Biomedical subjects

E A Walker

Publications and source records attributed to E A Walker.

At least 73 records · Page 4Linked to original sources

PubMed1993

The relationship of chronic fatigue to psychiatric illness in community, primary care and tertiary care samples.

This paper reviews the psychiatric disorders associated with the symptom of fatigue in community, primary care and tertiary care samples. In each of these subsamples, studies using structured psychiatric interviews and operational diagnostic criteria are compared and contrasted. In summary, in community, primary care and tertiary care populations, there was a high association between the symptom of fatigue and affective and anxiety disorders. The prevalence rates of affective illness went up linearly in patients with fatigue as one moved from community to primary care and tertiary populations. The fact that fatigue is a common symptom in the community and is associated with significantly higher medical utilization when associated with affective and anxiety disorders may explain the increased association between this symptom and affective illness in primary and tertiary care.

Chronic Disease↗

PubMed1993

Psychiatric disorders and medical care utilization among people in the general population who report fatigue.

OBJECTIVE: To study the prevalence of fatigue in the general population and its association with psychiatric disorders, somatization, and medical utilization. SETTING: The public-use data tape from the 1984 National Institute of Mental Health Epidemiologic Catchment Area Study. PARTICIPANTS: Household sample of 18,571 subjects. INTERVENTIONS: Structured psychiatric interviews were reviewed to study the prevalence of complaints of current and lifetime fatigue and their relationship to selected psychiatric disorders. RESULTS: Fatigue has high current (6.7%) and lifetime (24.4%) prevalences in the general population. Medically unexplained fatigue also has high current (6.0%) and lifetime (15.5%) prevalences. When compared with those reporting no current fatigue, subjects who reported current (one-month) fatigue were significantly more likely to have experienced current and lifetime episodes of major depression, dysthymic disorder, panic disorder, and somatization disorder. They also had significantly higher mean numbers of lifetime and current DSM-III psychiatric diagnoses, medically unexplained physical symptoms (not just fatigue-related symptoms), and visits to health care providers than did patients without current episodes of fatigue. CONCLUSIONS: The high prevalence of fatigue in the general population appears to be significantly associated with increased lifetime and current risk for affective, anxiety, and somatoform disorders, as well as increased utilization of medical services. These data suggest that assessment of both medical and psychological health may be essential for the proper care of patients with fatigue.

Adult↗

PubMed1993

Histories of sexual victimization in patients with irritable bowel syndrome or inflammatory bowel disease.

OBJECTIVE: Two reports have suggested a possible association between a history of sexual trauma and irritable bowel syndrome, but several factors in their study designs limited their generalizability. The authors used a more rigorous methodology to confirm this association. METHOD: They administered structured psychiatric and sexual trauma interviews to 28 patients with irritable bowel syndrome and 19 patients with inflammatory bowel disease and compared prevalence rates of sexual victimization in the two groups. RESULTS: Compared with patients diagnosed as having inflammatory bowel disease, patients with irritable bowel syndrome had a significantly higher rate of severe lifetime sexual trauma (32% versus 0%), severe childhood sexual abuse (11% versus 0%), and any lifetime sexual victimization (54% versus 5%). The nine patients who had experienced severe lifetime victimization had significantly higher odds ratios for lifetime depression, panic disorder, phobia, somatization disorder, alcohol abuse, functional dyspareunia, and inhibited sexual desire than the 38 patients who had experienced less severe sexual trauma or no trauma. A logistic regression analysis showed that gender, the number of medically unexplained physical symptoms, and self-reported anxiety and hostility accounted for all of the variance in the victimized group. CONCLUSIONS: These preliminary results suggest that sexual victimization may be an important factor in the development of irritable bowel syndrome in some patients. Future studies attempting to categorize subgroups of patients with irritable bowel syndrome should inquire into past histories of sexual victimization.

Adult↗

PubMed1993

Choosing a career: why not nursing for more high school seniors?

Using a descriptive design, 641 college-bound high school seniors (CBHSS) in the Washington, DC, metropolitan area were surveyed to determine why nursing is not selected more frequently as a career. The findings indicated that the decision to choose or not choose nursing was significantly influenced by demographic characteristics (age, ethnicity, and race), past experiences with nurses/illness, and characteristics preferred in a future career. Those respondents who selected nursing cited wanting to help people, to do important work, and to work with a variety of people as important reasons for their choice. Those not choosing nursing indicated dislike of dying people and the salary as the main reasons for choosing another career.

Adolescent↗

PubMed1993

Opioid thermal antinociception in rhesus monkeys: receptor mechanisms and temperature dependency.

