Bacterial meningitis in Swaziland: an 18 month prospective study of its impact

STUDY OBJECTIVE: To describe the epidemiology, clinical features, and outcome of bacterial meningitis in Swaziland. DESIGN: Prospective study of patients diagnosed as having meningitis of nonviral aetiology during an 18 month period from February 1991 to July 1992. SETTING: Four regional hospitals covering the population of the four districts in Swaziland. SUBJECTS: All patients with non-viral meningitis admitted to hospital within the study period. MAIN RESULTS: Altogether 85 patients were reported to have bacterial meningitis: 48.3% were aged under 1 year. Causative organisms were identified in 60% of cases, and Streptococcus pneumoniae was found to be the commonest (49% of cases). Overall, case fatality was 38.8% for all age groups, and 62.5% (15 of 25) for adults. Neurological sequelae occurred in 22.4%. Three of the adult cases were HIV seropositive. Seizures, but not duration of symptoms before admission, were associated with a poor prognosis. There was a significant rise in incidence related to a period of drought. Fifteen patients were reported with tuberculous meningitis, of whom five were known to be HIV seropositive; the case fatality was 73.3%. CONCLUSIONS: The aetiology and age distribution of cases of meningitis differs greatly from that in developed countries. Rising HIV infection may have an important impact on the future incidence of meningitis. The high case mortality found should encourage efforts towards earlier diagnosis and treatment, and strengthens the need to develop appropriate vaccines.     

Perindopril postmarketing surveillance: a 12 month study in 47,351 hypertensive patients

We investigated the effect of electrical cardioversion of atrial fibrillation in patients with heart failure. The study group consisted of 24 patients with mild to moderate heart failure [13 men, mean age 67+/-7 years, mean peak oxygen consumption (peak VO2) 16.3+/-2.8 ml/min/kg] and chronic atrial fibrillation (median duration 19 (1-228) months). Patients were stable on digoxin, diuretics, nitrates and angiotensin converting enzyme inhibitors; no prophylaxis with antiarrhythmics was started after cardioversion. Cardioversion was unsuccessful in 6 patients; of the 18 patients in whom sinus rhythm was obtained 9 had a relapse of atrial fibrillation within 6 weeks after cardioversion. The remaining 9 patients with maintenance of sinus rhythm and the 15 (6+9) patients with atrial fibrillation at follow-up after 6 weeks did not differ with respect to any baseline characteristic, including age, peak VO2, duration of atrial fibrillation, echocardiographic left ventricular and left atrial dimensions, plasma atrial natriuretic peptide and norepinephrine. In the patients with maintenance of sinus rhythm, baseline measurements were repeated at follow-up. Peak VO2 did not change significantly (16.7+/-2.8 to 17.6+/-3.3 ml/min/kg, P=0.29); also, echo parameters, atrial natriuretic peptide and norepinephrine were not significantly affected. These results indicate that it is difficult to achieve lasting sinus rhythm through electrical cardioversion in patients with atrial fibrillation and mild to moderate heart failure. Moreover, in patients with maintenance of sinus rhythm after cardioversion no significant benefit in terms of peak VO2, cardiac dimensions, and neurohumoral status is to be expected. Hence, indiscriminate cardioversion of atrial fibrillation in the setting of heart failure does not appear to be useful.     

The temporal dynamics of reading: a PET study

The temporal dynamics of evoked brain responses are normally characterized using electrophysiological techniques but the positron emission tomography study presented here revealed a temporal aspect of reading by correlating the duration a word remained in the visual field with evoked haemodynamic response. Three distinct types of effects were observed: in visual processing areas, there were linear increases in activity with duration suggesting that visual processing endures throughout the time the stimulus remains in the visual field. In right hemisphere areas, there were monotonic decreases in activity with increased duration which we relate to decreased attention for longer stimulus durations. In left hemisphere word processing areas there were inverted U-shaped dependencies between activity and word duration indicating that, after 400-600 ms, activity in word processing areas is progressively reduced if the word remains in the visual field. We conclude that these inverted U effects in left hemisphere language areas reflect the temporal dynamics of visual word processing and we highlight the implication of these effects for the design of activation studies involving reading.     

