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Biomedical subjects

B S McCann

Publications and source records attributed to B S McCann.

At least 19 recordsLinked to original sources
PubMed2000

Attention-deficit/hyperactivity disorder and learning disabilities in adults.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a developmental disorder which begins in childhood. It is now recognized that ADHD persists into adolescence and adulthood in the majority of cases. Significant psychiatric comorbidity, particularly substance abuse, antisocial personality disorder, and mood and anxiety disorders occurs in adolescent and adult ADHD. Perhaps one fifth of childhood cases of ADHD may also have co-morbid learning disorder. Significant legal, academic, social, and occupational problems have been observed in adults with ADHD. The clinician faces a diagnostic and treatment challenge in trying to determine whether ADHD and learning disabilities (LDs) are present in the adult patient. Treatment and recommendations for accommodations in institutions of higher education and the workplace may rest on accurate discrimination between ADHD and LD.

Adult↗
PubMed2000

Reliability and validity of screening instruments for drug and alcohol abuse in adults seeking evaluation for attention-deficit/hyperactivity disorder.

A growing number of adults are seeking evaluation for Attention-Deficit/Hyperactivity Disorder (ADHD). Screening for substance use disorders should be included as part of any comprehensive ADHD evaluation. We describe the validity and reliability of the Drug Abuse Screening Test (DAST) and the Alcohol Use Disorders Identification Test (AUDIT) in adults seeking evaluation for ADHD. Internal reliability estimates were excellent for both instruments. Scores on the DAST and AUDIT were higher among patients with a DSM-IV diagnosis of current drug abuse or dependence or current alcohol abuse or dependence, respectively. A cutoff score of 6 or above appears to be optimal for identifying individuals who are current drug abusers. A cutoff score of 6 or above on the AUDIT is suggested for detection of current alcohol abuse in this population. Comparable rates of substance use disorders were observed in ADHD and non-ADHD patients. Both measures are valid and reliable instruments for screening for alcohol and drug abuse among adults seeking evaluation for ADHD.

Adolescent↗
PubMed2000

Differential effect of National Cholesterol Education Program (NCEP) Step II diet on HDL cholesterol, its subfractions, and apoprotein A-I levels in hypercholesterolemic women and men after 1 year: the beFIT Study.

We previously reported that high density lipoprotein cholesterol (HDL-C) decreases more in hypercholesterolemic (HC) women than in HC men ingesting an National Cholesterol Education Program (NCEP) Step II diet for 6 months. We examined these subjects to determine whether the differential HDL-C reduction persists after 12 months and whether it is associated with decreased HDL(2)-C and apoprotein A-I. Subjects were screened from an industrial workforce and were defined as HC if 2 low density lipoprotein cholesterol measurements were >/=75th percentile or defined as combined hyperlipidemic (CHL) if triglycerides were also >/=75th percentile. The subjects were then taught the NCEP Step II diet in 8 weekly classes and counseled quarterly. Seventy-three HC and 92 CHL women (mean ages 43 and 44 years, respectively) and 112 HC and 106 CHL men (ages 45 and 41 years, respectively) were studied. All groups reported similar total fat (24% to 26% kcal) and saturated fat (7.1% to 7.9% kcal) intakes at 1 year. HDL-C decreased 7.6% in HC women (P<0.01), exceeding the nonsignificant 1.3% decrease in HC men (P=0.000). HDL(2)-C decreased 16.7% in HC women (P<0.01) compared with the nonsignificant 0.5% increase in HC men (P=0.000). In CHL women and men, HDL-C decreased 3.5% and 3.9% (both P<0.01); HDL(2)-C decreased more in women (7.1%, P<0.01) than in men (4.3%, a nonsignificant difference). Apoprotein A-I decreased significantly (5.3%, P<0.01) in HC women only. Plasma triglycerides were unchanged. Low density lipoprotein cholesterol and weight changes were not different among the 4 groups. HDL-C, HDL(2)-C, and apoprotein A-I levels decreased more in HC women than in HC men after following the NCEP Step II diet for 1 year, continuing a trend observed with HDL-C at 6 months. The total HDL-C and HDL(2)-C reductions narrow the baseline differences between men and women by 50%. Whether this reduction impacts women's protection from cardiovascular disease deserves future study. Nonetheless, the results point to sex-based differences in intrahepatic glucose and fatty acid metabolism linked to alterations in HDL formation and removal.

Adult↗
PubMed2000

Discriminant validity of the Wender Utah Rating Scale for attention-deficit/hyperactivity disorder in adults.

