Normal Comparison Group Research Articles

Progression of impairment in adolescents with attention-deficit/hyperactivity disorder through the transition out of high school: Contributions of parent involvement and college attendance.

Long-term, prospective follow-up studies of children diagnosed with attention-deficit/hyperactivity disorder (ADHD) show that symptoms tend to decline with age, but impairments in daily life functioning often persist into adulthood. We examined the developmental progression of impairments before and after the transition out of high school in relation to parent involvement during adolescence, parent support during adulthood, and college attendance, using 8 waves of data from the prospective 16-year follow-up of the Multimodal Treatment of ADHD (MTA) study. Participants were 548 proband children diagnosed with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV; American Psychiatric Association, 2000) ADHD Combined Type and 258 age- and sex-matched comparison children (Local Normative Comparison Group; LNCG) randomly sampled from probands' schools. Impairment was assessed consistently by parent report from childhood through adulthood. Results showed that impairment worsens over time both before and after the transition to adulthood for those with ADHD histories, in contrast to non-ADHD peers, whose impairments remained stably low over time. However, impairment stabilized after leaving high school for young adults with ADHD histories who attended college. Involved parenting in adolescence was associated with less impairment overall. Attending college was associated with a stable post-high school trajectory of impairment regardless of parents' involvement during adolescence, but young adults with histories of involved parenting and who attended college were the least impaired overall.

Malocclusion and the need for orthodontic treatment in 8-year-old children with Down syndrome: a cross-sectional population-based study.

To describe the arch morphology and the prevalence and severity of malocclusions in 8-year-old children with DS, and to evaluate their need for treatment using the Norwegian Need for Orthodontic Treatment Index (NOTI), and comparing the findings with a control group. This population-based cross-sectional study was part of a national prospective study evaluating upper airway function, hearing, dental, and craniofacial characteristics in a cohort of children with DS in Norway. The cohort consisted of 32 children with DS and represented 57% of all children born with DS in Norway in 2002. Dental arch morphology and malocclusion were assessed on dental casts. Data were collected prospectively at the TAKO-centre, National Resource Center for Oral Health in Rare Medical Conditions. All the children with DS (100%) had objectively assessed needs for orthodontic treatment, compared with 30% of the normative comparison group. Among the children with DS, 68% were objectively categorized as being in "great need" (Category B) for treatment and the 75% were categorized as having "obvious need" (Category C). In comparison, only 20% of children without DS were in Category B, and 44% were in Category C. This study indicates significantly higher prevalence and severity of malocclusions in 8-year-old children with DS compared with control group.

Diabetes and quality of life—a pilot study

Background: India is regarded as the “Diabetes Capital” of the world owing to the existence of the largest number of people with diabetes in this country. Diabetes is a serious public health problem that has a strong negative impact on the health-related quality of life (HRQoL). Objective: To know the quality of life (QoL) of diabetic persons and compare them with normal subjects. Materials and Methods: This cross-sectional study was done among 85 diabetic patients and 85 age- and sex-matched normal comparison group. We used the World Health Organization Quality of Life Questionnaire—short version (WHOQoL-BREF) to assess QoL. Result: The mean QOL-BREF instrument score, indicating the QoL of the patients, was 57.80. Domain-wise, 55% of the patients revealed good physical QoL, 47% good psychological QoL, 55% good social QoL, and 45% good environmental QoL. The mean score of physical domain of diabetic patients was significantly lower than nondiabetic subjects. Conclusion: This study has shown that the physical domain of QoL was significantly affected in diabetic persons. So, apart from taking regular medications and health checkup, there is a need to address other components of physical domain so that their QoL will improve. While it might not be easy to modify clinical outcomes with good services and support, it might be much more effective in bringing a change in QoL.

ADHD and cannabis use in young adults examined using fMRI of a Go/NoGo task.

