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Biomedical subjects

D Shaffer

Publications and source records attributed to D Shaffer.

At least 73 records · Page 4Linked to original sources
PubMed1995

Demographic predictors of treatment attendance among adolescent suicide attempters.

The relationship between age and gender and treatment attendance was prospectively examined among a consecutive series of 143 adolescent emergency room attendees referred for outpatient therapy after a suicide attempt. Consistent with previous reports, nonadherence was high. Over 40% of patients had their cases terminated because of nonattendance; on average, however, patients received almost 6 sessions of treatment and 91% attended at least 1 therapy session. Adolescents terminated from treatment for nonadherence were significantly older than those completing treatment. Younger male patients were scheduled for significantly more therapy sessions than older male patients and kept significantly more scheduled sessions than did older male and female patients. Vigorous case-tracking procedures may have a significant impact on treatment attendance. Nevertheless, therapists must design strategies to increase treatment adherence among older adolescent, especially male, patients.

Adolescent↗
PubMed1995

Incidence, timing, and follow-up of periventricular leukomalacia.

Screening cranial ultrasounds were performed on 115 very low birthweight infants during the first week of life. Fourteen infants (12%) developed changes of periventricular leukomalacia. All 14 weighted 1100 g or less at birth. Eight infants' initial studies were normal, four had intraventricular hemorrhage, and two had periventricular echo densities. Cystic periventricular leukomalacia developed between 17 and 104 days of age and occurred later in those infants whose initial study was normal. There were tone abnormalities in 11 of the 12 infants who received developmental follow-up. Severe cognitive delays were common in the older infants. This study demonstrates the need for late ultrasound screening even in the presence of initial normal ultrasound examinations.

Cerebral Hemorrhage↗
PubMed1995

Seasonal rhythm of platelet [3H]imipramine binding in adolescents who attempted suicide.

OBJECTIVE: This study was designed to determine the seasonality of serotonin functions among adolescents who attempt suicide. METHOD: Platelet [3H]imipramine binding was assessed over a period of 18 months in 98 adolescents who attempted suicide and a comparison group of 23 never-suicidal youths with conduct disorder. RESULTS: [3H]Imipramine (Bmax) was uncorrelated with age, but showed considerable seasonal variability over time in those who had attempted suicide. CONCLUSIONS: [3H]Imipramine binding density in adolescents who attempted suicide exhibited significant seasonality, reaching a nadir in late winter/early spring.

Adolescent↗
PubMed1995

Lessons from vascular access procedures for hemodialysis.

Although specific requirements for vascular access in chronic hemodialysis differ from those of the oncology patient, many of the problems encountered are common to the two groups. This article reviews the current state-of-the-art of vascular access for hemodialysis. Particular emphasis is placed on the expanding use of dual-lumen silicone central venous dialysis catheters and their use in vascular access for the oncology patient.

Arteriovenous Shunt, Surgical↗
PubMed1995

Sexual orientation in adolescents who commit suicide.

It has been suggested that there is a strong relationship between suicidal behavior and homosexuality in adolescence. It has been further suggested that it is due to the stigmatization and feelings of isolation that are experienced by many gay adolescents. Much of the literature that has given support to these hypotheses has been conducted on uncontrolled nonrepresentative samples and its generalizability is open to question. An opportunity to examine the relationship in an unselected sample arose in a case control, psychological autopsy study of 120 of 170 consecutive suicides under age 20 and 147 community age, sex, and ethnic matched controls living in the Greater New York City area. Homosexuality was defined as having had homosexual experiences or having declared a homosexual orientation. Three teenagers and no controls met these criteria. The difference was not significant. The circumstances of death were examined and are described. In no instance did suicide directly follow an episode of stigmatization. All three suicides had evidence of significant psychiatric disorder before death. In spite of opportunities for biased reporting, it is concluded that this study finds no evidence that suicide is a common characteristic of gay youth, or that when suicide does occur among gay teenagers, that it is a direct consequence of stigmatization or lack of support.

