Neuropsychiatric development: two case reports about the use of dietary fish oils and/or choline supplementation in children.

Choline supplementation has been used with moderate success in subgroups of adult patients with neuropsychiatric and medical problems. The dietary fish oils have also been used in adults with hypercholesterolemia. We report on two young children with multiple neurodevelopmental delays, one who responded to choline and eicosapentaenoic acid, and the other to choline alone.

Genetic heterogeneity in Alzheimer's disease: a grade of membership analysis.

Grade of membership analysis (GoM) may have particular relevance for genetic epidemiology. The method can flexibly relate genetic markers, clinical features, and environmental exposures to possible subtypes of disease termed pure types even when population allele frequencies and penetrance functions are not known. Hence, GoM may complement existing strategies that sometimes fail in the presence of heterogeneity or when case definition is not well established.

Neuroleptic-induced catatonia as a stage in the progression toward neuroleptic malignant syndrome.

Neuroleptic-induced catatonia is reported in an adolescent patient who responded successfully to lorazepam. The authors propose five discrete stages toward the progression of neuroleptic malignant syndrome, each with a separate treatment.

An integrated medical and psychiatric approach to conversion symptoms in a four-year-old.

Conversion disorder is a challenging diagnosis in children and adolescents. Medical and psychiatric diagnoses need to be evaluated both separately and in relation to each other. This case highlights both the diagnostic criteria for a conversion disorder in a young child and the need for an integrated medical and psychiatric approach by physicians.

Assessment of spatial variation of risks in small populations.

Often environmental hazards are assessed by examining the spatial variation of disease-specific mortality or morbidity rates. These rates, when estimated for small local populations, can have a high degree of random variation or uncertainty associated with them. If those rate estimates are used to prioritize environmental clean-up actions or to allocate resources, then those decisions may be influenced by this high degree of uncertainty.

Cancer mortality, aging, and patterns of comorbidity in the United States: 1968 to 1986.

Cancer is often reported as contributing to the risk of noncancer causes of death. The age variation of these reports was studied using U.S.

Empirical Bayes Approaches to Multivariate Fuzzy Partitions.

In describing high dimensional discrete response data, mathematical and statistical issues arise that require multivariate procedures that are not based on normal distributions, that is, the mathematical representation of high dimensional discrete response data (Event Spaces) requires a representation in lower dimensional parameter spaces consistent with the discrete properties of the Event Space. Mapping discrete responses to latent discrete classes has the limitation of not representing real individual variation within the categories. The use of a fuzzy partition model is proposed which describes individuals in terms of partial membership in multiple latent categories which represents bounded discrete event spaces with significant third and higher order moments.

Multivariate procedures to describe clinical staging of melanoma.

Analyzing multivariate clinical data to identify subclasses of patients being treated for a specific disease may improve patient management and increase understanding of the behavior of disease under clinical conditions. In some cases, patients have been classified on prognostic characteristics using standard risk assessment procedures (e.g.

Functionally and medically defined subgroups of nursing home populations.

The functional and health characteristics of nursing home residents in New York State using a multivariate classification procedure are examined in this article. This analysis suggested that these characteristics could be explained in terms of six dimensions. The association of these six dimensions with two existing sets of nursing home case-mix groups was analyzed in order to determine how groups based only on the health and functional characteristics of residents related to groups based primarily on measures of current service use.

Case-control studies of environmental influences in diseases with genetic determinants, with an application to Alzheimer's disease.

Many diseases have both genetic and environmental determinants. Some require both, and the disease phenotype then appears only when a vulnerable genotype is expressed after interaction with environmental factors. The detection of such environmental factors has received little prior consideration in diseases with genetic causes.

Grade of Membership generalizations and aging research.

The Grade of Membership (GOM) model is a general multivariate procedure for analyzing high dimensional discrete response data. It does this by estimating, using maximum likelihood principles, two types of parameters. One describes the probability that a person who is exactly like one of the K analytically defined types has a particular response on a given variable.

The psychological sequelae of disaster stress prospectively and retrospectively evaluated.

Aimed to document the psychological sequelae of a disaster in the adult (17-68 years) population of the Caribbean island of Puerto Rico, by surveying 912 persons (including 375 previously interviewed) with a Spanish version of the Diagnostic Interview Schedule. A rigorous methodology, which included both retrospective and prospective designs, was used, enabled by the occurrence of a catastrophic disaster only a year after a comprehensive survey was completed. Framed in a stress theoretical perspective, disaster effects for new depressive, somatic, and posttraumatic stress symptoms were identified, even after adjusting for demographic and methodologic factors.

Relationship classification using grade of membership analysis: a typology of sibling relationships in later life.

The results of a comparison of two typologies of sibling relationships in old age are reported. Both analyses rely on the same data collected in individual interviews with adults over the age of 65. The first typology was constructed using constant comparative analysis; the second relied on the grade of membership (GOM) technique.

Quantitative analysis of cold stress performance after digital replantation.