Children diagnosed with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for substance abuse. Response inhibition is a hallmark of ADHD, yet the combined effects of ADHD and regular substance use on neural networks associated with response inhibition are unknown. Task-based functional Magnetic Resonance Imaging (fMRI) data from young adults with childhood ADHD with (n = 25) and without (n = 25) cannabis use ≥ monthly in the past year were compared with a local normative comparison group (LNCG) with (n = 11) and without (n = 12) cannabis use. Go/NoGo behavioral and fMRI data were evaluated for main and interaction effects of ADHD diagnosis and cannabis use. ADHD participants made significantly more commission errors on NoGo trials than controls. ADHD participants also had less frontoparietal and frontostriatal activity, independent of cannabis use. No main effects of cannabis use on response inhibition or functional brain activation were observed. An interaction of ADHD diagnosis and cannabis use was found in the right hippocampus and cerebellar vermis, with increased recruitment of these regions in cannabis-using controls during correct response inhibition. ADHD participants had impaired response inhibition combined with less fronto-parietal/striatal activity, regardless of cannabis use history. Cannabis use did not impact behavioral response inhibition. Cannabis use was associated with hippocampal and cerebellar activation, areas rich in cannabinoid receptors, in LNCG but not ADHD participants. This may reflect recruitment of compensatory circuitry in cannabis using controls but not ADHD participants. Future studies targeting hippocampal and cerebellar-dependent function in these groups may provide further insight into how this circuitry is altered by ADHD and cannabis use.

Herbal formula menoprogen alters insulin-like growth factor-1 and insulin-like growth factor binding protein-1 levels in the serum and ovaries of an aged female rat model of menopause.

Menoprogen (MPG), a traditional Chinese medicine formula for menopause, improves menopausal symptoms; however, its mechanism remains unknown. Previous studies have shown that MPG is not directly estrogenic; thus, the goal of this study was to investigate the effects of MPG on insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-1 (IGFBP-1) levels in an aged female rat model of menopause. In a six-arm study, 14-month-old female Sprague-Dawley rats (n = 8 per arm) were randomly divided into the following groups: untreated aged, 17β-estradiol-treated aged (estradiol [E2]), and three arms with increasing doses of MPG (162, 324, or 648 mg/kg/d). The sixth arm contained 4-month-old female Sprague-Dawley rats as a normal comparison group. Four weeks after MPG or E2 administration, animals were killed after blood draws, and ovarian tissues were excised. Levels of E2 and progesterone (P4) were determined by radioimmunoassay. Serum and ovarian tissue levels of IGF-1, IGFBP-1, and IGF-1 receptor were determined by enzyme-linked immunosorbent assay. Compared with the normal group, aged rats had significantly reduced serum levels of E2, P4, and IGF-1, and increased serum and ovarian tissue levels of IGFBP-1. MPG restored serum IGF-1 and IGFBP-1 levels and down-regulated ovarian levels of IGFBP-1, which were closely related to increases in E2 and P4 levels in aged rats. No significant differences in either IGF-1 or IGFBP-1 were observed between the three doses of MPG. MPG exerts a direct in vivo effect on aged female rats by positively regulating serum and ovarian IGF-1 and IGFBP-1 levels.

A TCM herbal formula increases IGF-1 and IGFBP-1 levels in the sera and ovaries in an aged female rat model of menopause

Menoprogen (MPG), a TCM herbal formula improves menopausal symptoms in clinical trials, however its mechanism has remained elusive. Previous studies show that MPG is not directly estrogenic, thus the goal of this study was to investigate the effects of MPG on IGF-1 and IGFBP-1 levels in an aged female rat model of menopause. In a six-armed study, 14-month-old Sprague-Dawley (SD) female rats (n = 8 per arm) were randomly divided into an untreated aged group, an E2-treated aged group (17β-estradiol), and three arms with increasing doses of MPG groups (162, 324, or 648 mg/kg/day). The sixth arm contained four-month-old SD female rats as a normal comparison group. Four weeks after MPG or E2 administration, the animals were sacrificed after blood draws, and then ovarian tissues were excised. The levels of E2 and progesterone (P4) were determined by radioimmunoassay, and serum and ovarian tissue levels of IGF-1, IGFBP-1, and IGF-1 receptor (IGFR) were determined by ELISA. Compared with the normal group, the aged rats had significantly reduced serum levels of E2, P4, and IGF-1 and increased serum and ovarian tissue levels of IGFBP-1. MPG restored serum IGF-1 and IGFBP-1 levels and down-regulated the ovarian levels of IGFBP-1, which were closely related to increases of E2 and P4 levels in the aged rats. No significant differences were observed between the three doses of MPG for either IGF-1 or IGFBP-1. MPG has a direct in vivo effect in aged female rats by positively regulating serum and ovarian IGF-1 and IGFBP-1 levels.