The authors examined the factor structure and discriminant validity of the Wender Utah Rating Scale (WURS) in adults seeking evaluation for attention-deficit/hyperactivity disorder (ADHD). Three factors (Dysthymia, Oppositional/Defiant Behavior, and School Problems) accounted for 59.4% of the variance. In a stepwise discriminant function analysis, age and childhood school problems emerged as significant variables. The classification procedure correctly classified 64.5% of patients. Among those who did not have ADHD, only 57.5% were correctly classified compared with 72.1% among those with ADHD. The WURS is sensitive in detecting ADHD, but it misclassifies approximately half of those who do not have ADHD.

Adult↗
PubMed1999

Plasma lipid concentrations during episodic occupational stress.

The possibility that stress affects plasma lipid concentrations has been the subject of recent investigation, but the findings are equivocal in nonlaboratory settings. To determine whether psychological stress contributes to variability in plasma lipid concentrations and concomitant changes in health behaviors, the effect of increased work load on plasma lipids and apolipoproteins was examined in 173 lawyers. Plasma cholesterol, triglyceride, and apolipoprotein concentrations were studied during periods of high work load (corresponding to impending tax deadlines) and during periods of usual work load. Self-reports of stress, work load, and time pressure, and cortisol, blood pressure, and heart rate were measured to verify that impending deadlines were associated with increased stress levels. Health behaviors which may affect plasma lipoprotein concentrations, including dietary intake and exercise, were also examined. High work load was accompanied by increases in self-reported work load among lawyers most directly affected by the impending deadlines. Plasma apolipoprotein B and triglycerides increased during periods of high work load (M = 1.9 mg/dL, SD = 10.1 and M = 5.3, SD = 34.4, respectively). No changes in dietary intake and exercise were observed. Psychological stress (high work load) is associated with potentially atherogenic changes in plasma lipid concentrations. While the lipoprotein effect of this short-term work stress is small, the effects of longer-term stress on multiple rise factors including triglycerides and apolipoprotein B could have significance for the development of coronary artery disease.

Adult↗
PubMed1999

Lipid-lowering medication and risk of injury.

Meta-analyses of early primary prevention trials of lipid-lowering therapies suggested increased risk of injury deaths among treated persons. Our population-based case-control study examined the association of lipid-lowering medication use with fatal and nonfatal injuries in 298 cases and 332 controls. No increased injury risk was observed among current (OR = 0.46, 95% CI 0.18-1.21) or past users (OR = .92, 95% CI 0.44-1.95), after adjustment for behavioral disorders, medical conditions, and health status. Stratified analyses did not reveal sub-groups at significantly increased risk. These results, consistent with recent clinical trials and meta-analyses, suggest no increased injury risk associated with lipid-lowering medications.

Accidents, Home↗
PubMed1997

Long-term cholesterol-lowering effects of 4 fat-restricted diets in hypercholesterolemic and combined hyperlipidemic men. The Dietary Alternatives Study.

CONTEXT: The long-term effect of aggressively vs moderately fat-restricted diets has not been studied extensively in free-living subjects with different types of hyperlipidemia. OBJECTIVE: To compare the cholesterol-lowering effects of 4 levels of dietary fat intake restriction after 1 year. DESIGN: Randomized, parallel, comparison trial. SETTING: Male employees of a large industry. PARTICIPANTS: A total of 444 men had low-density lipoprotein cholesterol (LDL-C) levels above the 75th age-specific percentile. Subjects with triglyceride (TG) levels less than the 75th age-specific percentile were defined as hypercholesterolemic (HC) and those with TG levels at or above the 75th age-specific percentile were defined as combined hyperlipidemic (CHL). INTERVENTIONS: Hypercholesterolemic subjects were randomized to diets 1, 2, 3, and 4 taught to contain 30%, 26%, 22%, and 18% fat, and the CHL subjects were randomized to diets 1, 2, and 3. All 4 diets were taught to subjects and spouses or partners in 8 weekly 2-hour classes. MAIN OUTCOME MEASURES: Plasma lipoprotein levels after 1 year. RESULTS: Fat intake after 1 year declined from a mean of 34% to 36% of energy to 27%, 26%, 25%, and 22% in the 4 HC diet groups and 28%, 26%, and 25% in the 3 CHL diet groups. Mean+/-SD percent LDL-C reductions were 5.3%+/-16.2%, 13.4%+/-12.6%, 8.4%+/-11.2%, and 13.0%+/-15.7% in the HC diet groups and 7.0%+/-16.2%, 2.8%+/-15.8%, and 4.6%+/-13.5% in the CHL diet groups (P<.01 in all but 1 instance). Apoprotein B levels decreased 8.6%, 10.7%, 4.3%, and 5.3% in the HC groups and 14.6%, 11.4%, and 9.9% in the CHL groups (P<.05-.01 in each instance). Triglyceride levels increased significantly in subjects following HC diets 3 and 4, 21.7% and 38.7% (P<.05 and .01), but not in any CHL subjects. High-density lipoprotein cholesterol decreased 2.8% and 3.2% in subjects on HC diets 3 and 4, respectively (P<.05 in both cases). CONCLUSIONS: After 1 year, moderate restriction of dietary fat intake attains meaningful and sustained LDL-C reductions in HC subjects and apoprotein B reductions in both HC and CHL subjects. More extreme restriction of fat intake offers little further advantage in HC or CHL subjects and potentially undesirable effects in HC subjects.