Isolated cold stress testing (ICST) has been used to assess cold stress performance or digital thermoregulation, but statistical analysis of the results has been limited to visual comparisons of data. In this prospective study, 11 patients who underwent complete digital replantation were followed serially with ICST at 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively, and the results were analyzed quantitatively. For that analysis, we devised a mathematical method that provided a cooling and a warming coefficient to fit the data.

Classification of depression by grade of membership: a confirmation study.

One hundred and thirty out-patients with depression were studied by grade of membership multivariate (GOM) analysis. Five depressive types were generated. Pure Type I represented a mild form of melancholia in older, stable males, who showed a modest drug response.

Empirical Bayes procedures for stabilizing maps of U.S. cancer mortality rates.

"The geographic mapping of age-standardized, cause-specific death rates is a powerful tool for identifying possible etiologic factors, because the spatial distribution of mortality risks can be examined for correlations with the spatial distribution of disease-specific risk factors. This article presents a two-stage empirical Bayes procedure for calculating age-standardized cancer death rates, for use in mapping, which are adjusted for the stochasticity of rates in small area populations. Using the adjusted rates helps isolate and identify spatial patterns in the rates.

Antisocial and related disorders in a southern community. An application of grade of membership analysis.

Symptoms of antisocial personality disorder (ASPD) and of psychiatric conditions reported to be related to ASPD were subjected to grade of membership analysis, a relatively new procedure for medical classification, to identify the pure types that would empirically emerge in the absence of prior assumptions about the clustering of those symptoms. The sample consists of 914 respondents who participated in the NIMH Epidemiologic Catchment Area Program at the North Carolina site. Symptom and diagnostic data were obtained using the Diagnostic Interview Schedule.

A statistical analysis of the classification of depression in a mixed community and clinical sample.

Depressive symptoms in three samples are assessed using grade-of-membership analysis to clarify the distribution of depressive symptoms across traditional affective diagnoses. The technique is used to examine whether depressive symptoms and symptoms frequently associated with depressive disorders cluster into recognizable syndromes or pure types that parallel current operational diagnoses. Three hundred and ninety subjects were studied to address the question: among a mixed population with a range of depressive symptoms, will syndromes resembling endogenous depression and demoralization emerge from the range of presentation of depressive symptoms? A single pure type is nearly identical to the DSM-III classification of major depression with melancholia.

Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico. The use of combined measures.

A two-stage epidemiologic survey was carried out on a probability sample of the population aged 4 through 16 years in Puerto Rico. The survey used the Child Behavior Checklist as a screening instrument, and prevalence rates were estimated on the basis of clinical diagnoses and other measures provided by child psychiatrists during the second stage. Maladjustment was operationally defined through the use of combined measures, including DSM-III diagnosis and a scale of functional impairment.

Depressive symptoms and depressive diagnoses in a community population. Use of a new procedure for analysis of psychiatric classification.

A multivariate classification technique was used to examine whether depressive symptoms and symptoms frequently associated with depressive disorders would cluster into recognizable syndromes that parallel traditional DSM-III psychiatric diagnoses. An analysis was made of all respondents in the Epidemiologic Catchment Area (ECA) project of the Piedmont region of North Carolina who reported suffering from depressive symptoms (n = 406) at the second wave of the ECA study. The analysis identified five profiles of symptoms that adequately described the interrelationships of the symptoms as reported in the population.

A survey of the readership of CVJ.

The results of a mail survey of a stratified random sample of Canadian Veterinary Journal (CVJ) subscribers are presented. The survey provided data about the level of satisfaction and amount of interest in journal articles, and associations between subscribers' willingness to purchase a subscription and area of professional activity, as well as with a number of readership variables.The readership indicated a general satisfaction with the CVJ.

Scintigraphic localization of ovarian dysfunction.

To assess the potential role of scintigraphy in the evaluation of clinically and biochemically suspect ovarian hyperandrogenism (HA), dexamethasone suppression 131I-6 beta-iodomethyl-19-norcholesterol (NP-59) scans were performed to characterize ovarian function in nine patients. Pelvic ultrasound and/or computed tomography (CT) identified anatomic abnormalities in the adnexal region in six women in whom there was discernible pelvic accumulation(s) of NP-59. In the remaining three patients testosterone levels were normal or only slightly elevated and the NP-59 scan did not demonstrate abnormal adrenal or pelvic uptake.

A study of depressive typologies using grade of membership analysis.

Grade of Membership (GOM) analysis, a multivariate technique for studying disease, was used to explore depressive typology and relationships between depression and anxiety. One hundred and ninety patients with RDC diagnoses of major or minor depression were assessed by the Hamilton and SCL-90 symptom rating scales, the Newcastle diagnostic indices for endogenous depression and for anxiety and depression. Demographic, family and treatment response information were used as external validators.

Estimating hidden morbidity via its effect on mortality and disability.

The applicability of the theory of partially observed finite-state Markov processes to the study of disease, morbidity, and disability is explored. A method is developed for the continuous updating of parameter estimates over time in longitudinal studies analogous to Kalman filtering in continuous valued continuous time stochastic processes. It builds on a model of filtering of incompletely observed finite-state Markov processes subject to mortality due to Yashin et al.