Validity of a brief screening instrument—CRAFFT in a multiethnic Asian population

Aim

To validate the CRAFFT screening test, against the DSM IV Axis 1-based diagnostic inventory in a population of adolescents and young adult males in Singapore.

Methods

The 23,248 participants belonged to a cohort of males who had undergone a medical examination prior to enlistment for military service. This study took place between August 2004 and August 2005. Subjects underwent a two-stage assessment and were administered the CRAFFT questionnaire and the Composite International Diagnostic Interview (CIDI).

Results

The mean age of the subjects was 19 years (range, 16 to 26 years). The CRAFFT showed moderately high levels of internal consistency (Cronbach's α = 0.73). The optimum cutoff point for drug-related disorder either abuse or dependence and alcohol-related disorder either abuse or dependence criterions were found at CRAFFT score of 1 or higher.

Conclusion

The CRAFFT test is a valid means of screening adolescents for substance-related disorders in a multiethnic population of adolescent and young adult males.     

Somatic disproportion predicts risk of high blood pressure among adolescent girls in India

OBJECTIVES: To examine the importance of somatic disproportion rather than absolute values of leg height and trunk height for predicting risk of high blood pressure among adolescents. METHODS: Adolescent girls (9-16 years old) from high (HSE) and low socio-economic (LSE) classes were examined (n = 1036 and n = 1040, respectively) in a cross-sectional study, for skeletal growth (height and sitting height), adiposity [weight, body mass index (BMI) and body fat] and blood pressure levels. RESULTS: Girls from LSE class were thin, short and undernourished compared to those from HSE class (average age-adjusted BMI, 16.47 +/- 2.61 versus 19.77 +/- 3.85, P < 0.000). A high prevalence of high systolic blood pressure (HSBP) was a problem in girls of the HSE (9.7 versus 4.4%, P < 0.001) class, while a high prevalence of high diastolic blood pressure (HDBP) was seen in girls of the LSE (15.3 versus 2.7%, P < 0.001) class. Further, in the HSE class, the prevalence of HSBP was higher only among girls in the third tertile of BMI and body fat, while in the case of the LSE class the prevalence of HDBP was higher (7-11%) even in the lowest tertile of these measures. The odds ratio (OR) for HDBP (2.28) in the LSE class and that for HSBP (2.27) in the HSE class were significantly higher for girls in the lower tertile of leg height to height ratio. This was also true in the case of leg height to sitting height ratio. CONCLUSIONS: Our findings showed that rather than absolute leg or trunk length, somatic disproportion may be a relevant biomarker associated with cardiovascular disease (CVD) risk, especially in an adolescent population.     

Perception of the public towards the mentally ill in developed Asian country

Objective This study assessed public perceptions and attitudes towards and causal beliefs about mental health problems in Singapore – a multi-racial country in South-East Asia. Method A nation-wide survey using a structured questionnaire was conducted on those aged between 15 and 69 years. Results The overall response rate was 68.1% with a total of 2,632 respondents. About 38.3% (95% CI, 36.4–40.2) believed that people with mental health problems were dangerous and 49.6% (95% CI, 47.7–51.5) felt that the public should be protected from them. A negative attitude towards mental health problems correlated with greater age and less education. The Chinese were more likely to want to hide their illness should they become mentally unwell while the Malays seemed to have a more tolerant attitude (P = 0.032). Conclusion Public awareness and anti-stigma campaigns should focus on those commonly held misconceptions and target specific populations.     

Impairment of story memory organization in patients with schizophrenia

The aim of the present paper was to examine the organization of story memory in schizophrenia. Participants were 35 patients with schizophrenia and 24 healthy subjects who completed the Wechsler Memory Scale-Revised. The organization of story memory was evaluated with the Logical Memory subtest. Schizophrenia patients scored significantly lower than controls on thematic sequencing, and significant negative correlations were found between positive symptoms and thematic sequencing. These findings suggest that schizophrenia has deficits in organization of story memory, which are related to symptoms such as disorganized thoughts and behavior.     

