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Biomedical subjects

B H Kaplan

Publications and source records attributed to B H Kaplan.

At least 19 recordsLinked to original sources
PubMed2000

Social and personal resources and the prevalence of phobic disorder in a community population.

BACKGROUND: Phobic disorder is one of the most prevalent psychiatric disorders in community populations and much attention has focused on the association of sociodemographic factors and social resources with the disorder. There has been little investigation of the more personal resources such as self-confidence, religiosity, social support and self-perceived health that may increase vulnerability. METHODS: We used a sample of 2914 community residents aged 18 or older who participated in the Duke University Epidemiologic Catchment Area Study to explore the relationship between both social and personal resources and the prevalence of DIS/DSM-III phobic disorder. RESULTS: The 1-month prevalence of any phobic disorder was 7.6%. In bivariate analyses, we found both race/ethnicity and gender differences in prevalence, with a higher prevalence of phobic disorder in African-Americans and females. Lower socio-economic status, rural residence and unmarried status were also associated with current prevalence. No association was found for social network and social interaction. Impaired subjective social support, low self-confidence, perceived poorer physical health and co-morbid psychiatric disorder were significantly associated with current prevalence in uncontrolled analyses, while associations between lack of a confidant as well as religiosity and phobic disorder were not. Female gender (OR = 1.7), perceived low self-confidence (OR = 2.0), and two interaction terms, age x co-morbid psychiatric disorder and race/ethnicity x perceived physical health were associated with phobic disorder in controlled analyses using logistic regression. CONCLUSIONS: We conclude that both social and personal resources, particularly self-confidence, co-morbidity and perceived physical health are important correlates of phobic disorder.

Adolescent↗
PubMed1996

Exploratory case-control analysis of psychosocial factors and adult periodontitis.

We explored the association between social factors and adult periodontitis by comparing self-reported information for daily strains and symptoms of depression in 71 cases and 77 controls. Cases and controls were selected from among 1,426 participants in the Erie County Risk Factor Study. We found differences among those who scored higher than their peers on measures of social strain. The odds ratio (OR) and 95% confidence interval (95% CI) for the association between case status and Role Strain score of 2.27 or more was 2.84, 95% CI = 1.08 to 7.46. We also examined serum antibody, dichotomized at the median, for three periodontal pathogens (Bacteroides forsythus [IgG Bf], Porphyromonas gingivalis [IgG Pg], Actinobacillus actinomycetemcomitans [IgG Aa]), and assessed interaction between antibody levels and a Depression score derived from the Brief Symptom Inventory. IgG Pg and IgG Aa were both strongly associated with case status (OR = 4.52, 95% CI = 1.99 to 10.3 and OR = 5.29, 95% CI = 2.34 to 12.0, respectively). IgG Bf was associated with periodontal disease but only among individuals who had higher scores for Depression (OR = 6.75, 95% CI = 1.25 to 36.5). Smoking status was associated with case status (OR = 4.95, 95% CI = 1.86 to 13.2). We assessed these findings prospectively by examining factors associated with more extensive disease among the 71 case subjects after 1 year of follow-up. We found baseline smoking status and IgG Bf among individuals scoring high on Depression at baseline to be associated with more extensive disease (8.1% or more of the sites showing further breakdown). In this population an elevated Depression score may be a marker for social isolation, which could play a role in immune function during periods of social strain. This exploratory analysis has served to identify specific lines of inquiry concerning psychosocial measures as important environmental factors in adult periodontitis.

Adult↗
PubMed1996

Correlates of perceived social support and equality of interpersonal relationships at mid-life.

An investigation into the correlates of perceived social support and the equality of interpersonal relationships at mid-life was conducted using a sample of 3954 adults from the University of North Carolina Alumni Heart Study (UNCAHS). Participants ranged in age from forty to fifty years. Results suggested that while the number of family roles and social activities are the same for men and women, women perceive a greater availability of social support and report they give more than they take in relationships with family. There was no association found between the perceived availability of social support and global indices of equality of interpersonal relationships; suggesting an independence between these two psychological aspects of social support. Further, multiple regression correlational analyses indicated gender, level of social activity, and self-esteem as significant predictors of perceived social support; with self-esteem being the best single predictor. Relatedly, gender and number of children were found to be significant predictors of the perceived equality of relationships with family. These findings suggest differences in mid-life men and women's psychological perception of the availability of social support, and the give and take of relationships with family.

Adult↗
PubMed1996

Aqueous humor flow in unilateral carotid stenosis.

Our purpose was to study the relationship between carotid artery occlusive disease and aqueous flow in human subjects. Aqueous humor flow was measured by fluorophotometry in seven patients with unilateral carotid artery disease documented by oculoplethysmography. The mean (+/- SD) flow was 2.03 +/- 0.38 microliter/min in the affected eyes, 2.44 +/- 0.66 microliter/min in the unaffected contralateral eyes, and 2.56 +/- 0.61 microliter/min in a group of 14 age-matched controls. A statistically significant difference (p < 0.05) in the aqueous flow rate was seen between the affected and unaffected eyes and between the affected and control eyes. Aqueous flow in the unaffected and control eyes was not statistically different. The anterior chamber volumes and intraocular pressures were also not significantly different among groups. Severe carotid artery disease may reduce aqueous humor formation by lowering ciliary body blood flow to a point beyond which the eye cannot compensate.

