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OBJECTIVE: Prefrontal dysfunction is considered a fundamental characteristic of schizophrenia. Recent electrophysiological evidence points to a major instability of signal processing in prefrontal cortical microcircuits because of reduced phase-synchronization (i.e., an increased stimulus-related variability [noise] of single-trial responses in the spatial and time domain). The authors used functional magnetic resonance imaging (fMRI) during a visual two-choice reaction task in order to measure, with higher topographic accuracy, signal stability in patients with schizophrenia and its relationship to more traditional measures of activation. METHOD: Twelve clinically stable inpatients with schizophrenia and 16 matched comparison subjects were evaluated. Event-related blood-oxygen-level-dependent responses were subjected to an analysis of residual noise variance and to independent data dimension independent component analysis in the medial prefrontal cortex. RESULTS: In patients with schizophrenia, the authors found increased residual noise variance of the blood-oxygen-level-dependent response that predicted the level of prefrontal activation in these subjects. In the left hemisphere, residual noise variance strongly correlated with psychotic symptoms. Independent component analysis revealed a 'fractionized' and unfocussed pattern of activation in patients. CONCLUSIONS: These findings suggest that unstable cortical signal processing underlies classic abnormal cortical activation patterns as well as psychosis in schizophrenia. [ABSTRACT FROM AUTHOR]

Background: The metabolic syndrome is a common risk factor for cardiovascular disease.Objective: To examine the association between the metabolic syndrome and risk for chronic kidney disease and microalbuminuria.Design: Cross-sectional study.Setting: The Third National Health and Nutrition Examination Survey.Patients: Participants 20 years of age or older were studied in the chronic kidney disease (n = 6217) and microalbuminuria (n = 6125) analyses.Measurements: The metabolic syndrome was defined as the presence of 3 or more of the following risk factors: elevated blood pressure, low high-density lipoprotein cholesterol level, high triglyceride level, elevated glucose level, and abdominal obesity. Chronic kidney disease was defined as a glomerular filtration rate less than 60 mL/min per 1.73 m2, and microalbuminuria was defined as a urinary albumin-creatinine ratio of 30 to 300 mg/g.Results: The multivariate-adjusted odds ratios of chronic kidney disease and microalbuminuria in participants with the metabolic syndrome compared with participants without the metabolic syndrome were 2.60 (95% CI, 1.68 to 4.03) and 1.89 (CI, 1.34 to 2.67), respectively. Compared with participants with 0 or 1 component of the metabolic syndrome, participants with 2, 3, 4, and 5 components of chronic kidney disease had multivariate-adjusted odds ratios of 2.21 (CI, 1.16 to 4.24), 3.38 (CI, 1.48 to 7.69), 4.23 (CI, 2.06 to 8.63), and 5.85 (CI, 3.11 to 11.0), respectively. The corresponding multivariate-adjusted odds ratios of microalbuminuria for participants with 3, 4, and 5 components were 1.62 (CI, 1.10 to 2.38), 2.45 (CI, 1.55 to 3.85), and 3.19 (CI, 1.96 to 5.19), respectively.Conclusions: These findings suggest that the metabolic syndrome might be an important factor in the cause of chronic kidney disease. [ABSTRACT FROM AUTHOR]

BACKGROUND: Ethnic differences in the relation of body mass index (BMI; in kg/m2) to morbidity and mortality have led investigators to question whether a single cutoff for obesity should be applied to all ethnic groups. OBJECTIVE: The effects of using 4 different outcomes and 3 different measures of effect as criteria for comparing BMI cutoffs were shown with the use of data from 45- to 64-y-old African American and white women. DESIGN: Data were from the Cancer Prevention Study I (CPS-I) and the Atherosclerosis Risk in Communities (ARIC) Study. The outcomes were mortality (9211 deaths), diabetes (757 cases), hypertension (1518 cases), and hypertriglyceridemia (1264 cases). The measures of effect were incidence rate, rate ratio, and rate difference. The BMI in African American women that was associated with a risk equivalent to that of white women with a BMI of 30 was estimated. RESULTS: There was no significant association between BMI and mortality in African American women. The BMI in African American women that was associated with a risk of diabetes equivalent to that of white women with a BMI of 30 was 28.0-34.5, depending on the measure of effect. For hypertension, the equivalent risk in African American women occurred at a BMI of <18-38, depending on the measure of effect. There was no BMI at which African American women had an incidence rate or rate ratio for hypertriglyceridemia that was as high as that of white women with a BMI of 30. CONCLUSION: BMI cutoffs associated with equivalent risk across ethnic groups differ widely depending on the outcome and the risk estimate. Copyright © 2002 American Society for Clinical Nutrition [ABSTRACT FROM AUTHOR]