A lesson for everyone in drug-drug interactions

An 84-year-old man was admitted to the hospital for severe rhabdomyolysis induced by drug-drug interactions between simvastatin and ketoconazole and he recovered completely. Guidelines are suggesting lower goals for low density cholesterol leading to increased statin use. As the population is aging and treated with multiple medications for other co-morbidities, it is imperative for physician to be aware of potential fatal drug-drug interactions, in our case statins, and look for alternatives.     

Detoxification of benzidine-based azo dye by E. gallinarum: time-course study

Direct black 38 (DB38) dye is a well-established toxic and carcinogenic compound. Present investigation reports isolation of an Enterococcus gallinarum strain capable of decolorizing and degrading it. Changes in toxicity and mutagenicity of DB38 and its metabolites were also determined using a battery of carefully selected tests (cytotoxicity, respiration inhibition test and Ames test). Toxicity assays were carried out on E. gallinarum itself as this also gave information about suitability of this strain for the dye decolorization operation. The strain was found to reduce both toxicity and mutagenicity of DB38 metabolites. Benzidine and 4-aminobiphenyl (4-ABP) were identified as the DB38 metabolites, responsible for its toxic and mutagenic properties, by HPLC-MS analysis. Further degradation of benzidine and 4-ABP was found to result in the decrease in toxicity and mutagenicity.     

Relationship of Electro-mechanical Remodeling to Survival Rates after Cardiac Resynchronization Therapy

Cardiac resynchronization therapy, when added to optimal medical therapy, increases longevity in symptomatic congestive heart failure patients with left ventricular ejection fractions (LVEF) ≤0.35 and QRS durations >120 ms. Cardiac resynchronization therapy is also associated with electrical and mechanical reverse remodeling. We examined whether reverse remodeling predicts increased survival rates in non-trial settings.Recipients of cardiac resynchronization therapy and defibrillators (n=112; 78 men; mean age, 69 ± 11 yr) underwent repeat echocardiography and electrocardiography at least 90 days after device implantation. Forty patients had mechanical responses of at least 0.05 improvement in absolute LVEF; 56 had electrical responses (any narrowing of biventricular-paced QRS duration compared with the electrocardiogram immediately after therapy). During a mean follow-up period of 3.1 ± 1.7 years, 55 patients died. The average death rate per 100 person-years was lower among mechanical responders than nonresponders (9.2% vs 23.9%; P=0.009); the unadjusted hazard ratio was 0.39 (95% confidence interval [CI], 0.19–0.79).In a multivariate model adjusted for age, sex, baseline LVEF, and QRS duration, mechanical responders had 60% better survival than nonresponders (hazard ratio=0.40; 95% CI, 0.21–0.79; P=0.008). No difference in survival was observed in electrical response. In our association of absolute change in LVEF over the observed range with death (using restricted cubic splines), we observed a linear relationship with survival.In patients given cardiac resynchronization therapy, mechanical but not electrical remodeling was associated with better survival rates, suggesting that mechanical remodeling underlies this therapy''s mechanism of conferring a survival benefit.Key words: Cardiac resynchronization therapy/methods, combined modality therapy, heart conduction system/physiopathology, heart failure/mortality/physiopathology/therapy, predictive value of tests, survival analysis, ventricular dysfunction, left/mortality/prevention & control/therapy, ventricular remodelingIn selected heart-failure patients, cardiac resynchronization therapy (CRT) improves exercise tolerance, maximal oxygen consumption, and quality of life, and reduces the risks of repeat hospitalization for heart failure or death.^1,2 Lower left ventricular ejection fraction (LVEF) is a predictor of cardiac events independently of QRS duration or electrical evidence of dyssynchrony.^3,4 Secondary data analyses from clinical trials yielded better clinical outcomes in the context of reverse mechanical remodeling.^5,6 In addition, electrical dyssynchrony—commonly observed in patients with left ventricular (LV) dysfunction⁷—is a predictor of LV systolic dysfunction.^8,9 Data from clinical practice are sparse in regard to associations of reverse mechanical and electrical remodeling with improved survival rates. In this study, we examined the association between electromechanical reverse remodeling and survival rates in a tertiary-care hospital.