Biomedical subjects

D Brogan

Publications and source records attributed to D Brogan.

At least 37 records · Page 2Linked to original sources

PubMed1996

The NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study: background and methodology.

OBJECTIVE: A collaborative study was conducted to develop methods for surveys of mental disorder and service utilization in unscreened population-based samples of children and adolescents. METHOD: Probability household samples of youths 9 through 17 years of age were selected at four sites and interviews were conducted with a total of 1,285 pairs of youths and their adult caretakers in their homes. Lay interviewers administered a computer-assisted version of the NIMH Diagnostic Interview Schedule for Children Version 2.3 and structured interviews to assess demographic variables, functional impairment, risk factors, service utilization, and barriers to service utilization. RESULTS: More than 7,500 households were enumerated at four sites, with enumeration response rates above 99%. Across sites, 84% of eligible youth-caretaker pairs were interviewed for about 2 hours each. Ninety-five percent of both youths and caretakers found the interview to be acceptable enough to recommend to a friend. CONCLUSIONS: These findings indicate that large-scale epidemiological surveys of mental disorders and mental health service use involving lengthy interviews in the homes of unscreened population-based samples of youths and their adult caretakers are acceptable to the community and can achieve good response rates. The other reports in this Special Section address the reliability and validity of the various survey instruments and other key findings.

Adolescent↗

PubMed1996

Analysis of consecutively placed loaded root-form and plate-form implants in adult Macaca mulatta monkeys.

The present paper describes 36 consecutively treated non-human primates (Macaca mulatta) as part of a balanced block design study to examine osseointegration in root- and plate-form implants prepared by atraumatic preparation of bone. Clinical measurements around selected teeth and digital radiology were utilized to monitor periodontal disease and bone loss around root- and plate-form implants which were loaded with a fixed prosthesis. Results indicate that once monthly regimen of scaling and root planing can prevent attachment loss in natural teeth, serving as abutments of loaded bridges. Root-form implants exhibited a significant loss of crestal bone height during the first year (P < 0.03) while plate-form implants showed less loss in bone height. There was an increase in bone mass over time for root-form or plate-form implants. Both root-form and plate-form implants provided radiographic evidence of osseointegration in loaded bridges.

Alveolar Bone Loss↗

PubMed1996

A modified cluster-sampling method for post-disaster rapid assessment of needs.

The cluster-sampling method can be used to conduct rapid assessment of health and other needs in communities affected by natural disasters. It is modelled on WHO's Expanded Programme on Immunization method of estimating immunization coverage, but has been modified to provide (1) estimates of the population remaining in an area, and (2) estimates of the number of people in the post-disaster area with specific needs. This approach differs from that used previously in other disasters where rapid needs assessments only estimated the proportion of the population with specific needs. We propose a modified n x k survey design to estimate the remaining population, severity of damage, the proportion and number of people with specific needs, the number of damaged or destroyed and remaining housing units, and the changes in these estimates over a period of time as part of the survey.

Cluster Analysis↗

PubMed1994

Increasing the accuracy of the Expanded Programme on Immunization's cluster survey design.

The Expanded Programme on Immunization (EPI) of the World Health Organization developed a cluster survey design for the rapid assessment of children's vaccination coverage in developing countries. Because of its simplicity and familiarity, the EPI methodology has been used for additional purposes, including the detection of relatively small changes in vaccination coverage levels that are already high and the estimation of other population parameters when moderate accuracy is required. This article suggests techniques for improving the accuracy of the EPI cluster survey method, including (a) segmenting sample clusters, if necessary, so that reasonably sized areas can be counted, mapped, and listed; (b) selecting an equal probability sample of housing units within a cluster; (c) selecting a fixed number of housing units per sample cluster; and (d) performing weighted analyses. These procedures will produce accurate estimators and corresponding standard errors in EPI cluster surveys.

Child↗

PubMed1994

Continued survival of older hemodialysis patients: investigation of psychosocial predictors.