The antinociceptive effects of the opioid agonists etonitazene and alfentanil, as well as the agonist/antagonists nalbuphine, [(1)-beta-2'-hydroxy-2,9-dimethyl-5-phenyl-6,7-benzomorphan (GPA 1657)] and profadol were studied in the warm water (48 degrees and 55 degrees C) tail-withdrawal assay in rhesus monkeys. Etonitazene and alfentanil produced dose-dependent increases in tail-withdrawal latency up to the maximum possible latency of 20 sec in 48 degrees and 55 degrees C water. Nalbuphine, GPA 1657 and profadol produced the maximum possible effect only at 48 degrees C, and were ineffective at 55 degrees C. The opioid antagonist quadazocine produced a dose-dependent antagonism of all agonists except profadol. In a Schild plot analysis, apparent pA2 values for quadazocine with alfentanil, etonitazene and nalbuphine were homogeneous (7.3-7.7 mol/kg), suggesting their effects were probably mediated by mu opioid receptors. The apparent pA2 value for GPA 1657 was significantly lower (6.2 mol/kg), suggesting GPA 1657 may have produced antinociception by a non mu receptor-mediated mechanism. The selective delta antagonist naltrindole (0.32-1.0 mg/kg) antagonized the antinociceptive effect of GPA 1657. The kappa-selective antagonist nor-binaltorphimine (nor-BNI, 3.2 mg/kg) caused a small rightward shift in the GPA 1657 dose-effect curve. Nalbuphine, GPA 1657 or profadol produced a rightward shift in the alfentanil dose-effect curve in 55 degrees C water, consistent with possible low-efficacy mu agonist effects of these compounds. These studies suggest agonists may be differentiated based on antinociceptive effectiveness, receptor selectivity and intrinsic efficacy in the rhesus monkey tail-withdrawal procedure.

Alfentanil↗

PubMed1993

Use of antidepressants in the management of women with chronic pelvic pain.

Despite a lack of formal evidence for the efficacy of antidepressants in the treatment of CPP, several lines of evidence suggest that they may play an increasingly important role in the treatment of this disorder. Although best combined as part of a multimodal treatment package that includes psychotherapy, behavior change, and physical activation, they appear to have promise for at least a subgroup of women with chronic pain. The relative safety of these medications and the high prevalence of major depression in this population of patients make the routine empirical trial of these medications a desirable, cost- and time-effective strategy in the treatment of this disorder.

Antidepressive Agents↗

PubMed1993

Sexual victimization and chronic pelvic pain.

Women with chronic pelvic pain are frequently found to have histories of sexual victimization. The authors review the evidence supporting this association and examine related questions regarding the association of chronic pelvic pain with other forms of abuse as well as the relationship of sexual victimization with other physical sequelae. Practical strategies are offered for the office management of patients with both chronic pelvic pain and sexual trauma.

Adolescent↗

PubMed1993

Discriminative-stimulus effects of the low efficacy mu agonist nalbuphine.

The discriminative stimulus effects of nalbuphine were studied in 15 male Sprague-Dawley rats trained to discriminate 3.2 mg/kg of nalbuphine from saline under a fixed-ratio 15 schedule of food delivery. Cumulative doses of nalbuphine produced nalbuphine lever responding at doses of 1.0 to 10 mg/kg and rate-suppressing effects at doses of 3.2 to 32 mg/kg. Experiments to evaluate the contribution of opioid receptor activity suggested that the stimulus effects of nalbuphine were mediated through mu systems, inasmuch as mu agonists (etorphine, fentanyl, morphine, buprenorphine, GPA 1657 and nalorphine) produced nalbuphine lever responding, whereas kappa agonists [EKC and U-50,488H (trans-3,4-dichloro-N-methyl-N-[2-(1-pyrrolidinyl) cyclohexyl] benzeneacetamide methanesulfonate hydrate)] and nonopioids (d-pentazocine, d-amphetamine and ketamine) produced saline lever responding. dl-Pentazocine produced nalbuphine lever responding in one-half the rats tested. Both high and low efficacy agonists produced nalbuphine lever responding, but the antagonist naltrexone produced predominantly saline lever responding. Increasing the training dose of nalbuphine by a 0.50 log unit failed to alter the potency of nalbuphine or any other compound to produce nalbuphine lever responding, suggesting that these training doses produce a maximum amount of stimulation at the mu receptor. Naltrexone antagonized the discriminative stimulus but not the rate-decreasing effects of nalbuphine, suggesting that only the discriminative stimulus effects of nalbuphine are mediated by a mu opioid mechanism.(ABSTRACT TRUNCATED AT 250 WORDS)

3,4-Dichloro-N-methyl-N-(2-(1-pyrrolidinyl)-cycloh↗

PubMed1993

Quality assurance for blood glucose monitoring. The balance of feasibility and standards.

