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Biomedical subjects

D Goldberg

Publications and source records attributed to D Goldberg.

At least 127 records · Page 7Linked to original sources
PubMed1996

Impact of medical therapy on pulmonary hypertension in patients with congestive heart failure awaiting cardiac transplantation.

Pulmonary artery (PA) hypertension in transplant recipients increases mortality from right heart failure following heart transplantation. We examined the impact of long-term medical therapy on the severity of PA hypertension in patients with end-stage congestive heart failure on a transplant waiting list. The initial and final, quarterly right heart catheterization data on 60 patients (50 men, aged 50 +/- 9 years, New York Heart Association class III to IV) awaiting heart transplantation were analyzed and the patients divided into 2 groups: group A, those with persistent elevated systolic PA pressures throughout the 10-month follow-up (n = 31 of 60), and group B, those who had any decrease in systolic PA pressure during that period (n = 29 of 60). Group A had no change in hemodynamics. Group B had a significant decrease( +/- SD) in right atrial (11 +/- 7 to 5 +/- 4 mm Hg), PA (57 +/- 11 to 37 +/- 11 mm Hg), and PA wedge (25 +/- 9 to 14 +/- 7 mm Hg) pressures, with increases in cardiac output (3.8 +/- 0.9 to 4.7 +/- 1.1 L/min) and ejection fraction (18 +/- 6% to 27 +/- 11%) (p < 0.05). The combined end point of transplant or death occurred in 28 of 31 patients (90%) in group A versus 14 of 29 (50%) in group B (p = 0.0004). Ischemic etiology was present in 71 % of patients in group A versus 68% with idiopathic dilated cardiomyopathy in group B (p = 0.003). The reversibility of PA hypertension rather than its initial severity is predictive of patient clinical outcome. Idiopathic, as opposed to ischemic, cardiomyopathy responds better to medical therapy.

Antihypertensive Agents↗
PubMed1996

Management of HIV infected health care workers: lessons from three cases.

Three cases in which doctors in Glasgow were diagnosed as having HIV infection were all handled differently in relation to telling patients and the media. In the first patients were not told because the doctor had been doing administrative work and there was thought to be no risk to patients; although the media did report the case, it accepted the assurances given. In the second case, where a doctor had done many jobs in different specialties and places, the media identified the doctor before most patients had been informed: most calls to the helpline subsequently set up by the health authority were from patients who had not been treated by this doctor. This episode, however, allowed the incident team to be prepared for the next case, enabling the helpline to be established swiftly. In this case the doctor voluntarily identified himself, and this served to allay public fears and reduce the number of inappropriate calls to the helpline.

Confidentiality↗
PubMed1996

Identification of an osteocalcin gene promoter sequence that binds AP1.

Osteoblasts are differentiated cells that produce bone matrix components including the bone-specific protein osteocalcin. The osteocalcin gene promoter has become a model for understanding how genes are regulated, specifically in osteoblasts. One model for cell-specific regulation suggests that osteoblast-expressed genes are regulated through common promoter sequences which bind osteoblast-specific transcriptional activators. The phenotype suppression model suggests osteoblast-specific promoters are switched off through the action of the common transcriptional activator AP1. We previously demonstrated that a short sequence element (OSCARE-2) in the osteocalcin promoter was homologous to a repressive element in the collagen type 1 (alpha 1) promoters. In this paper we use electrophoretic mobility shift (EMS) assays to examine DNA-protein interactions in the OSCARE-2 sequence. In EMS assays, OSCARE-2 binds a complex of proteins, including AP1. This supports the role of AP1 sites in contributing to the regulation of the osteocalcin promoter. Exogenous c-JUN protein bound to OSCARE-2 and increasing c-JUN incubated with nuclear extract amounts caused a progressive increase in a higher-molecular-weight complex, consistent with c-JUN involvement in protein-protein as well as DNA-protein interactions. Anti-c-FOS antibody was capable of supershifting OSCARE-2 DNA-protein complexes produced using osteoblast-like cell nuclear extracts. In addition, EMS assays of nuclear proteins from osteoblast-like cells indicated that 1,25 (OH)2D3-inducible proteins are bound to OSCARE-2. Osteocalcin promoter constructs showed that OSCARE-2 contributed to the 1,25 (OH)2D3 response, albeit in a minor way. These data support the role of AP1 protein as a regulator of osteoblast-specific gene expression during osteoblast development.

