonance imaging

Cardiovascular disease is the principal cause of mortality in patients with renal failure. Left ventricular (LV) abnormalities are adverse prognostic indicators for cardiovascular outcome. The aim of this study was to use cardiac magnetic resonance scanning (CMR) to define LV functional abnormalities in haemodialysis (HD) patients and clarify the determinants of blood pressure (BP) and the effect of anaemia in this population. We studied 44 HD patients and 11 controls with CMR performed following dialysis. Forty patients and 11 controls completed the study. LV mass (P<0.001) and estimated systemic vascular resistance (SVR) (P = 0.002) were significantly higher in the dialysis group compared to controls. LV ejection fraction (P = 0.002) and SV (P = 0.043) were lower than controls. In the HD patients, BP correlated significantly with cardiac output (CO; r = 0.569, P<0.001) and end diastolic volume (EDV; r = 0.565, P<0.001) but there was no correlation between BP and SVR (r = 0.201, P = 0.594). Haemoglobin was inversely correlated with both CO (r = -0.531, P<0.001) and EDV (r = -0.493, P = 0.001) and positively with SVR (r = 0.402, P = 0.009). HD patients had a higher LV mass and lower ejection fraction than controls. The relationship of BP with CO, but not SVR, supports the theory that a major determinant of BP is intravascular volume and CO rather than vascular resistance although there was a fixed increase in SVR in this population. Improved understanding of the mechanisms underlying increased SVR and improved control of CO and intravascular volume may allow better therapeutic strategies. CMR provides insights into the pathophysiology of hypertension and LV dysfunction in HD patients.     

Different alterations in the insulin-stimulated glucose uptake in the athlete's heart and skeletal muscle.

Physical training increases skeletal muscle insulin sensitivity. Since training also causes functional and structural changes in the myocardium, we compared glucose uptake rates in the heart and skeletal muscles of trained and untrained individuals. Seven male endurance athletes (VO2max 72 +/- 2 ml/kg/min) and seven sedentary subjects matched for characteristics other than VO2max (43 +/- 2 ml/kg/min) were studied. Whole body glucose uptake was determined with a 2-h euglycemic hyperinsulinemic clamp, and regional glucose uptake in femoral and arm muscles, and myocardium using 18F-fluoro-2-deoxy-D-glucose and positron emission tomography. Glucose uptake in the athletes was increased by 68% in whole body (P < 0.0001), by 99% in the femoral muscles (P < 0.01), and by 62% in arm muscles (P = 0.06), but it was decreased by 33% in the heart muscle (P < 0.05) as compared with the sedentary subjects. The total glucose uptake rate in the heart was similar in the athletes and control subjects. Left ventricular mass in the athletes was 79% greater (P < 0.001) and the meridional wall stress smaller (P < 0.001) as estimated by echocardiography. VO2max correlated directly with left ventricular mass (r = 0.87, P < 0.001) and inversely with left ventricular wall stress (r = -0.86, P < 0.001). Myocardial glucose uptake correlated directly with the rate-pressure product (r = 0.75, P < 0.02) and inversely with left ventricular mass (r = -0.60, P < 0.05) or with the whole body glucose disposal (r = -0.68, P < 0.01). Thus, in athletes, (a) insulin-stimulated glucose uptake is enhanced in the whole body and skeletal muscles, (b) whereas myocardial glucose uptake per muscle mass is reduced possibly due to decreased wall stress and energy requirements or the use of alternative fuels, or both.     

Development and validation of a short-form, rapid estimate of adult literacy in medicine

BACKGROUND: Although prior studies used the 66-item Rapid Estimate of Adult Literacy in Medicine (REALM instrument) for literacy assessment, researchers may require a shorter, validated instrument when designing interventions for clinical contexts. OBJECTIVE: To develop and validate a very brief literacy assessment tool, the REALM-Short Form (REALM-SF). PATIENTS: The model development, validation, and field testing validation samples included 1336, 164, and 50 patients, respectively. SETTING: General medicine and subspecialty clinics and medicine inpatient wards. DESIGN: For development and validation samples, indicator variables for REALM instrument items were evaluated as potential predictors of REALM instrument score by stepwise multiple regression analysis with subsequent bootstrap and confirmatory factor analysis of selected items. Pearson correlations compared REALM-SF and REALM instrument scores and kappa analyses compared grade level assignments. For the field testing validation sample, Pearson correlations compared Wide Range Achievement Test and REALM-SF scores. RESULTS: The REALM-SF included 7 items with stable model coefficients and 1 underlying linear factor. REALM-SF and REALM instrument scores were highly correlated in development (r = 0.95, P < 0.001) and validation (r = 0.94, P < 0.001) samples. There was excellent agreement between REALM-SF and REALM instrument grade-level assignments when dichotomized at the 6th grade (development: 97% agreement, K = 0.88, P < 0.001; validation: 88% agreement, K = 0.75, P < 0.001) and 8th grade levels (development: 94% agreement, K = 0.78, P < 0.001; validation: 84% agreement, K = 0.67, P < 0.001). REALM-SF and Wide Range Achievement Test scores were highly correlated (r = 0.83, P < 0.001) in field testing validation. CONCLUSIONS: The REALM-SF provides researchers a brief, validated instrument for assessing patient literacy in diverse research settings.     