Adolescent↗
PubMed1995

Role of calcium channel blockers in diabetic renal transplant patients: preliminary observations on protection from sepsis.

BACKGROUND: Diabetic recipients of kidney transplants have an excessively high risk of allograft loss, infectious complications with sepsis, cardiovascular events and early death. This study was designed in order to determine whether post-transplantation medical management influenced long-term results. METHODS: Seventy consecutive diabetic recipients of cadaveric renal allografts were followed from the time of transplant. Treatment regimens were based on the clinical judgement of transplant nephrologists and surgeons, not by the study team. Patients were followed for 2 to 9 years (mean follow-up of 50.85 months, one lost to follow-up). Groups were classified by HLA match, type of immunosuppression, prior cardiovascular history, type of antihypertensives (36 on calcium channel blockers, 32 on beta blockers, 8 ACE inhibitors). Events were defined as myocardial infarction, CVA, graft loss with return to dialysis, life-threatening sepsis, or death. RESULTS: Twenty allografts failed during the study, 24 patients died. Potentially cardioprotective drugs did not impact significantly on cardiac death, MI or CVA. Survivals were better when calcium channel blockers were used (mean 71.7 vs 38.6 months, p < 0.05; 4-year survival 84 vs 58%). When both beta and calcium channel blockers were used (n = 20), patients mean survival was 72.5 months vs 36.8 months for 21 patients who were not treated with blockers (p < 0.005). There was a lower incidence of graft loss when beta blockers and calcium channel blockers were used: at mean patient survival of 36.8 months, the no-blockers group had a mean graft survival of 19.3 months vs 72.5 months for blocker-treated patients (p < 0.002). Reinstitution of dialysis occurred less often with calcium channel blockers (17 vs 42%) or beta blockers (19 vs 38%) used either individually or together (5 vs 42%), all p < 0.05. Calcium channel blocker treated patients had 1/9 the number of septic deaths, fewer patients had multiple septic episodes, all p < 0.02. CONCLUSION: Allograft success and patient survivals may be improved and sepsis related events diminished when diabetic renal allograft recipients are treated with calcium channel blocking agents, plus or minus beta blockers. Considerable savings can be accomplished and graft results with these drugs can approach non-diabetic and live-related transplant results.

Adrenergic beta-Antagonists↗
PubMed1994

Worsening suicide rate in black teenagers.

Over the past 30 years the incidence of suicide in older adolescents in the United States has shown marked gender and ethnic variations. The rate has remained largely stable among females of all ethnic groups. Among white males it reached a peak in 1988 but has since stabilized. The rate for black and other minority males, however, has increased markedly since 1986. Increases have been more rapid in regions where the incidence was historically low. One effect of these changes has been to reduce the discrepancy between white and black teen suicide rates. The perception that young blacks are at much lower risk for suicide than whites requires revision.

Adolescent↗
PubMed1993

The Diagnostic Interview Schedule for Children-Revised Version (DISC-R): I. Preparation, field testing, interrater reliability, and acceptability.

OBJECTIVE: To describe the history and assessment strategies used to investigate and revise the Diagnostic Interview Schedule for Children (DISC), a highly structured interview form used by lay interviewers to elicit diagnostic criteria for the common psychiatric disorders of childhood and adolescence. METHOD: Revision was based on clinical and community data that identified unreliable and undiscriminating items in an earlier version of the instrument (DISC-1). A field study was carried out with 74 parent-child pairs. Interrater reliability and acceptability to patients was high. Accompanying papers describe the test-retest and construct validity of the instrument. CONCLUSIONS: Taken together, the findings suggest that the DISC is an acceptable, brief, inexpensive, and convenient instrument for ascertaining a comprehensive range of child and adolescent diagnoses whose methodological properties are comparable with other child diagnostic instruments.

Adolescent↗
PubMed1993

The Diagnostic Interview Schedule for Children-Revised Version (DISC-R): II. Test-retest reliability.