Static-99R reporting practices in sexually violent predator cases: Does norm selection reflect adversarial allegiance?

We surveyed experts (N = 109) who conduct sexually violent predator (SVP) evaluations to obtain information about their Static-99R score reporting and interpretation practices. Although most evaluators reported providing at least 1 normative sample recidivism rate estimate, there were few other areas of consensus. Instead, reporting practices differed depending on the side for which evaluators typically performed evaluations. Defense evaluators were more likely to endorse reporting practices that convey the lowest possible level of risk (e.g., routine sample recidivism rates, 5-year recidivism rates) and the highest level of uncertainty (e.g., confidence intervals, classification accuracy), whereas prosecution evaluators were more likely to endorse practices suggesting the highest possible level of risk (e.g., high risk/need sample recidivism rates, 10-year recidivism rates). Reporting practices from state-agency evaluators tended to be more consistent with those of prosecution evaluators than defense evaluators, although state-agency evaluators were more likely than other evaluators to report that it was at least somewhat difficult to choose an appropriate normative comparison group. Overall, findings provide evidence for adversarial allegiance in Static-99R score reporting and interpretation practices.

Damage to the Ventromedial Prefrontal Cortex Impairs Learning from Observed Outcomes.

Individuals learn both from the outcomes of their own internally generated actions (“experiential learning”) and from the observation of the consequences of externally generated actions (“observational learning”). While neuroscience research has focused principally on the neural mechanisms by which brain structures such as the ventromedial prefrontal cortex (vmPFC) support experiential learning, relatively less is known regarding how learning proceeds through passive observation. We explored the necessity of the vmPFC for observational learning by testing a group of patients with damage to the vmPFC as well as demographically matched normal comparison and brain-damaged comparison groups—and a single patient with bilateral dorsal prefrontal damage—using several value-learning tasks that required learning from direct experience, observational learning, or both. We found a specific impairment in observational learning in patients with vmPFC damage manifest in the reduced influence of previously observed rewards on current choices, despite a relatively intact capacity for experiential learning. The current study provides evidence that the vmPFC plays a critical role in observational learning, suggests that there are dissociable neural circuits for experiential and observational learning, and offers an important new extension of how the vmPFC contributes to learning and memory.

PPARγ suppressed Wnt/β-catenin signaling pathway and its downstream effector SOX9 expression in gastric cancer cells.

Wnt signaling pathway activation plays a critical role in biological processes of tumor progression. SOX9 belongs to the sry-related high-mobility group box (SOX) family and is a key transcription factor in the development and differentiation of multiple cell lineages. The purpose of this study was to investigate whether suppression of Wnt signaling pathway by PPARγ gene affects target SOX9 gene expression. The pEGFP-N1-PPARγ overexpression recombinant plasmid was structured by molecular biology technology. The overexpression plasmid and empty vector pEGFP-N1 were transfected into three types of human gastric cancer cell lines, with different levels of differentiation, MKN-28, SGC-7901 and BGC-823. The PPARγ, β-catenin and SOX9 mRNA levels and proteins were examined by real-time PCR and Western blot analysis. The pEGFP-N1-PPARγ recombinant plasmid was constructed and transfected into MKN-28, SGC-7901 and BGC-823 successfully. High expression of PPARγ (p < 0.05) for transfection recombinant plasmid group induced obviously decreased expression of β-catenin (p < 0.05), whereas SOX9 expression decreased significantly (p < 0.05) compared with the transfection empty vector group and normal comparison group. PPARγ can suppress β-catenin expression in Wnt signaling pathway and its downstream effector SOX9 expression in gastric cancer cells.

Risk for emerging bipolar disorder, variants, and symptoms in children with attention deficit hyperactivity disorder, now grown up.