Base Sequence↗
PubMed1996

Secrets and security: knowledge and the confinement of adolescents

Adolescents in a psychiatric unit may go through periods of crisis. This paper analyses crises occurring at a psychiatric adolescent unit over a period of 4 months. These crises were found to have a circular pattern and each stage in the crisis connected demands for security with demands for the passage of information. Four patterns of crisis were identified, named as ambivalent, avoidant, chaotic and rigid. In each crisis the transferred information was found to be descriptive of the adolescent's relationship with adults important in his or her life. Each crisis could be understood as an attempt to change the adolescent's relationship with these adults.

Journal Article↗
PubMed1996

Case recognition and interview utterances: effect of GHQ feedback.

Eighty-four audiotaped clinical interviews of seven general practitioners (GPs) with high scoring patients on the General Health Questionnaire (GHQ-28) were analysed at baseline and compared with a similar number at feedback during which doctors were presented with the GHQ-28 scores of their patients. At feedback, there was a significant reduction in the use of physical utterances (deviance 35.150, df 1, P < 0.001), an increase in the use of directive questions, a reduction in closed questions, and more advice and more psychological utterances were made. The five doctors who improved had a mean rise in identification index (ID) of 0.25 +/- 0.12. Such benefit was more apparent among doctors with lower IDs at baseline. There was no significant correlation in the magnitude of rise in ID and change in psychological utterances. Most doctors were not aware of the impact of the GHQ on their interview technique and case recognition ability.

Family Practice↗
PubMed1996

The treatment of common mental disorders by a community team based in primary care: a cost-effectiveness study.

Thirty patients suffering from new episodes of depression or anxiety disorders seen by a hospital-based psychiatric service were matched for severity of illness with 30 patients seen by a community mental health team based upon primary care. These patients were drawn from a total of 108 such patients seen in the community and 57 seen by the hospital service. Clinical and social outcomes were similar in both groups, and neither was clearly superior in terms of quality of clinical information recorded. However, patients treated in the community were seen more quickly, had more continuity of care and were more satisfied with the service. Health services costs were less for those patients treated in the community, because patients were less likely to be admitted. With one atypical patient excluded, treatment by the community team is more cost effective. The greater number of patients seen by the primary-care-based service means that there is no overall cost saving to the NHS.

Adolescent↗
PubMed1996

Validity of the schizophrenia diagnosis of the psychiatric assessment schedule for adults with developmental disability (PAS-ADD).

BACKGROUND: First rank symptoms are central to the diagnosis of schizophrenia, but their complexity makes it difficult to validly detect them in people with learning disability. This report investigates ability of PAS-ADD to detect schizophrenia, validated against expert clinical opinion. METHOD: The sample consisted of 98 patients with learning disabilities and a key informant for each sample member. Clinical opinions of the referring psychiatrists were sought using a symptom checklist. Reportage of remission, and the number of core schizophrenia symptoms identified, were used to estimate level of symptom activity at time of interview. RESULTS: The proportion of schizophrenia cases detected by PAS-ADD increases with the number of active core symptoms identified by the referrer. Where two or more core symptoms were indicated, PAS-ADD detected 71% cases. The most frequently fulfilled criterion was third-person auditory hallucinations. Six schizophrenia diagnoses disagreed with the clinician, four of which were referred as being hypomania. Overall symptom frequency detected by PAS-ADD was positively correlated with IQ. CONCLUSIONS: Results suggest there may be scope for modifying the ICD-10 diagnostic algorithm for use with learning disability, particularly in relation to the delusions and negative symptoms criteria.

Adolescent↗
PubMed1996

Reversal of end-stage heart failure is predicted by long-term therapeutic response rather than initial hemodynamic and neurohormonal profile.