Transsexualism--general outcome and prognostic factors: a five-year follow-up study of nineteen transsexuals in the process of changing sex

Nineteen transsexuals, approved for sex reassignement, were followed-up after 5 years. Outcome was evaluated as changes in seven areas of social, psychological, and psychiatric functioning. At baseline the patients were evaluated according to axis I, II, V (DSM-III-R), SCID screen, SASB (Structural Analysis of Social Behavior), and DMT (Defense Mechanism Test). At follow-up all but 1 were treated with contrary sex hormones, 12 had completed sex reassignment surgery, and 3 females were waiting for phalloplasty. One male transsexual regretted the decision to change sex and had quit the process. Two transsexuals had still not had any surgery due to older age or ambivalence. Overall, 68% (n = 13) had improved in at least two areas of functioning. In 3 cases (16%) outcome were judged as unsatisfactory and one of those regarded sex change as a failure. Another 3 patients were mainly unchanged after 5 years. Female transsexuals had a slightly better outcome, especially concerning establishing and maintaining partnerships and improvement in socio-economic status compared to male transsexuals. Baseline factors associated with negative outcome (unchanged or worsened) were presence of a personality disorder and high number of fulfilled axis II criteria. SCID screen assessments had high prognostic power. Negative self-image, according to SASB, predicted a negative outcome, whereas DMT variables were not correlated to outcome.     

Semantic involvement in reading aloud: Evidence from a nonword training study.

The current research uses a novel methodology to examine the role of semantics in reading aloud. Participants were trained to read aloud 2 sets of novel words (i.e., nonwords such as bink): some with meanings (semantic) and some without (nonsemantic). A comparison of reading aloud performance between these 2 sets of novel words was used to provide an indicator of the importance of semantic information in reading aloud. In Experiment 1, in contrast to expectations, reading aloud performance was not better for novel words in the semantic condition. In Experiment 2, the training of novel words was modified to reflect more realistic steps of lexical acquisition: Reading aloud performance became faster and more accurate for novel words in the semantic condition, but only for novel words with inconsistent pronunciations. This semantic advantage for inconsistent novel words was again observed when a subset of participants from Experiment 2 was retested 6-12 months later (in Experiment 3). These findings provide support for a limited but significant role for semantics in the reading aloud process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of a multi-application computer workstation in a clinical setting

The goal of this study was to assess the usage frequency, user satisfaction, and quality of literature searchers for a multi-application computer workstation in a university-based general medicine clinic. A computer with medical literature searching, textbook searching, and a decision-support program was deployed in the workroom of the clinic and made available for routine use. Data were collected for ten months. More than three quarters of the study participants used the computer, with use increasing by level of medical training. Despite physicians' known preferences for nonjournal sources of information, literature searching was the application used most frequently, followed by textbooks and decision support. The literature searches were replicated by experienced clinician and librarian searchers using first full MEDLINE and then text-word-only searching, to compare the quantities of relevant references retrieved. Novice searchers retrieved a larger number of relevant references than did the experienced searchers, but they also retrieved more nonrelevant references. For both groups of experienced searchers, the full MEDLINE feature set conferred little benefit over searching with only text words. These searching results call into question the value of traditional searching methods for both novice and experienced physicians.     