To determine the prevalence of bipolar disorder (BD) and sub-threshold symptoms in children with attention deficit hyperactivity disorder (ADHD) through 14 years' follow-up, when participants were between 21-24 years old. First, we examined rates of BD type I and II diagnoses in youth participating in the NIMH-funded Multimodal Treatment Study of ADHD (MTA). We used the diagnostic interview schedule for children (DISC), administered to both parents (DISC-P) and youth (DISCY). We compared the MTA study subjects with ADHD (n = 579) to a local normative comparison group (LNCG, n = 289) at 4 different assessment points: 6, 8, 12, and 14 years of follow-ups. To evaluate the bipolar variants, we compared total symptom counts (TSC) of DSM manic and hypomanic symptoms that were generated by DISC in ADHD and LNCG subjects. Then we sub-divided the TSC into pathognomonic manic (PM) and non-specific manic (NSM) symptoms. We compared the PM and NSM in ADHD and LNCG at each assessment point and over time. We also evaluated the irritability as category A2 manic symptom in both groups and over time. Finally, we studied the irritability symptom in correlation with PM and NSM in ADHD and LNCG subjects. DISC-generated BD diagnosis did not differ significantly in rates between ADHD (1.89%) and LNCG 1.38%). Interestingly, no participant met BD diagnosis more than once in the 4 assessment points in 14 years. However, on the symptom level, ADHD subjects reported significantly higher mean TSC scores: ADHD 3.0; LNCG 1.7; P < 0.001. ADHD status was associated with higher mean NSM: ADHD 2.0 vs LNCG 1.1; P < 0.0001. Also, ADHD subjects had higher PM symptoms than LNCG, with PM means over all time points of 1.3 ADHD; 0.9 LNCG; P = 0.0001. Examining both NSM and PM, ADHD status associated with greater NSM than PM. However, Over 14 years, the NSM symptoms declined and changed to PM over time (df 3, 2523; F = 20.1; P < 0.0001). Finally, Irritability (BD DSM criterion-A2) rates were significantly higher in ADHD than LNCG (χ(2) = 122.2, P < 0.0001), but irritability was associated more strongly with NSM than PM (df 3, 2538; F = 43.2; P < 0.0001). Individuals with ADHD do not appear to be at significantly greater risk for developing BD, but do show higher rates of BD symptoms, especially NSM. The greater linkage of irritability to NSM than to PM suggests caution when making BD diagnoses based on irritability alone as one of 2 (A-level) symptoms for BD diagnosis, particularly in view of its frequent presentation with other psychopathologies.

Maternal ADHD Symptoms, Personality, and Parenting Stress: Differences Between Mothers of Children With ADHD and Mothers of Comparison Children

Objective: Mothers raising a child with ADHD can experience high parenting stress. We evaluated if mothers’ personality traits and own ADHD symptoms could also affect parenting stress. Method: 430 biological mothers from the Multimodal Treatment Study of Children with ADHD (MTA mothers) and 237 of a local normative comparison group (LNCG mothers) were evaluated at baseline. Interactions were tested between mothers’ group and maternal personality/ADHD symptoms related to parenting stress. Results: Compared to LNCG, MTA mothers had higher parenting stress, self-reported ADHD, neuroticism, and lower conscientiousness and agreeableness. When personality and ADHD were evaluated together, ADHD symptoms interacted with mothers’ group: high maternal ADHD was positively associated with parenting stress for LNCG but not MTA mothers. Conclusion: Personality traits or ADHD characteristics do not appear operative for the high parenting stress of mothers of a child with ADHD. However, high maternal ADHD or low conscientiousness are associated with stress levels similar to raising a child with ADHD.

Study on the diversity of Bacteroides and Clostridium in patients with primary gout.

To analyze the diversity of both Bacteroides and Clostridium in patients with primary gout and the difference from that of normal individuals. And to investigate the relationship between the primary gout and the intestinal flora. Fecal samples of 90 cases with the primary gout and 94 cases normal comparison group were selected, together with the cases that match the filter criteria. The DNA is extracted from the feces. 16S rRNA specific primers of both Bacteroides and Clostridium were adopted for the PCR amplification. The molecular fingerprints of Bacteroides and Clostridium in both the primary gout group and the normal control group were obtained through DGGE and subjected for further analysis on both the diversity and the similarity. Compared with normal individuals, the number of bands and Shannon-Weaver (H') of Bacteroides in patients with primary gout was not reduced, but significantly decreased in Clostridium. Furthermore, the intra-group and inter-group similarity of both Bacteroides and Clostridium were lower. The primary gout has caused the structural change of both Bacteroides and Clostridium, inducing the low similarity, especially for Clostridium. It has statistic significance. The gut predominant flora may play an important role in the development of primary gout.