BACKGROUND: Long waiting list periods for heart transplantation have led to clinical improvements for some patients resulting in their removal from the waiting list. This study sought to determine what characteristics differentiated those patients with a good clinical outcome from those who continued to need a transplant. METHODS: The initial and final serial (every 3 months) right heart catheterization data of 60 patients awaiting transplantation were retrospectively analyzed, and the patients were divided into two groups: group A, patients who were taken off the list in follow-up because of improvement (n = 18 of 60), and group B who continued to require transplantation or died (n = 42 of 60). RESULTS: For Group A, there were significant declines in right atrial pressure (9 +/- 4 to 4 +/- 3 mm Hg, initial versus final, p = 0.001), systolic pulmonary arterial pressure (51 +/- 17 to 34 +/- 6 mm Hg, p = 0.0001), with an increase in electron in ejection fraction (20% +/- 4% to 34% +/- 10%, p = 0.005). The change in cardiac output and norepinephrine level was not statistically significant. For Group B, there were no changes in the initial and final values of right atrial pressure, systolic pulmonary arterial pressure, pulmonary capillary wedge pressure, or norepinephrine levels. A significant rise in ejection fraction from 17% +/- 22% +/- 8%, p = 0.003 did occur. The majority of patients in group A (12 of 18) had idiopathic dilated cardiomyopathy. In contrast, an ischemic etiology was found in the majority of group B patients (25 of 42). CONCLUSIONS: This study shows that transplant waiting list outcome cannot be predicted from a patient's initial hemodynamic or neurohormonal presentation. Rather, those patients capable of reversing their hemodynamic derangements with therapy over time are most likely to sustain a favorable clinical outcome. It appears that patients with idiopathic rather than ischemic cardiomyopathy respond more favorably to medical interventions with improved prognosis.

Adult↗
PubMed1996

A dimensional model for common mental disorders.

Although categorical diagnoses are valued by clinicians and those wishing to collect homogeneous groups of patients for research projects, in the field of non-psychotic mental disorders they correspond poorly to actual clinical syndromes. Indeed, patients often satisfy several sets of categorical criteria simultaneously. A more parsimonious representation of symptomatology can be obtained by using a dimensional model for symptoms-with two correlated axes corresponding to anxiety and depression for ratings derived from the Present State Examination. The Composite International Diagnostic Interview is likely to produce a third dimension-so-matic symptoms-because of a radically different symptom content. Preliminary data analysis indicates that the somatic symptoms dimension correlates with both anxiety and depression. Symptomatic individuals in particular areas of dimensional space will satisfy several criteria for categorical diagnoses, and thus display comorbidity. However, evidence that these disorders are distinct is far from persuasive, as they appear to share several common causes.

Adolescent↗
PubMed1996

Respondent and informant accounts of psychiatric symptoms in a sample of patients with learning disability.

This paper investigates differences in the nature and frequency of psychiatric symptoms reported by patients with learning disability and key informants. The study involved psychiatric assessment of 100 patients with learning disabilities and key informants using the Psychiatric Assessment Schedule for Adults with a Developmental Disability (PAS-ADD), a semi-structured psychiatric interview developed specifically for people who have a learning disability. There was considerable disagreement between respondent and informant interviews: only 40.7% of cases were detected by both interviews. Respondents were more likely to report on autonomic symptoms and certain psychotic phenomena. Other anxiety and depression symptoms were more frequently reported by informants. The results indicate that it is crucial for sensitive case detection to complete both interviews where possible. If the respondent cannot be interviewed, panic disorder or phobias may be particularly difficult to detect.

Adolescent↗
PubMed1996

Implications of the World Health Organization study of mental illness in general health care for training primary care staff.

A substantial international study of mental disorders seen in primary care settings has shown that there are marked differences in prevalence between centres. Detection of mental disorders is better in centres using a 'personal' style of clinical service, and where there has been close collaboration between psychiatrists and general practitioners. However, even in the better centres, substantial numbers of mental disorders are missed and treatment often appears to be given regardless of diagnosis. It is argued that changes need to be made to the way in which both undergraduates and vocational trainees are taught about mental disorders, so that teaching emphasizes the psychological syndromes that general practitioners are likely to meet in their everyday work. Training packages need to be developed for primary care staff in the detection and management of mental disorders.

Community Psychiatry↗
PubMed1995

Maintaining low HIV seroprevalence in populations of injecting drug users.

