Background. Little is known about longitudinal prescribing practices for psychoactive medications for individuals with intellectual disabilities and developmental disabilities (IDDD) who are living in community settings. Methods. Computerized pharmacy records were accessed for 2344 community-based individuals with IDDD for whom a total of 3421 prescriptions were written during a 17-month period of study. Forty-two psychoactive medications were rank ordered in terms of prescription frequency. Results. Fifty-two per cent (52%) of all prescriptions written during the study period were for psychoactive medications. Anticonvulsant, antipsychotic and antidepressant medications were the most commonly filled prescriptions among psychoactive medications. Sixty per cent (62%) of the study population was given prescriptions for more than one psychoactive medication and 36% received three or more psychoactive medications. During the study period there was a statistically significant increase in prescriptions filled for olanzapine, risperidone, valproic acid, and clonazepam whereas prescriptions filled for thioridazine, haloperidol, and benzotropine showed a significant decline (P < 0.05-0.001). Distribution of psychoactive drug class by age showed that the majority of prescriptions were filled for individuals between 20 and 50 years with the exception of prescriptions for psychostimulants which peaked for individuals prior to 20 years. Conclusions. (1) Analysis of pharmacy billing records provides a method for assessing prescribing patterns of psychoactive medications in community-based individuals with IDDD. (2) Polypharmacy for psychoactive medications is prevalent in this setting. (3) The second-generation antipsychotic medications are prominently represented by an increasing number of filled prescriptions during the study period.

Objectives: To determine whether dolichofacial (Frankfort horizontal mandibular plane angle (FHMPA) ≥30°) vs brachyfacial (FHMPA ≤22°) phenotypes differ in temporomandibular joint (TMJ) loads and whether these differences correlate longitudinally with mandibular ramus height (Condylion-Gonion, Co-Go). Setting and Sample Population: Lateral and posteroanterior cephalographs from ten dolichofacial and ten brachyfacial individuals made at average ages of 6 (T1), 12 (T2) and 18 (T3) years and available online (http://www.aaoflegacycollection.org/aaof_home.html) were used. Materials and Methods: Three-dimensional anatomical data were derived from cephalographs and used in numerical models to predict TMJ loads for a range of biting angles on incisors, canines and first molars. Two criteria were used to define clinically important between-group TMJ load differences: statistical significance was defined with a two-group t-test, and where differences were also ≥20%. A statistical approach called response surface analysis was used to assess correlation between TMJ loads and its predictors considered in this study. Results: The two phenotypes had significantly different FHMPA at all ages (P<.05). No differences in TMJ loads were found at T1. Ipsilateral and contralateral TMJ loads at T2 and T3 were significant and ≥20% larger in dolichofacial than brachyfacial phenotypes for specific biting angles (all adjusted P<.05). Regression analysis indicated age and ramus height contribute 53% of the variability in normalized values of TMJ loads. At higher ages, dolichofacial phenotypes had significantly higher TMJ loads which were correlated with shorter ramus heights compared to brachyfacial phenotypes. Conclusions: Craniofacial mechanics may explain, in part, mandibular growth differences between dolichofacial and brachyfacial phenotypes.

Background: The present study examined the effects of breastfeeding and its duration on the development of childhood obesity from 24 months through grade 6. Methods: U.S. longitudinal data collected from 1234 children were analyzed using logistic regression models and generalized estimating equation (GEE). Child height and weight were measured six times at ages of 24 months, 36 months, 54 months, grade 1, grade 3, and grade 6. Results: During the early 1990s, prevalence of breastfeeding was low in the United States, 60% and 48% at 1 and 6 months, respectively. Nonsmoking, white, married mothers with both parents in the household, and with income above the poverty line, were more likely to breastfeed at 1 month of age of their babies. Obesity rate of the children increased with age from 24 months to grade 6. Logistic regression showed that breastfeeding at month 1 was associated with 53% (odds ratio [OR]: 0.47, 95% confidence interval [CI]: 0.30-0.73) and 47% (OR: 0.53, 95% CI: 0.36-0.78) decreased risks for childhood obesity at grades 1 and 6, respectively. GEE analysis showed that breastfeeding at 1 month reduced risk for childhood obesity by 36% (95% CI: 0.47-0.88) from ages 24 months through grade 6. Regarding breastfeeding duration, more than 6 months (vs. never) was associated with a decreased risk for childhood obesity by 42% (OR: 0.58, 95% CI: 0.36-0.94). Conclusions: Breastfeeding at 1 month and more than 6 months reduced the risk of childhood obesity. Rate of breastfeeding was low in the United States in the 1990s, which may have had long-term implications on children.