Capillary BGM is a test performed by persons with diabetes as well as health care professionals, i.e., nonlaboratory personnel. Although there are specific actions to be taken to enhance the quality of the test results, these recommendations are frequently not followed. Because therapeutic regimens for medication, diet, and exercise may be changed based on the BGM data and because there is a possibility of adverse outcome to a patient with erroneous results, assuring the quality of the data is reasonable. The challenge to nurses is to make what is reasonable also feasible and practical.

Blood Glucose↗

PubMed1992

Comorbidity of gastrointestinal complaints, depression, and anxiety in the Epidemiologic Catchment Area (ECA) Study.

The purpose of this investigation is to determine if the high prevalence rates of major depression, panic disorder, and agoraphobia found in tertiary-care studies of irritable bowel syndrome and medically unexplained gastrointestinal symptoms are also found in the general population. Structured psychiatric interviews on 18,571 subjects from the NIMH Epidemiologic Catchment Area (ECA) Study were reviewed for prevalence of gastrointestinal distress symptoms and selected psychiatric disorders. Medically unexplained gastrointestinal symptoms had a high prevalence in the general population (6-25%). When compared with those reporting no gastrointestinal symptoms, subjects who report at least one of these symptoms were significantly more likely to have also experienced lifetime episodes of major depression (7.5% vs 2.9%), panic disorder (2.5% vs 0.7%), or agoraphobia (10.0% vs 3.6%). Subjects with two gastrointestinal symptoms had even higher lifetime rates of depression (13.4%), panic (5.2%), or agoraphobia (17.8%). Lifetime rates of affective and anxiety disorders in the general population are higher in subjects with gastrointestinal symptoms compared with subjects without gastrointestinal symptoms. An even higher prevalence of affective and anxiety disorders is found in patients with medically unexplained gastrointestinal symptoms in tertiary-care clinics. Future studies are needed in primary-care populations where prevalence rates of psychiatric illness are probably intermediate between those of the general population and tertiary care.

Agoraphobia↗

PubMed1992

Dissociation in women with chronic pelvic pain.

OBJECTIVE: The authors' goal was to determine if women with chronic pelvic pain are significantly more likely to use dissociation as a coping mechanism than women without pain. METHOD: The subjects were recruited from women who attended a university women's clinic during a 1-month period. Twenty-two women who reported that they had at any time in their lives experienced pelvic pain nearly every day for a period of at least 6 months were included in the study, along with 21 randomly selected women without a history of chronic pelvic pain. The 43 women were given structured sexual assault interviews and completed psychological self-report measures. RESULTS: The women with chronic pain were significantly more likely to use dissociation as a coping mechanism, to show current psychological distress, to see themselves as medically disabled, to experience vocational and social decrements in function, and to amplify physical symptoms. They were also significantly more likely to have experienced severe childhood sexual abuse. In the total study group, women with a childhood history of sexual abuse had significantly higher scores on measures of psychological distress, somatization, and dissociation and viewed their physical health and functioning as more impaired. CONCLUSIONS: The authors discuss a model for the development of somatization, dissociation, and pain symptoms in victims of early sexual abuse.

Adult↗

PubMed1991

An open trial of nortriptyline in women with chronic pelvic pain.

Although antidepressants have been used in the management of several types of chronic pain there have been no systematic trials of these medications in women with chronic pelvic pain. The authors report on the use of nortriptyline in fourteen women with chronic pelvic pain. Seven women dropped out of the study. These seven subjects were significantly different from the treated group only in lower tolerance of antidepressant side effects. Six of the seven treated subjects reported complete or partial relief from pain. Fifty seven percent of the drop-outs and the one nonresponding treated subject had histories of childhood sexual abuse. This open trial suggests that antidepressants may be effective in the treatment of some women with chronic pelvic pain. However, the frequent association of sexual abuse with this disorder indicates that accepted treatment trial designs may need to be altered.

Abdominal Pain↗

PubMed1991

Quality assurance for blood glucose monitoring in health-care facilities.