OBJECTIVES: To describe prevention activities and risk behavior in cities where human immunodeficiency virus (HIV) was introduced into the local population of injecting drug users (IDUs), but where seroprevalence has nevertheless remained low (< 5%) during at least 5 years. DESIGN AND SETTING: A literature search identified five such cities: Glasgow, Scotland; Lund, Sweden; Sydney, New South Wales, Australia; Tacoma, Wash; and Toronto, Ontario. Case histories were prepared for each city, including data on prevention activities and current levels of risk behavior among IDUs. PARTICIPANTS: Injecting drug users recruited from both drug treatment and non-treatment settings in each city. INTERVENTIONS: A variety of HIV prevention activities for IDUs had been implemented in each of the five cities. RESULTS: There were three common prevention components present in all five cities: (1) implementation of prevention activities when HIV seroprevalence was still low, (2) provision of sterile injection equipment, and (3) community outreach to IDUs. Moderate levels of risk behavior continued with one third or more of the IDUs reporting recent unsafe injections. CONCLUSIONS: In low-seroprevalence areas, it appears possible to severely limit transmission of HIV among populations of IDUs, despite continuing risk behavior among a substantial proportion of the population. Pending further studies, the common prevention components (beginning early, community outreach, and access to sterile injection equipment) should be implemented wherever populations of IDUs are at risk for rapid spread of HIV.

HIV Infections↗
PubMed1995

Outbreak of HIV infection in a Scottish prison.

OBJECTIVE--To investigate the possible spread of HIV infection and its route of transmission among prison inmates. DESIGN--In response to an outbreak of acute clinical hepatitis B and two seroconversions to HIV infection, counselling and testing for HIV were offered to all inmates over a two week period in July 1993. Information was sought about drug injecting, sexual behaviour, and previous HIV testing. SETTING--HM Prison Glenochil in Scotland. SUBJECTS--Adult male prisoners. MAIN OUTCOME MEASURES--Uptake of HIV counselling and testing; occurrence and mode of HIV transmission within the prison. RESULTS--Of a total 378 inmates, 227 (60%) were counselled and 162 (43%) tested for HIV. Twelve (7%) of those tested were positive for antibody to HIV. One third (76) of those counselled had injected drugs at some time, of whom 33 (43%) had injected in Glenochil; all 12 seropositive men belonged to this latter group. Thirty two of these 33 had shared needles and syringes in the prison. A further two inmates who injected in the prison were diagnosed as positive for HIV two months previously. Evidence based on sequential results and time of entry into prison indicated that eight transmissions definitely occurred within prison in the first half of 1993. CONCLUSION--This is the first report of an outbreak of HIV infection occurring within a prison. Restricted access to injecting equipment resulted in random sharing and placed injectors at high risk of becoming infected with HIV. Measures to prevent further spread of infection among prison injectors are urgently required.

Adult↗
PubMed1995

L-2-oxothiazolidine-4-carboxylic acid (procysteine) inhibits expression of the human immunodeficiency virus and expression of the interleukin-2 receptor alpha chain.

These studies were undertaken to examine the in vitro effects of the cysteine pro-drug L-2-oxothiazolidine-4-carboxylic acid (Procysteine) on human immunodeficiency virus expression. Procysteine inhibited HIV expression in human peripheral blood mononuclear cells as detected by measurement of supernatant core antigen. In transient transfection assays, Procysteine inhibited gene expression controlled by the HIV-1 promoter in activated Jurkat cells but not in resting Jurkat cells. Gel-shift assays showed that Procysteine inhibited NF-kappa B DNA binding activity in nuclear extracts. Procysteine did not affect the production of interleukin-2 by peripheral blood mononuclear cells of healthy HIV-seronegative subjects, as measured by bioassay but it decreased the density of cell-surface interleukin-2 receptors detected by flow cytometry after stimulation with phytohemagglutinin (PHA). Thus, Procysteine inhibits HIV expression, HIV promoter activity, and NF-kappa B binding activity in vitro. Procysteine does not affect interleukin-2 production but inhibits interleukin-2 receptor expression in PHA-stimulated peripheral blood mononuclear cells.

Cells, Cultured↗