Group Level Clinical Significance: An Analysis of Current Practice

Measures of clinical significance offer important information about psychological interventions that cannot be garnered from tests of the statistical significance of the change from pretest to posttest. For example, post-intervention comparisons to a nonclinical group often offer valuable information about the practical value of the change that occurred. This study explored the manner in which researchers conduct clinical significance analyses in an effort to summarize the effectiveness of an intervention at the group level. The focus was on the use of the original Jacobson and Truax (Journal of Consulting and Clinical Psychology, 59, 12–19, 1991) method and the normative comparisons method due to Kendall et al. (Journal of Consulting and Clinical Psychology, 67, 285–299, 1999). The results highlight that although the Jacobson and Truax method is routinely adopted for summarizing group-level clinical significance, advanced strategies for summarizing the results are very infrequently applied. Further, the Kendall et al. method, which provides valuable and distinct information regarding how the treated group is performing relative to a normal comparison group, is rarely adopted and even when it is it is often not conducted appropriately. Recommendations are provided for conducting group-level clinical significance analyses.

T.P.25: The benefit of attending a McArdle disease multidisciplinary clinic: Preliminary results on two outcome measures

McArdle disease is associated with muscle cramps caused by everyday activity and exercise. Secondary complications include reduced activity, fatigue and psychological distress. Incidence of obesity, cardiovascular disease and diabetes is also increased. A multidisciplinary approach is recommended for management of the condition and to address the secondary complications. Key outcome measures are the 12 min walk test (12MWT) and quality of life (SF-36v2). This poster reports the results of two outcome measures used routinely within the National McArdle multi-disciplinary service. Hypothesis is that attending the service will result in gains on these two measures. 74 patients completed the 12MWT on at least one occasion. 25% of patients had severe impairment, walking less than 500 m. 51% had mild impairment walking 500–800 m. 24% managed over 800 m. 65 patients completed the SF36v2. Patients scored below the normative comparison group on all subscales. There was correspondence between results on the 12MWT and SF-36v2. Patients with severe impairment had lower scores on the SF-36v2. 45 patients repeated the 12MWT. Average performance improved by 101 m (SD 186 m, range −290 to + 645). 13 patients also repeated the SF36v2. Scores improved significantly particularly in emotional and mental health, vitality and social functioning. This corresponded with an average increase of 185 m on the 12MWT. There is wide variation in performance on the 12MWT. Patients report significantly poorer physical and mental health on the SF-36v2. A poorer performance on the 12MWT corresponds with lower scores on the SF-36v2. There is a significant improvement on both outcome measures following intervention from the multi-disciplinary team. In summary, patients with McArdle disease may benefit from a multidisciplinary approach to reduce physical disability and improve psychological well-being. This study supports the use of the 12MWT and SF-36v2 as outcome measures for this population.

Assessing clinical significance using robust normative comparisons

Objective: Clinical significance determines whether an intervention makes a real difference in the everyday life of a client. One of the most recommended approaches for conducting group-level analyses of clinical significance is to evaluate whether the treated clinical group is equivalent to a normal comparison group (normative comparisons). The purpose of this study was to demonstrate the analytical and practical power of assessing clinical significance using normative comparisons that are robust to violations of normality and homogeneity of variance assumptions. Method: Six datasets were gleaned from published intervention studies for depression. Results: We found that normative comparisons using a robust Schuirmann-Yuen test determined equivalency for 11% fewer clinical samples compared to original normative comparisons that use a Schuirmann test of equivalence. Conclusions: We recommend that researchers conducting normative comparisons utilize the Schuirmann-Yuen procedure as it provides the most reliable method available for determining if a treated clinical group is equivalent to a normative comparison group.