OBJECTIVE: Test-retest reliability and internal consistency of the Diagnostic Interview Schedule for Children-Revised Version (DISC-R) were examined to evaluate the effects of a recent revision process. METHOD: A sample of outpatients 11 to 17 years old and their parents were administered the DISC-R in a test-retest design. RESULTS: For the parent interview, four diagnoses had sufficient cases to examine reliability; agreement was good to excellent for three of these. For the child interview, two of the four diagnoses with adequate cases showed good or excellent reliability. Using a combined parent-child algorithm, three of five diagnoses showed good or excellent reliability. Test-retest reliability for symptom scales was excellent for the parent DISC-R and good for the child version, except for oppositional defiant disorder. Maternal depressive symptoms did not affect reliability of reporting about the child's symptomatology. Internal consistency was satisfactory for symptom items comprising most diagnoses. CONCLUSIONS: Although some revision of the instrument will be necessary, the findings from this study suggest that the DISC-R is a promising research instrument for the diagnosis of psychopathology in older children and adolescents.

Adolescent↗
PubMed1993

The Diagnostic Interview Schedule for Children-Revised Version (DISC-R): III. Concurrent criterion validity.

OBJECTIVE: To examine the concurrent criterion validity of the Revised Diagnostic Interview Schedule for Children (DISC-R), a structured lay-administered instrument designed for use in community studies, under conditions designed to provide strict controls for information and method variance. METHOD: The DISC-R was compared with a semistructured clinical interview that covered a similar information base as the DISC-R, used standardized ratings to record symptom information, and, similar to the DISC-R, was scored by DSM-III-R-based computerized diagnostic algorithms. Subjects were 74 child and adolescent clinic attendees and their adult custodians. RESULTS: Overall, moderate levels of agreement were found between DISC-R and clinician-generated diagnoses; these findings were tempered, however, by the fact that the validation interview was less reliable than the DISC-R. CONCLUSIONS: Although these findings provide preliminary support for the use of the DISC-R, they cast some doubt on the adequacy of clinician-generated diagnoses as validation criteria and suggest that alternate approaches to the assessment of validation should be pursued.

Adolescent↗
PubMed1993

Sensitivity of the Diagnostic Interview Schedule for Children, 2nd edition (DISC-2.1) for specific diagnoses of children and adolescents.

OBJECTIVE: The sensitivity of the Diagnostic Interview Schedule for Children, second edition (DISC-2.1) was examined for certain "rare" disorders: eating disorders, major depressive episode, obsessive compulsive disorder, psychosis, tic disorders, and substance use disorders. METHOD: Subjects recruited from specialized centers were interviewed with the DISC-2.1; the centers' diagnoses served as the criterion measure. RESULTS: Overall the DISC showed good to excellent sensitivity (range = 0.73 to 1.0). Used alone, the DISC-P (parent interview) was generally more sensitive than the DISC-C (child interview). Areas for additional instrument revision were identified. Recommendations about informant choice by diagnosis are offered. CONCLUSIONS: The strategy used in this study was useful for assessing the DISC's sensitivity for these disorders. Additional work examining specificity of the DISC remains to be done. The DISC should prove a useful adjunct in clinical settings given the ease and relatively low cost of administration.

Adolescent↗
PubMed1993

Persistent emotional disorder in children with neurological soft signs.

OBJECTIVE: This paper provides clinical details in the form of case vignettes from a prospective epidemiological study that found the combination of childhood "soft" signs and anxious behavior to be a strong risk factor for adolescent emotional disorders. METHOD: The original study conducted a neuropsychiatric assessment of adolescents who had been followed through childhood. RESULTS: The at-risk subjects are shown to exhibit a persistent and specific pattern of both motor abnormalities and anxiety, obsessional compulsive, or depressive symptoms over time. DISCUSSION: The form of their neurological and psychiatric abnormalities is consistent with neuropsychiatric research linking motor system abnormalities to emotional disorders. It is recommended that children who present with anxious and depressive symptoms be examined for motor soft signs.

Adolescent↗