Aged↗
PubMed1994

The effects of glaucoma filtering surgery on the variability of diurnal intraocular pressure.

The results of this study indicate that filtration surgery reduces the mean diurnal IOP, the range of diurnal variation, and the day-to-day variability. The effect on the range is proportionally greater than on the other two parameters. Further study will be required to determine whether this selective effect makes surgical reduction of IOP any more effective in the prevention of further glaucomatous visual field damage than other therapeutic methods that lower mean IOP to the same degree.

Circadian Rhythm↗
PubMed1992

Social health and the forgiving heart: the Type B story.

The evolution of the Type A hypothesis is well documented. The protective corresponding Type B construct has not evolved similarly. Using experiences from Friedman's Recurrent Coronary Prevention Project, on a speculative basis, four neglected protective processes are examined: uniqueness/self-esteem/autonomy, forgiveness, sociability, and "causal" wisdom attributions. A more integrative set of questions is proposed to expand our knowledge of adaptive fitness and success.

Adaptation, Psychological↗
PubMed1992

Using college alumni populations in epidemiologic research: the UNC Alumni Heart Study.

The UNC Alumni Heart Study (UNCAHS) is a prospective study of the role of psychosocial factors, in particular hostility, in the development of coronary heart disease. The target population is composed of persons who completed the Minnesota Multiphasic Personality Inventory while attending the University of North Carolina in the mid-1960s. Logistic regression analyses were used to determine whether hostility, demographic and other variables were significant determinants of the subjects' locatability and participation. It was found that MMPI hostility scores at initial testing were unrelated to either potential or actual locatability or participation. Thus there is no evidence that hostility is the source of selection bias in the UNCAHS. Selection into the study was predicted by age, sex, degree status and variables concerned with the conditions under which the MMPI was administered. It is concluded that follow-up studies of college cohorts may have study-specific sources of selection bias.

Adolescent↗
PubMed1992

Hexamethylmelamine and low or moderate dose cisplatin with or without pyridoxine for treatment of advanced ovarian carcinoma: a study of the Eastern Cooperative Oncology Group.

A total of 248 analyzable patients with Stages III-IV ovarian epithelial cancer (114 with and 134 without prior chemotherapy) were randomized to one of four cisplatin (DDP)-hexamethylmelamine (HMM) regimens. In each, HMM, 200 mg/m2 was given orally daily on days 8-21 of each 21-day cycle. DDP was given i.v. on Day 1 at a dose of 37.5 mg/m2 (regimens A and B) or 75 mg/m2 (regimens C and D). In addition, since pyridoxine administration has been reported to reduce the neurotoxicity of HMM, that agent was given at a dose of 300 mg/m2 orally on Days 1-21 in regimens B and D. Randomization was stratified for performance status (0-1, 2-3) and largest tumor diameter at entry (greater than 2- less than or equal to 10 cm, greater than 10 cm) for previously untreated patients, and for performance status and time from initial diagnosis to entry on study (less than or equal to 1 year, greater than 1 year) for previously treated patients. The overall response rate (PR + CR) was 54%, with 25% of patients achieving a complete response. The 61% response rate with the higher dose DDP regimens was significantly greater than the 47% response rate with the lower dose regimens (p = 0.031). Multivariate analysis identified higher DDP dose, age less than 60 years, no prior chemotherapy, small tumor bulk and favorable tumor grade as significant prognosticators for response. The overall median response duration was 8.3 months (range 1-70 months). Prior chemotherapy, pyridoxine administration, recent diagnosis, and large tumor size were identified by multivariate analysis as factors adversely affecting response duration. Patients treated with the higher dose DDP regimens had more severe nausea, vomiting, and neurotoxicity. This study demonstrates that the combination of DDP + HMM is an effective regimen for advanced ovarian carcinoma that yields response rates comparable to other more complex regimens, and that there is a dose-response relationship for DDP in ovarian cancer. Although pyridoxine administration significantly reduced neurotoxicity, its adverse effect on response duration suggests that the agent should not be administered with DDP or HMM. The mechanism by which pyridoxine may unfavorably affect response duration deserves further investigation.

Altretamine↗
PubMed1991

Social environment and social support.

Research on the relevance of social support to cancer has been plentiful since the first American Cancer Society workshop on methodological issues in behavioral and psychosocial science. Nonetheless, critical shortcomings continue to characterize the attempt empirically to establish such things as the extent to which social support predicts adjustment to cancer diagnosis and treatment. Prominent among these is the failure to adequately address large elements of the social structure, such as social class and urbanization, and to investigate how they shape the well being of persons with or at risk for cancer and their caregivers. We recommend that more psychosocial research on the link between social support and cancer be conducted within populations beset by poverty and without adequate access to health care. Funding is needed for the training and maintenance of multidisciplinary and multicultural teams of researchers working within community-based organizations and hospitals serving the underserved.