Apolipoproteins↗
PubMed1997

Hostility, social support, and perceptions of work.

The aim of this study was to determine whether hostility and perceived availability of social support are related to perceptions of the work environment. The W.W. Cook and D.M. Medley (1954) Hostility (Ho) scale; the Interpersonal Support Evaluation List (S. Cohen, R. Mermelstein, T. Kamarck, & H. Hoberman, 1985); and measures of collegiality, time pressure, and job dissatisfaction were completed by 204 attorneys (159 men and 45 women). After controlling for age, gender, and other job characteristics, high Ho scores were related to lower perceived supportive collegiality at work. Low perceived availability of social support was related to greater job dissatisfaction. Neither hostility nor social support was associated with perceptions of time pressure at work. These findings suggest that hostility and availability of social support may be an important pathway linking certain job characteristics to cardiovascular disease and other illnesses.

Adaptation, Psychological↗
PubMed1997

Nutritional intake of women and men on the NCEP Step I and Step II diets.

OBJECTIVE: Restriction of dietary fat and cholesterol are recommended for treating hyperlipidemia, but may alter vitamin or mineral intakes. We evaluated changes in nutrients of individuals taught the National Cholesterol Education Program (NCEP) Step II diet. METHODS: Subjects participated in a randomized controlled trial of the cholesterol-lowering effect of the NCEP Step II diet. Eligibility criteria included elevated fasting plasma LDL-cholesterol, no lipid-altering medications, and diet not already fat-modified. Subjects attended eight weekly dietitian-led classes. Four-day food records collected 6 months post-intervention were compared to baseline records. RESULTS: Of 409 subjects with complete data, 123 met Step I and 166 met Step II diet criteria. Intakes of micronutrients associated with fruits and vegetables (beta-carotene and vitamin A, vitamin C, folic acid, magnesium, and potassium) increased on both diets. Patterns of decreased mean intake and/or fewer subjects consuming 2/3 Recommended Dietary Allowance were seen for calcium, vitamin E, and zinc. CONCLUSIONS: NCEP Step I and II diets generally match or exceed unmodified diet for vitamin and mineral content. Premenopausal women do not appear to be at increased risk of low iron intake. Vitamin E intake decreases, although the significance is unknown in the context of lower fat intake and increased intake of other antioxidants. Diet counseling and materials should encourage sources of calcium for women, and zinc for both women and men.

Adult↗
PubMed1997

Lipoprotein lipid response to the National Cholesterol Education Program step II diet by hypercholesterolemic and combined hyperlipidemic women and men.

The beFIT study tested whether teaching the NCEP step II diet (< 30% of calories from total fat and < 7% from saturated fat) is an effective therapy in hypercholesterolemic women and men with or without elevated triglycerides after 6 months. Hypercholesterolemic subjects had two LDL cholesterol measurements above the age- and sex-specific 75th percentile, and combined hyperlipidemic subjects additionally had similarly elevated triglyceride. Subjects were randomized to receive dietary intervention (eight weekly classes) immediately or 6 months later. Follow-up visits were quarterly, with lipid measurements and 4-day food records. Subjects randomized to delayed intervention did not report diet changes or experience lipid changes; the immediate intervention group significantly reduced fat and cholesterol intake, resulting in significant LDL cholesterol lowering. Six months after diet instruction, 178 women and 231 men reported total and saturated fat intakes of approximately 25% and 7.5% kcal LDL cholesterol was significantly reduced in women (7.6% and 8.1%) and men (8.8% and 8.1%) with hypercholesterolemia and combined hyperlipidemia, respectively, but was not different by sex or lipid disorder. Candidates for drug therapy were reduced from between 27% and 37% to 20%. HDL cholesterol was significantly decreased in women (-6.4% and -4.7%) but not in men (-1.3% and -2.7%). The 6.4% reduction in hypercholesterolemic women was significantly different from that of men. The significance of the HDL cholesterol reduction in women is unknown. LDL cholesterol response was similar between women and men and between hypercholesterolemic and combined hyperlipidemic subjects. LDL cholesterol lowering by diet can significantly reduce the number of hyperlipidemic persons requiring drug therapy.