This study investigated whether social and/or psychologic factors help to predict older dialysis patients' continued survival. A stratified (by race and sex) random sample of patients aged 60+ years was selected from the ESRD Network census of all patients in that age category residing in a single southeastern state (Georgia) and receiving chronic dialysis as of November 1987; personal interviews with patients were completed in 1988. This analysis includes 287 patients (mean age, 69 years) receiving outpatient hemodialysis for whom primary cause of renal failure and functional status data were complete. Patient tracking and vital statistics data determined that 49% of the sample survived as of October 31, 1990. Study variables included demographic, dialysis, health status, social situation, and psychologic outlook variables reported at the patients' 1988 interviews. Log rank tests showed univariate associations between patients' continued survival and race/gender, recovery time following dialysis treatments, cardiovascular co-morbidity, exercise activity score, freedom from health limitation of daily activity, functional status, leisure activity score, self-rated health status, overall life satisfaction, depression, and public religiosity. The Cox proportional hazards model was fit to the data, with continued survival from the time of the 1988 interview as the dependent variable. There was a significantly increased mortality risk for white men relative to the other race/gender groups and for patients reporting severely impaired functional status at the 1988 interview. With functional status in the model, no other social or psychologic variables were significant predictors of mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1993

Social and emotional competence in children of depressed mothers.

The relation between maternal unipolar major depression and children's self-concept, self-control, and peer relationships were studied in a middle-class, predominantly white sample of 96 families. Each family included a target child between the ages of 5 and 10. Depressed mothers varied on whether or not the child's father also had a psychiatric disorder. Well mothers all had spouses with no psychiatric disorders. Analyses controlled for marital status, age, and sex of child. Children completed measures of self-concept and peer relations skills; teachers completed measures of self-control and a rating of popularity with peers. Results supported the multiple risk factor model in that fathers' psychiatric status and parents' marital status explained much of the variability in children's social and emotional competence. Maternal depression alone, in the context of a well husband/father, was only related to children having been rated by their teachers as less popular. Results are discussed in terms of possible mechanisms by which maternal depression may interact with paternal psychopathology and divorce in relation to children's social and emotional competence. The findings may further indicate that older children are more vulnerable to these multiple risk factors than younger children.

Adult↗

PubMed1993

The spatial signal for saccadic eye movements emphasizes visual boundaries.

By investigating the visual processing involved when saccades are made to newly appearing targets, we show that this processing is significantly nonlinear and that texture boundary information predominates. We used the global, or center-of-gravity, effect whereby a saccadic eye movement directed to a target consisting of a pair of elements has an amplitude intermediate between that of saccades directed to the individual elements. We measured the effect using target elements with different visual characteristics, including phase-reversal checkerboard targets that had the same space-average luminance as the background. The contribution to the center-of-gravity calculation was used to measure relative salience. We found that positive and negative contrast elements contribute almost equal weightings. Thus, salience, assessed in this way, is a highly nonlinear function of luminance. The salience of checkerboard targets was found to decrease as check size was decreased and increase as the overall size of the target was increased. Checkerboards with an empty center were as effective as were full checkerboards, showing the importance of boundaries in the salience signal.

Adult↗

PubMed1992

Epidemic poliomyelitis in The Gambia following the control of poliomyelitis as an endemic disease. I. Descriptive findings.

An epidemic of type 1 poliomyelitis involving 305 cases occurred in The Gambia (estimated 1986 population, 768,995) from May through November 1986, following a 6-year period when only five cases were reported. Cases were identified by physician reporting during the epidemic and by a national village-to-village search conducted after the epidemic. The national attack rate was 40 cases per 100,000 people. Cases lived in all parts of the country except the capital, Banjul. The peak month of the epidemic was August (139 cases). The highest attack rate by year of age was in 1-year-old children (394 cases per 100,000 persons), and 75% of cases were 3 years of age or less. A vaccination coverage survey showed that 64% (95% confidence interval 60-68) of 1- to 2-year-old children were vaccinated with at least three doses of trivalent oral polio vaccine at the beginning of the epidemic. Fifty-seven cases became paralyzed more than 2 weeks after a national mass campaign in which 95% of children 1-7 years old were reported to have received a dose of trivalent oral polio vaccine. Experience in The Gambia shows that a several-year period of excellent control of endemic poliomyelitis by a vaccination program can be followed by a major epidemic and that a mass vaccination campaign may be only partially successful in ending the epidemic.

Age Factors↗

PubMed1992

Epidemic poliomyelitis in The Gambia following the control of poliomyelitis as an endemic disease. II. Clinical efficacy of trivalent oral polio vaccine.