Impact of ADHD and cannabis use on executive functioning in young adults

BackgroundAttention-deficit/hyperactivity disorder (ADHD) and cannabis use are each associated with specific cognitive deficits. Few studies have investigated the neurocognitive profile of individuals with both an ADHD history and regular cannabis use. The greatest cognitive impairment is expected among ADHD Cannabis Users compared to those with ADHD-only, Cannabis use-only, or neither. MethodsYoung adults (24.2±1.2 years) with a childhood ADHD diagnosis who did (n=42) and did not (n=45) report past year≥monthly cannabis use were compared on neuropsychological measures to a local normative comparison group (LNCG) who did (n=20) and did not (n=21) report past year regular cannabis use. Age, gender, IQ, socioeconomic status, and past year alcohol and smoking were statistical covariates. ResultsThe ADHD group performed worse than LNCG on verbal memory, processing speed, cognitive interference, decision-making, working memory, and response inhibition. No significant effects for cannabis use emerged. Interactions between ADHD and cannabis were non-significant. Exploratory analyses revealed that individuals who began using cannabis regularly before age 16 (n=27) may have poorer executive functioning (i.e., decision-making, working memory, and response inhibition), than users who began later (n=32); replication is warranted with a larger sample. ConclusionsA childhood diagnosis of ADHD, but not cannabis use in adulthood, was associated with executive dysfunction. Earlier initiation of cannabis use may be linked to poor cognitive outcomes and a significantly greater proportion of the ADHD group began using cannabis before age 16. Regular cannabis use starting after age 16 may not be sufficient to aggravate longstanding cognitive deficits characteristic of ADHD.

Fine motor skill predicts expressive language in infant siblings of children with autism.

We investigated whether fine motor and expressive language skills are related in the later-born siblings of children with autism (heightened-risk, HR infants) who are at increased risk for language delays. We observed 34 HR infants longitudinally from 12 to 36 months. We used parent report and standardized observation measures to assess fine motor skill from 12 to 24 months in HR infants (Study 1) and its relation to later expressive vocabulary at 36 months in HR infants (Study 2). In Study 1, we also included 25 infants without a family history of autism to serve as a normative comparison group for a parent-report fine motor measure. We found that HR infants exhibited fine motor delays between 12 and 24 months and expressive vocabulary delays at 36 months. Further, fine motor skill significantly predicted expressive language at 36 months. Fine motor and expressive language skills are related early in development in HR infants, who, as a group, exhibit risk for delays in both. Our findings highlight the importance of considering fine motor skill in children at risk for language impairments and may have implications for early identification of expressive language difficulties.

Ankle-Brachial Index Assessment: Does it Matter how arm Pressures are Measured?

Introduction —The ankle-brachial index (ABI) is an essential tool used not only in screening for peripheral artery disease (PAD) but also in deciding treatment options of the patient with known PAD. Most vascular laboratories have standardized testing, i.e., Doppler measurement of the arm and ankle pressures in ABI calculation. However, some centers still rely on auscultation with a stethoscope to measure arm pressure. This study sought to determine any differences in ABI calculation between the two techniques. Methods —Permission for the study was obtained by the Institutional Review Boards of Des Moines University and the Iowa Heath-Des Moines System. We first calculated the ABI in a group of 50 healthy volunteers with no history of PAD (control group) by using both Doppler arm pressure and stethoscope arm pressure and Doppler-derived ankle pressures. This represented our “normal” population. We enrolled patients in two Intersocietal Commission for the Accreditation of Vascular Laboratories–accredited Vascular Laboratories at the Iowa Methodist Medical Center (Des Moines, IA) and the Iowa Clinic (West Des Moines, IA) to perform similar Doppler and stethoscope arm pressure and Doppler ankle pressures for ABI determinations in 50 patients (study group). Results —In the comparison group of healthy volunteers, the mean Doppler ABI was 1.18 ± 0.17 in the left leg and 1.22 ± 0.21 in the right leg. Using stethoscope arm pressure measurement, we found that the mean left leg ABI was 1.18 ± 0.17 and 1.17 ± 0.20 in the right leg. The study group of patients showed a Doppler arm pressure determination of ABI in the left leg of 1.02 ± 0.24 and 1.02 ± 0.23 in the right leg. Stethoscope ABI calculation for the study patients showed a mean left leg ABI of 1.03 ± 0.24 and in the right leg of 1.04 ± 0.24. A test–retest reliability analysis was then performed via the parallel model. Cronbach's alpha was then calculated to ascertain the level of agreement between the two ABI data sets (Doppler versus stethoscope ABI) in both the control and study patient groups. The equality of variance was confirmed by the chi-squared test (χ2 = 0.532, df = 1, p &gt; 0.05) for the patient group and 0.972 for the normal population (df = 1, p &gt; 0.05) indicating equal variance in both groups and therefore no difference between test results by method of arm blood pressure assessment. The reliability scale estimate was alpha = 0.99 for the patients and alpha = 0.90 for the normal comparison group, confirming a high degree of correspondence between the two measurement approaches. There was a tendency toward a greater degree of variance in the comparison group of healthy volunteers. Testing was performed by less-experienced, third-year podiatry medical students and may reflect an “experience” factor in measuring ankle and arm pressures, but the differences were not statistically significant. Conclusions —Our study showed very little difference in ABI calculation between Doppler versus stethoscope determination of the highest arm pressure. It appears that both techniques produced similar results. On the basis of our findings, ABI calculations can be performed with the use of either technique, provided they are standardized to one method of arm pressure determination.