It is argued that an important factor behind the lack of direction in current policies towards serious mental illness has been the failure to critique properly the highly entwined relationship between the discourses of psychiatry and 'the family'. Interviews carried out with an ethnically diverse group of Londoners, who had a relative diagnosed as suffering from serious mental illness, suggest that while the families have an allegiance to a medical model, they are also actively and critically appropriating psychiatric discourse. Closer examination suggests that concerns about sexuality and people's apparent ability to engage successfully with intimate relationships are prominent among the criteria that family members use to judge sanity. A certain amount of historical explication is necessary to put these observations into context, since there has been so little critical analysis of the role that families play in psychiatry. A number of points can be made from the known histories of asylums and psychiatry that suggest that families and familial ideologies were significantly involved in defining ideas of insanity during both the rise and demise of asylum. On the one hand, idealizations of familial and emotional life came to be seen as connected to the causes and treatments of sanity. On the other hand, families were themselves actively involved in the construction of the asylums since they were choosing to commit relatives they deemed to be mad. These historical observations can help illuminate material from contemporary interviews with families. It is argued that our contemporary understandings of mental illnesses are immanent to ideas of family and emotional life. [ABSTRACT FROM AUTHOR]

The standard Jamar(R) hydraulic power grip test device is not always the best instrument to use in cases of pain and dysfunction ofthe hand/forearm.Test systems may vary greatly in terms of the force values generated, even when the devices calibrate egually.Athletic trainers and therapists should consistently use the same type of device to measure hand strength, in order to maximize the accuracy of estimates of change in patient status over time. [ABSTRACT FROM AUTHOR]

Investigates the responses of rotational agricultural to social and environmental changes in the event that farmers have rational expectations. Expectations of the values of key economic variables; Spatial model of endogenous expectations in rotational agriculture; Analysis; Replication of key features of rotational agriculture.

OBJECTIVE: This observational study was performed in order to determine the hypertension awareness, treatment, and control rates for the country of Korea. METHODS: Rates were determined in conjunction with a national blood pressure survey in Korea in 1990. Through cluster sampling, individuals aged > 30 in 190/146,944 districts were selected for study. Among 25,567 eligible individuals, 21,242 had measurement of blood pressure (BP) and answered a standard questionnaire. BP was recorded as the mean of two measurements with a standard mercury manometer. Hypertension was defined either as BP > or = 160/95 mm Hg or on treatment (n = 2628), or as BP > or = 140/90 mm Hg or on treatment (n = 4219). Treatment was defined as any method of BP treatment, including dietary, traditional, or medication. RESULTS: Rates for BP > or = 160/95 mm Hg or on treatment: aware 1057 (40%), treated 696 (27%), controlled 367 (14%). Rates for BP > or = 140/90 mm Hg or on treatment: aware 1069 (25%), treated 696 (16%), controlled 221 (5%). CONCLUSIONS: Hypertension awareness, treatment, and control rates are relatively low in Korea. Blood-pressure control programs, including detection strategies, are needed here and worldwide. [ABSTRACT FROM AUTHOR]