Design of a study to improve accuracy in reading mammograms

This paper is concerned with the design and analysis of mammography reading studies. In particular we consider studies aimed at evaluating interventions to improve the accuracy with which mammograms are read. A simple randomized design is suggested in which a relatively large group of readers read sets of mammograms before and after an intervention phase. We propose solutions to three difficult statistical issues that arise in the context of such studies: (i) the choice of primary outcome measure; (ii) the data analysis technique to be employed; and (iii) the methodology for calculating sample sizes for readers and images to be read. First, we argue in favor of using sensitivity and specificity as the primary outcome measures rather than receiver operating characteristic (ROC) curves in mammography studies, although the latter are considered state of the art for many types of radiology reading studies. We argue that sensitivity and specificity are more clinically relevant and conceptually more straightforward than ROC curves. Second, we suggest a bivariate approach to data analysis for evaluating intervention effects on sensitivity and specificity. This accommodates the correlations inherent between these measures and allows for estimation of joint effects on them. Finally we propose a method for power calculations that uses computer simulation techniques. Simple formulas for sample size calculations are not available in part because variability in accuracy amongst readers and variation in difficulty among images introduce complexity into power calculations. The simulation method that we propose accommodates such complexity and is easy to implement. The methodology was motivated by a study funded by the Department of Defense to evaluate the potential efficacy of an educational intervention. In the context of this study we illustrate the steps involved in power calculations and apply the data analytic techniques to the sort of data expected to result from this study. Though the proposed methods were motivated by this particular study, the statistical considerations are relevant more broadly in mammography and indeed in other types of radiologic imaging studies. Standards for the conduct of radiologic reading studies are not yet well developed, as they are for randomized clinical trials and for case-control studies. We hope that the discussion in this paper will add to the dialogue necessary for development of such standards.     

Training industrial executives in reading: A methodology study.

A controlled-method study of gains achieved and retained by industrial executives as a result of reading improvement training. 4 groups consisting of 56 executives were equated on reading-ability score and related criteria. 1 group served as a control, while 3 experimental groups were trained with different methods. Each group received 16 hours of training. Progress and permanence were evaluated by equated forms of a reading test. Results were analyzed by t tests between and within groups. No significant differences were found between methods. Very significant progress and retention was found within all groups. Industrial executives can be trained to read more efficiently, and do retain that efficiency. Mechanical aids are not required for reading training of executives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Awareness of language in children who have reading difficulties: historical comparisons in a longitudinal study

The purpose of this study was to assess factors associated with the use of family planning at first sexual intercourse among young adults aged 15 to 24 in urban Ecuador. The study population consisted of 1443 young adults (494 females and 949 males) in the cities of Quito and Guayaquil, interviewed by the 1988 Ecuador Young Adult Reproductive Health Survey, who reported having experienced consensual sexual intercourse. Approximately 11% of females and 15% of males reported using contraception at first intercourse. Binary logistic regression was performed to assess jointly the effect of multiple factors on contraceptive use at first intercourse. The regression model was first run on the entire study population and then separately for males and females. In the overall population, the following variables were significantly related to using family planning at first sex: being male; being from Guayaquil; older age; father's completion of secondary school. Having lost one's virginity to a prostitute was significantly associated with non-use of family planning. Males were 3.6 times more likely than females to use family planning during their first sexual intercourse. For each year older a young adult was at first sex, his or her odds of using family planning was multiplied by a factor of 1.3. Twenty-eight per cent of males in this study experienced their first sexual intercourse with a prostitute, and these young men were highly unlikely to use family planning. A male who experienced first intercourse with his girlfriend was more than five times as likely to use contraception than a male who lost his virginity to a prostitute.     

Intrinsic and extrinsic reading motivation as predictors of reading literacy: A longitudinal study.

The purpose in this study was to examine the longitudinal relationships of intrinsic and extrinsic motivation with reading literacy development. In particular, the authors (a) investigated reading amount as mediator between motivation and reading literacy and (b) probed for bidirectional relationships between reading motivation and reading literacy, controlling for previous reading literacy. A total of 740 students participated in a longitudinal assessment starting in Grade 3, with further points of measurement in Grades 4 and 6. Structural equation models with latent variables showed that the relationship between intrinsic reading motivation and later reading literacy was mediated by reading amount but not when previous reading literacy was included in the model. A bidirectional relationship was found between extrinsic reading motivation and reading literacy: Grade 3 reading literacy negatively predicted extrinsic reading motivation in Grade 4, which in turn negatively predicted reading literacy in Grade 6. Implications for research and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Localizing the lexicon for reading aloud:replication of a PET study using fMRI