An epidemic of poliomyelitis caused by poliovirus type 1 occurred in The Gambia from May to November 1986. Descriptive findings and vaccination coverage levels are reported in part I. This article (part II) describes a case-control study to estimate the clinical efficacy of three or more doses of trivalent oral polio vaccine compared with zero doses. "Cases" were 1- to 7-year-old children paralyzed during the epidemic who were diagnosed as having poliomyelitis by designated referral physicians. They were identified by reports from referral physicians during the epidemic and by a nationwide village-to-village search after the epidemic. Up to five controls were randomly selected for each case from among children of the same age and sex living in neighboring households. In a matched analysis of 195 cases and 839 controls, the efficacy of three or more doses of trivalent oral polio vaccine was 72% (95% confidence interval 57-82) when children without vaccination cards were considered unvaccinated. The efficacy of three or more doses in 1- to 2-year-old children, in whom the determination of vaccination status was considered to be more accurate than in older children, was 81% (95% confidence interval 66-90). Vaccine failure was not associated with short intervals between doses. Higher levels of vaccination coverage and efficacy than those achieved in The Gambia may be needed in African countries to prevent the return of poliomyelitis as an epidemic disease after it has been controlled as an endemic disease.

Age Factors↗

PubMed1992

Survival differences among older dialysis patients in the southeast.

Older end-stage renal disease (ESRD) patients treated by chronic dialysis have higher mortality in the United States than in many other countries. While increasing age, white race, male sex, and/or diabetes are considered risk factors for survival, few studies of older dialysis patients have simultaneously considered multiple predictor variables and their interactions. Using information contained in the 1982 to 1986 ESRD Network 20 database for Georgia and South Carolina, we studied hospitalizations and survival of 1,354 blacks and 965 whites who were age 60 years or older when they began dialysis therapy. Survival time was modeled using the Cox life-table regression method. Older blacks' median age at dialysis initiation was 67.4, compared with 68.7 for older whites (P = 0.001). Blacks were more likely than whites (P < 0.001) to have hypertension-related or diabetes-related ESRD. White patients experienced approximately 25% more hospitalization when adjustment was made for patient-days at risk. Separate multivariate survival models were required for patients with diabetes-related versus non-diabetes-related ESRD. Among diabetics, mortality was higher among whites and among patients who were older when they began dialysis. Among patients with non-diabetes-related ESRD, mortality was higher among patients who were older when they began dialysis, but the age effect was much stronger for white males. Our hospitalization and mortality data support the view that unmeasured severity (or frailty) differences characterize white as compared with black dialysis patients. Among non-diabetes-related ESRD patients, the age effect on survival was more severe in white males than in blacks or in white females. The high mortality we observed among older dialysis patients in Georgia and South Carolina warrants further study; the data may in part reflect patients' lower socioeconomic status compared with age, race, and sex-matched controls.

Aged↗

PubMed1991

The Pregnancy Risk Assessment Monitoring System: design, questionnaire, data collection and response rates. PRAMS Working Group.

The birth certificate, the primary tool for population-based surveillance of the condition of infants at birth and maternal status during pregnancy, provides little data about maternal behaviour during pregnancy. To collect data on maternal behaviours that influence pregnancy outcome, we implemented the Pregnancy Risk Assessment Monitoring System in seven states. For this population-based surveillance, new mothers were sampled from birth certificates 2 to 6 months after delivery and contacted by mail; follow-up of nonrespondents was by telephone. Participants completed a 10-page questionnaire. Stratification permitted over-sampling of women with adverse pregnancy outcomes. Among 10,563 women sampled during 1988 and 1989, stratum-specific response rates ranged from 30% to 89%. In 11 of the 28 strata, response rates were greater than 70%. Response rates varied considerably between states. Rates were lower for Black mothers, mothers of low birthweight infants, unmarried mothers and mothers with less than 12 years of education. Active refusal to participate and undelivered mail occurred infrequently. Mail and telephone surveillance of new mothers can yield adequate response rates in selected population groups. Trials of alternative approaches to enhancing response among Black and disadvantaged mothers, such as additional mailings or post-partum in-hospital recruitment, are needed.

Black or African American↗

PubMed1991

Employment status and ability to work among working-age chronic dialysis patients.

283 patients, age 18-59 years on chronic dialysis were interviewed about their current work status and their ability to work if currently not employed. Only 11% of the total sample was currently employed. However, one third of the nonemployed patients said they were able to work, and most of these patients had made an effort to be employed. Age, race, educational level, health status, and physical ability to perform job tasks, recent work experience, and interest in working were related to the reported ability to work. Patients who said they were able to work were also likely to be rated able to work by the medical director of their dialysis facility. The data indicate the importance of helping work-interested patients maintain their jobs when they start chronic dialysis treatment.

Adult↗

PubMed1990

The internal clock: evidence for a temporal oscillator underlying time perception with some estimates of its characteristic frequency.