Background: Impaired joint position sense (JPS) has been shown in anterior cruciate ligament (ACL) deficient and osteoarthritic knees. The relation between JPS and function is uncertain. The aim of this study was to determine further if ACL deficient knees show abnormal JPS and the effect of exercise therapy on JPS, and also to assess the relation between JPS, functional stability, and strength.Methods: Fifty patients (46 men and four women, mean age 26.3 years) with unilateral ACL deficient knees were assessed on admission and after rehabilitation (5 hours a day for four weeks). JPS was assessed by reproduction of passive positioning using a visual analogue incorporating a goniometer. Knee stability was analysed by self report questionnaire (score 0-280) and functional activity test (single leg hop and figure of eight run). Isokinetic dynamometry was performed to evaluate quadriceps and hamstring peak torque strength. Controls were either age and sex matched individuals or the contralateral knee. Statistical analysis was by Wilcoxon signed rank test and Spearman rank order correlation coefficient.Results: JPS was impaired in ACL deficient knees. The mean (SD) errors in reproducing angles were 9.4 (3.1) degrees and 7.1 (2.3) degrees for the ACL deficient knee and control knee respectively (P < 0.0005). There was no improvement in JPS after rehabilitation (9.4 (3.1) degrees and 8.5 (3.2) degrees before and after rehabilitation respectively, P = 0.14). There was improvement as ascertained from the questionnaire (on admission 202 (32.1), after rehabilitation 243 (25.4), P < 0.0001) and functional activity testing (hop: on admission 148.7 (37.3) cm, after rehabilitation 169.8 (31.1) cm, P < 0.0005; figure of eight: on admission 48.4 (16.6) seconds, after rehabilitation 41.6 (3.4) seconds, P < 0.0001). Quadriceps strength improved (peak torque on admission 198.5 (58.9) Nm, after rehabilitation 210.5 (54.2) Nm, P < 0.05), but not hamstring strength (peak torque on admission 130.6 (28.1) Nm, after rehabilitation 135.5 (27.7) Nm, P = 0.24). JPS did not correlate with the functional activity tests (hop and figure of eight run), the responses to the questionnaire, or strength. There was no correlation between the responses to the questionnaire and functional activity tests or muscle strength.Conclusions: JPS was impaired in ACL deficient knees. Although knee stability improved with exercise therapy, there was no improvement in JPS. The role of JPS in the stability of ACL deficient knees remains unclear. [ABSTRACT FROM AUTHOR]

The efficacy, tolerability, and safety of the potent angiotensin II receptor blocker candesartan cilexetil were evaluated in 217 adult patients (68% men, 41% black) with severe systemic hypertension on background therapy with hydrochlorothiazide (HCTZ) in a 4-week, multicenter, randomized, double-blind, placebo-controlled study. Patients with sitting diastolic blood pressure (BP) > or =110 mm Hg during the placebo run-in received HCTZ 12.5 mg once daily for 1 week. Those with sitting diastolic BP >95 mm Hg after the HCTZ run-in were randomized (2:1) to receive candesartan cilexetil 8 mg once daily (n = 141) or placebo (n = 76), plus HCTZ 12.5 mg. After 1 week of double-blind treatment, patients with sitting diastolic BP > or =90 mm Hg were uptitrated to candesartan cilexetil 16 mg once daily or matching placebo, plus HCTZ 12.5 mg; 84% required uptitration. Primary efficacy measurement was a change in trough (24+/-3 hours after treatment) sitting diastolic BP from the end of the HCTZ run-in to double-blind week 4. Mean changes in systolic and diastolic BP were significantly greater with candesartan cilexetil than with placebo, -11.3/-9.1 mm Hg versus -4.1/-3.1 mm Hg, p <0.001/p <0.001, respectively. Patients with higher sitting diastolic BP at the end of the HCTZ run-in tended to have greater decreases in BP (p <0.05). Most patients (53%) receiving candesartan cilexetil were responders (diastolic BP <90 mm Hg or > or =10 mm Hg decrease) and 32% were controlled (diastolic BP <90 mm Hg). Tolerability and safety profiles were similar in the candesartan and placebo groups. In conclusion, candesartan cilexetil 8 to 16 mg once daily was an effective and well-tolerated therapy for lowering BP when added to HCTZ 12.5 mg in a diverse population of patients with severe systemic hypertension in the United States. [ABSTRACT FROM AUTHOR]