Barbara Napolitano

Predictors of survival in patients undergoing dialysis

Survival and risk analyses were performed on all 532 patients in whom long-term dialysis was started from 1970 through 1985. During this 16-year period, starting age increased from 47 to 60 years (p less than 0.001), and the incidence of diabetes mellitus and renal vascular disease increased. Survival analysis showed age, renal diagnosis, type of dialysis, and year starting dialysis to be important predictors of survival. There was a fourfold rise in the risk ratio as starting age increased from 25 to 65 years. The risk was 1.5 times higher for those patients who did not start dialysis in 1978 through 1981 than for those who did. Risk decreased fivefold for patients choosing home hemodialysis. Home hemodialysis patients survived longer compared with patients utilizing other dialysis modalities, possibly because of a younger average age and a lower incidence of diabetes mellitus and renal vascular disease. There was greater than a threefold rise in risk ratio with the diagnosis of diabetes mellitus compared with either chronic glomerulonephritis or polycystic kidney disease. Older patients and those with diabetes mellitus formed the high-risk group; these two characteristics have been increasing during the last eight years of the study. It is concluded that although patients with high risk have an increased and a high mortality, overall survival has improved.

Eating attitudes, health-risk behaviors, self-esteem, and anxiety among adolescent females in a suburban high school

In order to determine whether adolescent females with abnormal eating attitudes display lower levels of self-esteem and higher levels of anxiety than their peers, and whether these adolescents participate in health-risk behaviors to a greater or lesser degree than their peers, we administered a series of questionnaires to the females attending a suburban high school in New York State. The questionnaires, completed by 268 students (mean age, 16.2 years), included data on health-risk behaviors and weight attitudes, an Eating Attitudes Test, a self-esteem scale, and an anxiety inventory. Results indicated that almost two-thirds of the students described themselves as overweight, almost three-quarters felt they were above the healthiest weight for their age and height, and almost four-fifths were above the weight at which they would be most happy; 18% of the students scored 30 or more on the Eating Attitudes Test, a score suggestive of an eating disorder. Use of Spearman-rank correlation coefficients and multiple linear regression analysis revealed that those with more unhappiness with their weight and higher scores on the eating attitudes test were more likely to have lower self-esteem and higher anxiety and to participate more in health-risk behaviors, including cigarette smoking, alcohol use, drug use, and sexual activity with more total partners. The data from this study further corroborate the growing belief that health-risk behaviors tend to cluster together in vulnerable adolescents and demonstrate that abnormal eating attitudes and behaviors may be part of this cluster, especially in females with low self-esteem and high levels of anxiety.

Eating attitudes in urban and suburban adolescents

We administered the Eating Attitudes Test (EAT), Rosenberg Self-Esteem Scale, and Spielberger Trait Anxiety Inventory to two populations of high school students. The first group, 268 suburban females (mean age 16.2 years), completed their questionnaires in May 1988. The second population, 389 females and 281 males (mean age 16.0 years) in a city school with 92% black of Hispanic students, completed their questionnaires in February 1990 and were also measured for height and weight as part of a health screening. Scores of 21 or higher on the EAT-26 were achieved by 17.5% of the suburban females, 15.0% of the urban females, and 6.0% of the urban males. Significantly more suburban females (63%) considered themselves overweight, compared with both urban females (35%) and males (19%), yet only 14% of suburban females were calculated to be > 10% over ideal body weight, compared with 45% of urban females and 39% of urban males. Contrary to expectations, self-esteem was higher and anxiety lower in the urban students than the suburban students; self-esteem and anxiety were each significantly correlated with higher EAT scores in both populations, but believing oneself overweight was correlated with higher EAT scores in only the suburban students. These data indicate that abnormal eating attitudes are present among both urban and suburban students but with important differences in their manifestations and implications.

Premenstrul symptoms in adolescents

To assess the prevalence and severity of premenstrual symptoms in adolescents, we administered the Premenstrual Assessment Form, a 95-item instrument previously validated in adults. Adolescent females (n = 207) at a suburban-based adolescent health service completed the form. Subjects had a mean age of 17.6 years, 89% were white, 59% were in high school, 28% were in college. Almost all subjects reported at least one premenstrual change of minimal (96%) or moderate (89%) severity, while many reported changes they considered severe (59%) or extreme (43%). The most commonly reported changes in physical condition were general discomfort and water retention symptoms, fatigue, and autonomic physical changes. The most commonly reported changes in mood and behavior included impaired social function, depressive changes, and impulsive behavior. These changes matched almost exactly those previously reported in adults and were most severe in those adolescents who reported having dysmenorrhea and were not on an oral contraceptive. We believe that clinicians and researchers who evaluate and treat adolescents should view the physical and emotional complaints of teenagers in the context of our findings.