Evidence for the proposition that human time perception is determined by an internal clock is largely indirect. It would strengthen the case for this hypothesis if a model for the internal clock were available from which predictions could be derived and tested, and if the basic parameter of such a model, the frequency at which the clock runs, could be estimated. A model for an internal temporal pacemaker is briefly described and its properties are explored by computer simulation. Results are obtained that provide a basis for predicting that, under appropriate conditions, interference between an imposed rhythm and the frequency of a temporal oscillator may cause perturbations in temporal judgment which are related to the characteristic frequency of that oscillator. Experimental data are reported which appear to demonstrate such an interference pattern. These results allow some estimates of the characteristic frequency of the temporal oscillator to be obtained.

Adult↗

PubMed1990

Gender roles, medical practice roles, and ob-gyn career choice: a longitudinal study.

This paper discusses follow-up data from physicians who were studied ten years earlier when they were medical students. Seventeen physicians were practicing ob-gyn, and 57 of the physicians studied had been interested in an ob-gyn career when they were medical students. At Time 1, women were more likely than men to be strongly interested in ob-gyn, but they were no more likely than men to be ob-gyn physicians at Time 2. The desire to have a surgical specialty was much more important to men than to women practitioners. Men ob-gyn practitioners were significantly more traditional in their sex-role outlook as medical students than were either women practitioners or women who had been strongly interested in the field but did not enter it. The data suggest that women ob-gyn physicians are more likely than their male peers to be egalitarian in their relationships with female patients.

Career Choice↗

PubMed1990

Expectations and psychological needs of elderly dialysis patients.

Half of the patients currently beginning chronic kidney dialysis therapy each year in the United States are sixty years of age or older. This is expensive therapy, and patients must cope with limitations stemming from physical debilitation, disruption of normal living routines, and dialysis dependency. It is important, therefore, to investigate patients' views of the quality of their lives. As limitations associated with receipt of chronic dialysis are lessened, patients' overall psychological outlook tends to be increasingly positive. Adjustment problems may persist, however, for those who were especially active before their kidney failure and for those who are coping not only with their own physical adjustment to dialysis but also with family relationship problems. The social context of dialysis treatment can potentially compensate for several losses that often accompany aging, especially if dialysis staff have sufficient time and patience to address issues impacting the psychological well-being of their elderly patients.

Aged↗

PubMed1990

The epidemiology of end-stage renal disease in Georgia.

We have examined the incidence of end-stage renal disease (ESRD) in Georgia in 1986 and 1987. We found high age-sex-race specific and total incidence rates compared to rates reported for other U.S. populations. Cause-specific and total ESRD incidence rates were significantly higher among blacks as compared to whites. In both races, the majority of new cases of ESRD occurring in Georgia during 1986 and 1987 can be attributed to diabetes or hypertension. Total ESRD rates were not uniform throughout the state; counties of the Coastal Plain (South) were significantly more likely to have higher rates than counties in the Piedmont Region (North). These patterns of ESRD in Georgia have implications for possible prevention efforts.

Adult↗

PubMed1988

Continuity of care in hypertension. An important correlate of blood pressure control among aware hypertensives.

Hypertensive patients frequently discontinue follow-up care. In a population-based survey of 4688 adults, we examined the impact of nonattendance on blood pressure control in aware hypertensives. Nonattendance was defined as a failure to visit a physician for hypertensive care within a six-month interval and was reported by 29% of 907 aware hypertensives. Nonattenders had a higher prevalence of diastolic blood pressure above 90 mm Hg (67% vs 30% for attenders). The nonattender profile was male, young, active in the work force, and without coexisting chronic diseases. Poor blood pressure control among nonattenders was associated with a lower treatment rate. Uncontrolled diastolic hypertension and less adherence to medications in nonattenders warrants concern by clinicians.

Adult↗

PubMed1987

Isolated systolic hypertension: declining prevalence in the elderly.

Isolated systolic hypertension is a prevalent condition among elderly U.S. residents of all age, sex, and race groups. In a population-based survey conducted on 4,672 adult residents of Georgia in 1981, prevalence rates were considerably below those noted in earlier surveys, such as Baldwin County, Georgia (1962), National Health Examination Series I (1960-1962), Evans County, Georgia (1967-1969), National Health and Nutrition Examination Survey I (1971-1974) and/or II (1976-1980). The lower 1981 prevalence of isolated systolic hypertension in Georgia was observed in association with a much greater likelihood of anti-hypertensive therapy in adult and elderly patients. The overall trend for early and more aggressive therapy of diastolic hypertension might account for less arterial rigidity and occurrence of isolated systolic hypertension in later life.

Age Factors↗