Adult↗
PubMed1996

Predicting participation in a dietary intervention to lower cholesterol among individuals with hyperlipidemia.

Adult men and women (N = 8,748) were given blood cholesterol tests and completed a measure of fat intake and a staging questionnaire that assessed readiness to adopt a cholesterol-lowering diet. Eligibility for the trial was based on plasma cholesterol levels and self-reported dietary intake. Of 772 eligible participants, 545 (70.6%) agreed to join. In multivariate analyses, joiners did not differ from nonjoiners by age, total cholesterol levels, or self-reported dietary fat intake. Women were more likely than men to join the study. Individuals in the preparation stage (defined on the basis of a staging algorithm derived from the transtheoretical model of change) were more likely to join the trial than were precontemplators. An understanding of the determinants of participation in a dietary intervention may be important in the enhancement of high-risk individuals' acceptance of recommendations to make dietary changes.

Adult↗
PubMed1996

Variations in plasma lipid concentration during examination stress.

The effect of psychological stress on plasma lipids was studied in 40 law students (20 men and 20 women). Plasma cholesterol, triglyceride, and apolipoprotein concentrations were examined at the beginning of the quarter and during the week before final examinations. Cortisol, blood pressure, and heart rate, and self-reports of stress and workload were also measured to verify that examinations were associated with increased stress levels. Perceived stress, perceived workload, and cortisol increased before examinations. Low density lipoprotein cholesterol (LDL-C) increased 5.8 +/- 13.9 mg/dL, and apolipoprotein B (apo B) increased 2.9 +/- 4.0 mg/dL. High density lipoprotein cholesterol decreased in women only. These changes were not due to changes in dietary intake or indexes of plasma volume. However, changes in cortisol and changes in LDL-C and apo B were associated, suggesting a neuroendocrine component to the effects. These results suggest that episodic, stressful situations may lead to potentially atherogenic changes in lipid and lipoprotein concentrations.

Journal Article↗
PubMed1995

Spouse support and long-term adherence to lipid-lowering diets.

Social support is inversely associated with heart disease risk. Support may influence heart disease by encouraging health behavior change in high-risk individuals. This study examined the association between spouse support and maintenance of low-fat diets in men with hypercholesterolemia. Participants were 254 men enrolled in a 24-month randomized trial of lipid-lowering diets initiated in 1985 in Seattle, Washington. The Evaluation of Spouse Support, which assesses the extent to which spouses supported maintenance of lipid-lowering diets, was administered after the last of eight dietary classes and at 3, 12, and 24 months postinstruction. Attainment of dietary goals was determined from food records completed at the end of the class and at 3, 12, and 24 months. Compared with those in the lowest quartile, those in the highest quartile of support were more likely to attain dietary goals at 3 months (odds ratio (OR) = 4.5, 95% confidence interval (CI) 1.9-10.4), 12 months (OR = 5.5, 95% CI 2.4-12.5), and 24 months (OR = 3.9, 95% CI 1.7-9.3). Support was not associated with end-of-class dietary goal achievement. Social support may be an important factor in the maintenance of low-fat diets.

Adult↗
PubMed1995

Changes in plasma triacylglycerol concentrations among free-living hyperlipidemic men adopting different carbohydrate intakes over 2 y: the Dietary Alternatives Study.

We reported previously that low-fat, high-carbohydrate diets containing < 26% of energy as fat and > 57% of energy as carbohydrate induce hypertriacylglycerolemia (hypertriglyceridemia) in hypercholesterolemic but not in combined hyperlipidemic (CHL) subjects. Because subjects may not consistently adhere to an assigned diet long term, we examined the extent to which plasma triacylglycerols (triglycerides) increase at four consistently reported carbohydrate intakes at intervals of up to 2 y. Three hundred seventy-two subjects reported consistent carbohydrate intakes of < 45%, 45-51.9%, 52-59.9%, or > or = 60% of energy on food records for 3, 12, and 24 mo. Among hypercholesterolemic subjects reporting a carbohydrate intake > or = 60% of energy, triacylglycerols increased by 0.25, 0.18, and 0.27 mmol/L (22, 16, and 24 mg/dL) over baseline at 3, 12, and 24 mo, respectively (P < 0.01 in each instance), and 0.32 mmol/L (28 mg/dL) above the group with a carbohydrate intake 52-59.9% of energy (P < 0.05) after 3 mo. No statistically significant effects were observed among CHL subjects, but compared with baseline, triacylglycerols decreased during the first 3 mo (-0.29 to -0.04 mmol/L, or -26 to -4 mg/dL), were unchanged over 12 mo, and were increased after 24 mo in three of four carbohydrate intake strata (0.27-0.36 mmol/L, or 24-32 mg/dL). These data confirm our previous observation that a moderately but not extremely low-fat, high-carbohydrate diet can be used long-term without deleterious effects on plasma triacylglycerols in the management of hypercholesterolemia, whereas CHL is unaffected by the amount of carbohydrate ingested.