The plasma homocysteine concentration is better than that of serum methylmalonic acid as a marker for sociopsychological performance in a psychogeriatric population

BACKGROUND: Cobalamin/folate deficiency in elderly subjects may lead to psychiatric symptoms, but more often it increases the severity of various organic and nonorganic mental diseases. A major clinical problem, however, is the uncertainty and controversy concerning biochemical markers of cobalamin/folate deficiency to be used in the diagnostic evaluation of suspected cobalamin/folate deficiency. METHODS: We measured plasma homocysteine (tHcy), blood folate, serum methylmalonic acid, and serum cobalamin in 80 psychogeriatric patients (age, 77.3 +/- 8.6 years) and 50 controls (age, 76.1 +/- 8. 0 years). We assessed associations of these tests with measures of cognitive and behavior performance by use of regression analyses. RESULTS: Plasma tHcy was increased in 45% of the psychogeriatric population (mean, 20.5 +/- 9.2 micromol/L vs 15.3 +/- 4.7 micromol/L for controls; P <0.01). Plasma tHcy correlated with severity of dementia (r = 0.36; P <0.01), the Katz ADL index (r = 0.29; P <0.05), the Berger scale (r = 0.29; P <0.05), and the score of symptoms (r = 0.39; P <0.001) in the psychogeriatric population. Similarly, blood folate was significantly correlated with these measures, but the concentrations of serum cobalamin and methylmalonic acid were not. In a stepwise multiple regression analysis including the biochemical markers, tHcy was the only significant predictor of the severity of dementia (r(2) = 0.11; P <0.01) and the score of symptoms (r(2) = 0.16; P <0.001). CONCLUSION: Plasma tHcy is the best marker of those measured to investigate suspected tissue deficiency of cobalamin/folate.     

Elevated high density lipoprotein cholesterol levels correlate with decreased apolipoprotein A-I and A-II fractional catabolic rate in women.

High levels of HDL-cholesterol (HDL-C) protect against coronary heart disease susceptibility, but the metabolic mechanisms underlying elevated HDL-C levels are poorly understood. We now report the turnover of isologous radioiodinated HDL apolipoproteins, apo A-I and apo A-II, in 15 female subjects on a metabolic diet with HDL-C levels ranging from 51 to 122 mg/dl. The metabolic parameters, fractional catabolic rate (FCR) and absolute synthetic rate (SR), were determined for apo A-I and apo A-II in all subjects. There was an inverse correlation between plasma HDL-C and the FCR of apo A-I and apo A-II (r = -0.75, P less than 0.001, and r = -0.54, P = 0.036, respectively), but no correlation with the SR of either apo A-I or apo A-II (r = 0.09, and r = -0.16, respectively, both P = NS). Apo A-I levels correlated inversely with apo A-I FCR (r = -0.64, P = 0.01) but not with apo A-I SR (r = 0.30, P = NS). In contrast, plasma levels of apo A-II did not correlate with apo A-II FCR (r = -0.38, P = 0.16), but did correlate with apo A-II SR (r = 0.65, P = 0.009). Further analysis showed that apo A-I and apo A-II FCR were inversely correlated with the HDL-C/apo A-I + A-II ratio (r = -0.69 and -0.61, P = 0.005 and 0.015, respectively). These data suggest that: (a) low HDL apolipoprotein FCR is the predominant metabolic mechanism of elevated HDL-C levels; (b) apo A-I FCR is the primary factor in controlling plasma apo A-I levels, but apo A-II SR is the primary factor controlling plasma apo A-II levels; (c) low HDL apolipoprotein FCR is associated with a lipid-rich HDL fraction. These findings elucidate aspects of HDL metabolism which contribute to high HDL-C levels and which may constitute mechanisms for protection against coronary heart disease.