Functional magnetic resonance imaging (fMRI) was used to investigate the neural basis of written word recognition in two normal subjects. With a 1.5T scanner and temporal surface coil, T2 gradient echo images were obtained while subjects read words aloud. As a control condition, subjects visualized false font strings and said the word "range' each time such a string appeared. These two conditions were presented in an oscillatory pattern, alternating 30 s of each condition for a total of 4 min. Comparison of the two conditions using cross-correlation demonstrated strong activation in both subjects in the left posterior superior temporal gyrus, near the site predicted for the visual input lexicon by Déjerine and recently demonstrated by positron emission tomography.     

Gene × environment interactions in reading disability and attention-deficit/hyperactivity disorder.

This article examines Gene × Environment (G × E) interactions in two comorbid developmental disorders--reading disability (RD) and attention-deficit/hyperactivity disorder (ADHD)--as a window on broader issues on G × E interactions in developmental psychology. The authors first briefly review types of G × E interactions, methods for detecting them, and challenges researchers confront in interpreting such interactions. They then review previous evidence for G × E interactions in RD and ADHD, the directions of which are opposite to each other: bioecological for RD and diathesis stress for ADHD. Given these results, the authors formulate and test predictions about G × E interactions that would be expected at the favorable end of each symptom dimension (e.g., above-average reading or attention). Consistent with their prediction, the authors found initial evidence for a resilience interaction for above-average reading: higher heritability in the presence of lower parental education. However, they did not find a G × E interaction at the favorable end of the ADHD symptom dimension. The authors conclude with implications for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relations of television viewing and reading: Findings from a 4-year longitudinal study.

This longitudinal study explored the long-term effects of television viewing on the development of children's reading competencies. Among 2 cohorts of German children (N? = 165, N? = 167), measures of television viewing were collected over 4 years, and tests of reading speed and reading comprehension were administered annually. As a main result, TV genre (educational vs. entertainment programs) produced different effects. Whereas educational program viewing was positively correlated with reading achievement, relations between entertainment program viewing and reading performance were generally negative. Children who were classified as heavy viewers (average viewing time per day = 117 min) showed lower progress in reading over time as compared to medium and light viewers (average viewing times per day 69 and 35 min, respectively). Partial support was found only for 1 of the 3 tested causal mechanisms, namely television-induced reduction in leisure-time book reading. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social support and hostility as predictors of depressive symptoms in cardiac patients one month after hospitalization: a prospective study

OBJECTIVE: Hospitalization for cardiac disease is associated with an increased risk for depression, which itself confers a poorer prognosis. Few prospective studies have examined the determinants of depression after hospitalization in cardiac patients, and even fewer have examined depression within the weeks after hospital discharge. The present study assessed the prospective relations among perceptions of social support and trait hostility in predicting symptoms of depressive symptoms at 1 month after hospitalization for a diagnostic angiography in 506 coronary artery disease (CAD) patients. METHOD: A series of structural equation models 1) estimated the predictive relations of social support, hostility, and depressive symptoms while in the hospital to symptoms of depression 1 month after hospitalization, and 2) compared these relations across gender, predicted risk classification, and age. RESULTS: Social support assessed during hospitalization was independently negatively associated with depressive symptoms 1 month after hospitalization, after controlling for baseline symptoms of depression, gender, disease severity, and age. Hostility was an indirect predictor of postdischarge depressive symptomology by way of its negative relation with social support. This pattern of relations did not differ across gender, predicted risk classification, and age. CONCLUSIONS: Our findings suggest that a patient's perceived social support during hospitalization is a determinant of depressive symptoms 1 month later. The relation of social support and hostility to subsequent depressive symptoms was similar across a variety of populations.