Body Weight↗
PubMed1992

Influence of age, sex, and family on Type A and hostile attitudes and behaviors.

We describe the influence of age, sex, and family on Type A and hostility indices that have been related to rates of coronary heart disease (CHD). The sample consisted of 120 girls and 95 boys (ages 6 to 18 years) and 141 women and 120 men (ages 31 to 62 years) from 142 families residing in an upper middle class community. Results showed little familial aggregation of Type A and hostility. Adults had higher Structured Interview (SI) Potential for Hostility ratings than did children, whereas children had higher Minnesota Multiphasic Personality Inventory (MMPI)-derived Hostility scores and SI Anger-In ratings than did adults. Male adults and male children had higher SI Potential for Hostility ratings and MMPI-derived Hostility scores than did their female counterparts. The heightened hostility of males may account, in part, for their heightened risk of CHD relative to females'.

Adolescent↗
PubMed1991

Alternative fat-restricted diets for hypercholesterolemia and combined hyperlipidemia: feasibility, design, subject recruitment, and baseline characteristics of the dietary alternatives study.

UNLABELLED: Dietary recommendations for the treatment of hypercholesterolemia (HC) emphasize stepwise reductions in fat intake, but there is no agreement on what lower limit is desirable or achievable. These recommendations have applied broadly to persons with HC alone, as well as to those with a combined elevation in triglyceride (TG) and cholesterol, even though they may differ in pathophysiological mechanisms and response. In this paper, we describe the design and feasibility of recruiting and randomizing subjects with HC or combined hyperlipidemia (CHL) to an outpatient dietary intervention study of progressively fat-restricted diets. Diets were designed to contain 30, 26, 22, and 18% of calories from fat; 300, 200, 100, and 100 mg cholesterol/day; and a polyunsaturated/saturated fat ratio of approximately 1.0. Triglyceride and low-density-lipoprotein cholesterol (LDL-C) cutpoints were based on the age-specific 75th percentile value. Over 18 months, 8372 men were screened, yielding 320 HC subjects randomized to the four diets and 211 CHL subjects randomized to the first three diets (because of fewer CHL subjects). At baseline, HC and CHL subjects were similar in age, education, lifestyle, dietary intake, and LDL-C, but CHL subjects were heavier, more hyperglycemic, hyperinsulinemic, and hypertensive. CONCLUSIONS: Recruiting a large cohort of HC and CHL subjects from an industrial workforce is feasible in a restricted time frame. CHL subjects demonstrate features of the insulin resistance/hypertension syndrome, differing from HC subjects. CHL is sufficiently common relative to HC (2:3) to permit a comparison of dietary responses between the two conditions. Finally, the randomization of HC and CHL subjects to the diets yielded statistically indistinguishable groups, permitting a test of the efficacy of the alternative diets within each hyperlipidemic (HL) category.

Adult↗
PubMed1991

Changes in vitamin and mineral intakes and serum concentrations among free-living men on cholesterol-lowering diets: the Dietary Alternatives Study.

Nutritional adequacy of diets with 18-30% of calories from fat was investigated in men with elevated serum cholesterol (n = 396) at the end of diet classes and 1 and 2 y later. On 4-d food records, intakes of vitamin A, beta-carotene, folate, vitamin C, magnesium, vitamin B-6, iron, thiamin, and riboflavin increased from baseline whereas niacin, selenium, vitamin E, and zinc decreased. Median zinc intake, 80% of the recommended dietary allowance (RDA) at baseline, decreased to approximately 75% of the RDA, most markedly when intakes of meat, fish, and poultry were limited to 85 g/d. Nutrient densities generally increased. Of the serum nutrients measured, median beta-carotene and vitamin C increased, whereas vitamin B-6, iron, and zinc were unchanged. Below-normal values were fewer for vitamin C and magnesium. Diets similar to the National Cholesterol Education Program Step-Two Diet [less than 7% saturated fatty acids, less than 200 mg cholesterol/d] appeared to provide increased levels of most micronutrients both short and long term to men receiving comprehensive dietary counseling.

Ascorbic Acid↗