Humans↗
PubMed1991

Social support and the cancer patient. Implications for future research and clinical care.

This review assesses past progress, current practices, and future needs in research and clinical practice involving the social support needs of cancer patients. A review is given of the various conceptualizations of the social support/stress paradigm and of the state of the art of measuring social support. Then the current work in the field of social support and cancer is considered and an argument is made for the use of social support measures, which are relevant to the experiences of the cancer patient. Potential adaptations of an existing instrument (the Duke-UNC Functional Social Support Scale) are demonstrated, and a taxonomy of stages of cancer that would require additional types of social support measures and interventions is outlined. Interventions are discussed in terms of the traditional support groups as well as interventions by the oncologist and primary care physician. An argument is made for the inclusion of quality of life or functional measures as outcomes in clinical trials and the care of the cancer patient. Finally, the need to address the existential, philosophic, or religious issues surrounding cancer and its treatment is discussed.

Forecasting↗
PubMed1991

Seatbelt effectiveness and cost of noncompliance among drivers admitted to a trauma center.

Enactment of seatbelt legislation in Maryland presented the opportunity to compare seatbelt compliance among seriously injured drivers admitted to a Level I trauma center and to establish levels of severity, length of stay, and hospital cost differences among the study population. Fifty-five randomly selected drivers were examined from a total surgical population of 689. Seatbelt compliance rate was 41.8%, reflecting the rate in the community. Seatbelts reduced the total number of injuries by 34%, major injuries by 57%, and minor injuries by 20%. No deaths occurred among the belted group. The unbelted group had a mean Injury Severity Score two times as great as the belted group and were hospitalized 1.6 times longer at double the cost. Major injuries to the face, chest, and pelvic regions were prevented by the seatbelt. Among the belted group, severe injuries did occur to the head, neck, and abdominal regions. It is recommended that both air bags and automatic restraining devices be required for all drivers if the trauma occurring daily on highways is to be eliminated and acute hospital cost minimized.

Accidents, Traffic↗
PubMed1991

Self-help quit smoking interventions: effects of self-help materials, social support instructions, and telephone counseling.

Smokers requesting self-help materials for smoking cessation (N = 2,021) were randomized to receive (a) an experimental self-quitting guide emphasizing nicotine fading and other nonaversive behavioral strategies, (b) the same self-quitting guide with a support guide for the quitter's family and friends, (c) self-quitting and support guides along with four brief counselor calls, or (d) a control guide providing motivational and quit tips and referral to locally available guides and programs. Subjects were predominantly moderate to heavy smokers with a history of multiple previous quit attempts and treatments. Control subjects achieved quit rates similar to those of smokers using the experimental quitting guide, with fewer behavioral prequitting strategies and more outside treatments. Social support guides had no effect on perceived support for quitting or on 8- and 16-month quit rates. Telephone counseling increased adherence to the quitting protocol and quit rates.

Behavior Therapy↗
PubMed1990

Epidemiologic analysis of a reported cancer cluster in a small rural population.

This study investigated a reported cluster of cancer deaths in the small rural community of Bynum, North Carolina. Residents felt the proportion of deaths involving cancer had been increasing since the mid-1960s. To address this concern, cancer mortality was investigated from 1947 to 1985 to determine 1) if the proportion of cancer deaths had increased since the mid-1960s, 2) if it differed from what should be expected based on comparison with the reference population of the state of North Carolina, and 3) if observed mortality was within the bounds of statistical probability. Results indicated that the proportion of cancer deaths remained relatively constant from 1947 to 1964 (ranging from 9% to 14%) but increased steadily after 1965 to a high of 58% (1980-1985). Standardized proportionate mortality ratios adjusted for age, sex, race, and calendar time indicated that from 1975 to 1985 cancer deaths were 2.4 to 2.6 times greater than expected. Cancer mortality exceeded the upper limit of 95 percent Poisson confidence intervals from 1975 to 1985, which suggested that the excess proportion of cancer deaths was not likely to represent random case clustering. These findings serve to illustrate the feasibility of and a methodology for assessing reports of clusters in small populations.

Adult↗
PubMed1989

The association between depressive symptoms and mortality among older participants in the Epidemiologic Catchment Area-Piedmont Health Survey.

The association between depression and two-year mortality risk was assessed in 1,606 elderly community participants in the 1982-83 Epidemiologic Catchment Area-Piedmont Health Survey. Two depression measures were formed from the Diagnostic Interview Schedule (DIS) depressive symptom items. Neither measure was associated with mortality in univariate or multiple logistic regression analyses. The adjusted relative risk of mortality comparing the lowest to highest levels of a three-level depression variable was 0.9 (95% confidence interval = 0.5-1.4). Similar results were obtained with other versions of the depression variables, with each depressive symptom category, and within sex, chronic disease, widowhood status, and age groups. These results indicate that depression does not increase mortality in elderly adults, but the short follow-up, sample characteristics, and operationalization of depression may have affected this association.

Age Factors↗