Clinical Significance of Neutropenia in Patients With Human Immunodeficiency Virus Infection

OBJECTIVE To determine the incidence of infection in human immunodeficiency virus (HIV)-infected patients during periods of neutropenia and non-neutropenia. To compare the infection rates in patients with HIV disease to those in a group hospitalized with neutropenia and hematologic malignancy. DESIGN Prospective observational study conducted between December 1985 and December 1987 at a university teaching hospital. Thirty patients with documented acquired immunodeficiency syndrome (AIDS) and absolute T-helper cells less than 200 mm/mm3. All patients had a period of non-neutropenia following a neutropenic period (neutrophils less than 1000 cells/mm3). RESULTS The rate of first infection during neutropenic and non-neutropenic periods for opportunistic infection and nonopportunistic infections were compared. There were no differences between infection rates for the two time periods for both types of infections. A subgroup of patient care days in which non-neutropenic days followed neutropenic days also was studied to eliminate selection bias. In this group, a comparison of infection rates also revealed no difference between neutropenic and non-neutropenic periods. An alternate analysis of the time until first infection during periods of neutropenia or non-neutropenia was done using the Kaplan-Meier product limit method. There was a longer infection-free period for the neutropenic group for opportunistic infections, but it was not statistically significant (p less than .1). In addition, we compared HIV-infected patients with a group of 37 patients with neutropenia from hematologic malignancy. There was a significantly higher rate of all infections, particularly bacteremias (p less than .001), in the group of patients with hematologic malignancies when compared with all subsets of patients with HIV disease. CONCLUSION We conclude that patients with HIV disease and modest neutropenia do not have an increased risk of bacterial infection. The incidence of all infections is significantly greater in patients with neutropenia secondary to hematologic malignancy.

Event-related potentials to an "oddball" auditory paradigm in children with learning disabilities with or without attention deficit hyperactivity disorder.

Event Related Potentials (ERP) were recorded during a two-tone discrimination task in 18 children with Learning Disabilities (LD) and 36 children with Learning Disabilities and Attention Deficit Hyperactivity Disorder (LD-ADHD). Twenty-seven normal children served as a control group. P3 wave amplitude was significantly smaller in the LD and LD-ADHD groups compared with normal children. There was no difference between the LD and LD-ADHD groups. It is suggested that the smaller P3 amplitude in children with LD-ADHD syndromes reflects cognitive and processing difficulties, which frequently coexist with ADHD in these children and is not specifically related to an attention deficit.

Electrophysiological changes in children with learning and attentional abnormalities as a function of age : Event-related potentials to an oddball paradigm

This study investigated age-related electrophysiological differences between children diagnosed with Learning Disabilities (LD), Attention Deficit Hyperactivity Disorder (ADHD), LD-ADHD and Conduct Disorder, using Event-Related Potentials recorded during a two-tone discrimination test. Although age-related (N1 and N2 amplitude), as well as diagnostic group-related (P3 latency and amplitude) ERP changes were found, there was no significant interaction between the diagnostic groups and age grouping. We conclude that: 1) Electrophysiological abnormalities in LD and ADHD do not significantly change with age during childhood. This study does not, therefore, support a hypothesis of age-related brain abnormalities in LD and ADHD. 2) Significant group differences for P3 latency and amplitude were found between normal children and the LD groups (LD and LD-ADHD), but not between normal children and those with ADHD alone, suggesting that main correlates of P3 abnormalities in these children are processing and not attentional problems.

Use of the dementia rating scale as a test for neuropsychological dysfunction in HIV-positive IV drug abusers

Intravenous drug abusers (IVDAs) represent an increasing proportion of the HIV epidemic. Forty-three IVDAs (22 HIV-negative, 21 HIV-positive) were studied using the Mattis Dementia Rating Scale (DRS). All subjects had used intravenous heroin, but reported that they were drug-free at the time of testing. HIV-positive subjects were predominantly symptomatic and were dichotomized into AIDS and non-AIDS groups. All subjects with abnormal DRS scores were HIV-positive (57% of all HIV-positives). All HIV-negative subjects had normal DRS scores while 43% of the positive group obtained such scores. The DRS reliably identifies neuropsychological impairment, and may be a useful screening tool in this population.

Visual event related potentials and reaction time in normal adults, normal children, and children with attention deficit hyperactivity disorder : Differences in short-term memory processing

Visual Event Related Potentials were recorded during a memory search paradigm in 30 normal adults, 17 normal children, and 14 children with Attention Deficit Hyperactivity Disorder (ADHD). Group differences were found in P3 latency and amplitude, Reaction Time and number of errors. The findings indicate a different information processing pattern for ADHD children who possibly use a self-terminating as opposed to exhaustive search strategy.

Weight gain in an eating disorders day program.

Abstract Background: Day treatment programs have increasingly become an important level of care in the medical and psychiatric management of patients with eating disorders, yet there is little in the literature describing the weight gain patterns of patients in these programs. Methods: Weight gain accomplished by 198 patients admitted to a day program over a 2-year period was studied. Weight gain was analyzed by demographic, diagnostic and program-related variables and was compared for weekdays and weekends. Results: The mean length of stay was 2.6 weeks and patients gained a mean of 2.1 pounds (0.95 kg) in the program. Approximately one-quarter of patients lost weight, one-quarter gained 0 to <2 pounds (0.9 kg), one-quarter gained 2–4 pounds (0.9–1.8 kg), and one-quarter gained more than 4 pounds (1.8 kg). Weight gain was greater in those with a diagnosis of anorexia nervosa or eating disorder not otherwise specified (compared to bulimia nervosa), a longer time in the program, and a lower body mass index on admission. Patients gained more on weekdays, while in the program, than on weekends, when they were home. Conclusions: The data showed that most patients accomplished modest weight gains during a relatively short stay in an eating disorders day program, demonstrating what can be expected for this level of care in the current healthcare environment.