A number of methods have been developed to analyze longitudinal data with dropout. However, there is no uniformly accepted approach. Model performance, in terms of the bias and accuracy of the estimator, depends on the underlying missing data mechanism and it is unclear how existing methods will perform when little is known about the missing data mechanism. Here we evaluate methods for estimating change over time in longitudinal studies with informative dropout in three settings: using a linear mixed effect (LME) estimator in the presence of multiple types of dropout; proposing an update to the pattern mixture modeling (PMM) approach in the presence of imprecision in identifying informative dropouts; and utilizing this new approach in the presence of prognostic factor by dropout interaction. We demonstrate that amount of dropout, the proportion of dropout that is informative, and the variability in outcome all affect the performance of an LME estimator in data with a mixture of informative and non-informative dropout. When the amount of dropout is moderate to large (>20% overall) the potential for relative bias greater than 10% increases, especially with large variability in outcome measure, even under scenarios where only a portion of the dropouts are informative. Under conditions where LME models do not perform well, it is necessary to take the missing data mechanism into account. We develop a method that extends the PMM approach to account for uncertainty in identifying informative dropouts. In scenarios with this uncertainty, the proposed method outperformed the traditional method in terms of bias and coverage. In the presence of interaction between dropout and a prognostic factor, the LME model performed poorly, in terms of bias and coverage, in estimating prognostic factor-specific slopes and the interaction between the prognostic factor and time. The update to the PMM approach, proposed here, outperformed both the LME and traditional PMM. Our work suggests that investigators must be cautious with any analysis of data with informative dropout. We found that particular attention must be paid to the model assumptions when the missing data mechanism is not well understood.

Utilizing longitudinal panel data from Youth In Transition Project, the Person-Environment fit (P-E Fit) theory and its specific application to the area of delinquency and aggression was investigated longitudinally. Analysis of Covariance Structure Technique (LISREL) was used to address the issues of multi-dimensionality, stability, measurement of total P-E fit and to test the proposed delinquency model. The relationships between P-E fit, psychological strain, and delinquency were tested both cross-sectionally and longitudinally . The student sub-group (those respondents who stayed in school after high school) and the working sub-group (those who went to work after high school) were tested separately. P-E fit had significant negative effect on both psychological strain and delinquency in most of the cross-sectional models. Similar results were obtained in three of the longitudinal models also . The evidence from longitudinal models tended to support the idea that the causal flow of the relationship between P-E fit, psychological strain and delinquency to be from P-E fit to both psychological strain and delinquency. The longitudinal and cross sectional relationship between P-E fit, psychological strain, and delinquency were more pronounced among the working sub-group than the student sub-group of the sample population. P-E fit tended to be quite stable during the high school years and subject to noticeable change when the transition was made to work or college environments.

The goal of the present study was to verify whether four purported risk factors predate the development of eating disorder symptoms, particularly bulimia nervosa. The four major purported risk factors for developing bulimia nervosa (and eating disorders in general) among female adolescents include: (a) over internalization of culture’s value of thinness in women, (b) inordinate dissatisfaction with body form, (c) depression, and (d) irrational beliefs and cognitions about thinness and the benefits of dieting. The present study involved a 5-year follow-up of adolescent girls initially identified as being either at high or low risk for developing an eating disorder, particularly bulimia nervosa. Subjects completed the risk factor inventories, and eating disorder diagnoses were based upon a structured Diagnostic and Statistical Manual of Mental Disorders clinical interview. Results indicated that: (a) two bulimic cases were found in the high-risk group, with an overall prevalence rate of 3.5% (2/57); (b) the total 6-month incidence rate (for any eating disorder) was 6.5% in the high-risk group, and 0.0% in the low-risk group; (c) younger at-risk girls tended to generally acknowledge more eating disorder symptoms; (d) z-score means of the low and high risk group are dramatically different at both Time #1 and 5 years later at Time l#2, with the high-risk group exhibiting more severe and quite stable symptomatology relative to the low-risk group; and (e) change in scores over time, in all four risk factor measures, was related to bulimia, binge-related symptoms, and overall (total) symptoms. The study confirmed the importance of these risk factors in the etiology of eating disorder symptoms, as well as the significance of tracking girls in early adolescence in longitudinal studies.

The primary focus of this dissertation is an empirical investigation of three approaches to the measurement of longitudinal change. For the present study, difference scores, residual change scores, and percentage gain scores are compared to determine if their use results in similar findings when the relationships between three resource areas (health, social, and financial) and subjective well-being are analyzed. The propositions which are tested were derived from current aging theories. Meta-analysis procedures were employed to synthesize past research findings in gerontology. The data which were analyzed are those of the Longitudinal Retirement History Study (LRHS), a research project sponsored by the Social Security Administration. The sample consists of 8922 continuers who participated in the 1969, 1971, and 1973 waves of data collection. Findings from the meta-analysis suggest that the correlation coefficients calculated from the LRHS data on the relationship between subjecive well-being and the areas of health resources and social resources are similar to those of other aging studies. The relationship between measures of financial resources and subjective well-being is stronger for the LRHS respondents than that reported in other aging studies. The results on the analysis of longitudinal change indicate that change in health resources and in financial resources are significant predictors of subjective well-being at a later-point-in-time and of change in subjective well-being. For the present study, change in social resources contributes little to the regression equations. The three selected approaches to the measurement of change rank individuals similarly on the construct of change. However, the use of difference scores, residual change scores, and percentage gain scores does not always result in similar findings when multivariate procedures are used. Residual change scores appear to possess a number of advantages. They tend, however, to be strongly related to the time 2 scores from which they are derived, a phenomenon not emphasized in the measurement of change literature. Improving the reliability of measures, allowing adequate time for change to occur, and using sample sizes which are large are suggested to maximize the possibility of obtaining correlation coeffecients based on change scores which are large and stable.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13230号 / 論医博第2170号 / 新制||医||1036(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 中山 健夫, 教授 松田 文彦, 教授 富樫 かおり / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

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