The sociodemographic and health‐related characteristics of a regional population with chronic disease at an interprofessional student‐assisted clinic in Queensland Capricornia Allied Health Partnership

This paper describes the sociodemographic and health-related characteristics of people with chronic disease attending an interprofessional student-assisted clinic in regional Queensland. A retrospective review of data collected during the first 10 months of operation of the clinic was conducted. SETTING, PARTICIPANTS AND OUTCOME MEASURES: Data was collected on up to 378 patients during an intake appointment at the Capricornia Allied Health Partnership (CAHP) community-based clinic and compared with normative reference groups where available. Sociodemographic characteristics included age, gender and education level; health-related characteristics included body mass index and hospitalisations in the previous 12 months; and risk factors included prescribed medications, smoking status and general practitioner-diagnosed medical conditions. Patients attending the CAHP clinic had a mean number of chronic conditions of 4.9 ± 2.1 per patient, and 97% of patients had multimorbidities. A high level of socioeconomic disadvantage was found in comparison with normative comparison groups based on employment, highest level of schooling completed and the index of social disadvantage. Patients predominantly lived in inner regional areas (76.7%). The most common diagnoses of patients attending the clinic for the first time were hypertension, osteoarthritis, high cholesterol, diabetes and chronic back pain. The CAHP clinic offers a unique student-assisted service model for interprofessional management of patients who are socioeconomically disadvantaged, have multimorbid chronic disease and live in regional areas. The description of baseline data in this paper is important to refine clinic services, to guide other chronic disease clinics and to inform future research study designs.

Anxiety and related outcomes in young adults 7 to 19 years after receiving treatment for child anxiety.

This study evaluated follow-up outcomes associated with cognitive behavioral therapy (CBT) for childhood anxiety by comparing successfully and unsuccessfully treated participants 6.72 to 19.17 years after treatment. Participants were a sample of 66 youths (ages 7-14 years at time of treatment, ages 18-32 years at present follow-up) who had been diagnosed with an anxiety disorder and randomized to treatment in a randomized clinical trial on average 16.24 (SD = 3.56, range = 6.72-19.17) years prior. The present follow-up included self-report measures and a diagnostic interview to assess anxiety, depression, and substance misuse. Compared with those who responded successfully to CBT for an anxiety disorder in childhood, those who were less responsive had higher rates of panic disorder, alcohol dependence, and drug abuse in adulthood. Relative to a normative comparison group, those who were less responsive to CBT in childhood had higher rates of several anxiety disorders and substance misuse problems in adulthood. Participants remained at particularly increased risk, relative to the normative group, for generalized anxiety disorder and nicotine dependence regardless of initial treatment outcome. The present study is the first to assess the long-term follow-up effects of CBT treatment for an anxiety disorder in youth on anxiety, depression, and substance abuse through the period of young adulthood when these disorders are often seen. Results support the presence of important long-term benefits of successful early CBT for anxiety.