OBJECTIVE: To describe the practice of quality assurance (QA) for capillary blood glucose monitoring (CBGM) in health-care facilities. RESEARCH DESIGN AND METHODS: Descriptive survey data were collected from a purposive sample of 378 health-care providers, who use CBGM and direct CBGM QA programs, from acute- and chronic-care facilities in 47 states. Subjects completed a 36-item multiple-choice survey about QA practices for CBGM by providers. RESULTS: Only 53.4% of respondents reported a multidisciplinary advisory group to assist in decision making for the CBGM program. Almost one-third reported no clinical laboratory involvement in their QA program. Over 70% of respondents reported inclusion of all clinical areas in the CBGM program. Comparison of results of the same patient sample by laboratory reference method and CBGM system was done routinely by only 43.6% of respondents. Scheduled proficiency testing was reported by 33.4%. Only 5.8% of respondents reported the coexistence of a CBGM advisory group, full participation of the laboratory, and quarterly proficiency testing. Over 50% of respondents reported a patient charge for CBGM. CONCLUSIONS: When survey results are compared with regulatory and accreditation standards, it is evident that a wide gap exists. Resources to bridge this gap may be scarce in many facilities. Further research is needed to determine minimal QA standards for CBGM that provide for optimal patient outcomes.

Blood Glucose↗

PubMed1991

Shaping the course of a marathon: using the Trajectory Framework for diabetes mellitus.

Persons with either insulin-dependent or non-insulin-dependent diabetes mellitus live with a chronic illness that can have both acute and long-term complications. The therapeutic regimen for glycemic control in diabetes is often complex and is lifelong; it requires special knowledge and skills for both patients and health care providers. In this article, the Corbin and Strauss trajectory framework for chronic illness management is clinically applied to the planning of patient care in two case studies of persons with diabetes. The benefits of using the trajectory framework as a model for care in diabetes include: introduction of the concepts of "locating" the patient on the trajectory and assessing the trajectory projection for both patient and provider, and a more realistic evaluation of incremental change in chronic illness. Two possible barriers to clinical application of the framework for diabetes management are: difficulty in translating the framework for clinical use, and some terminology in the framework that does not seem to describe reimbursable care. The trajectory framework provides a necessary shift in focus to quality of life issues in diabetes management over the lifespan.

Adaptation, Psychological↗

PubMed1991

The clinical utility of capillary blood glucose monitoring in the 1990s.

The purpose of this article is to explore the clinical utility of capillary blood glucose monitoring (BGM) in providing data for management decisions by persons with diabetes and by clinicians in acute and chronic care facilities, as well as in the private practice setting. Issues that affect clinical utility include: quality assurance for the BGM procedure, knowledge and beliefs regarding BGM of both the patient and the clinician, and communication patterns. Counseling patients regarding the frequency of their self-monitoring should be individualized and based on the type of treatment for managing the patients' blood glucose, their resources, and their motivation for making dietary, medication, or exercise changes based on the BGM results. Thus, the clinical utility of BGM is dependent on the quality of data generated and the utilization of these data for management decisions by informed and motivated patients and clinicians.

Blood Glucose↗

PubMed1991

Self-monitoring: the patient-practitioner alliance.

Self-monitoring of blood glucose (SMBG) is an essential component of the therapeutic regimen in diabetes management and new technology offers a variety of options for patients and practitioners. This article presents guidelines for appropriate use of SMBG in persons with diabetes and a discussion of quality assurance and infection control issues. A strong patient-practitioner alliance encourages compliance and supports the maximum use of information obtained by SMBG.

Blood Glucose Self-Monitoring↗

PubMed1991

Agonist and antagonist properties of serotonergic compounds in pigeons trained to discriminate either quipazine or L-5-hydroxytryptophan.

The serotonin (5-HT) receptor-related compounds metergoline, pirenperone, ketanserin, cyproheptadine, pizotyline, methysergide, lysergic acid diethylamide, mianserin and cinanserin were studied in pigeons trained to discriminate l-5-hydroxytryptophan (l-5-HTP) (18.0 mg/kg) from saline and in pigeons trained to discriminate quipazine (1.0 mg/kg) from saline. Metergoline did not generalize to either quipazine or l-5-HTP but did antagonize drug-appropriate responding in both groups. Ketanserin potently blocked the quipazine discriminative stimulus and neither generalized to nor attenuated the l-5-HTP discriminative stimulus. Pirenperone, cinanserin, cyproheptadine, methylsergide, pizotyline and mianserin attenuated the quipazine discriminative stimulus at low doses and, at higher doses, generalized to the l-5-HTP discriminative stimulus. No antagonism of the l-5-HTP-discriminative stimulus or generalization to the quipazine-discriminative stimulus were observed with these compounds. A correlation coefficient of 0.93 was calculated between the potencies of 5-HT compounds to generalize to the l-5-HTP stimulus and the binding affinities of these compounds for a 5-HT1 receptor in rat brain. In addition, a correlation coefficient of 0.78 was calculated between the potencies of 5-HT compounds to attenuate the quipazine stimulus and the binding affinities of these compounds for the 5-HT2 receptor in rat brain. These observations suggest cyproheptadine, pizotyline, methysergide, lysergic acid diethylamide, mianserin and cinanserin are agonists at the 5-HT1 receptor in the l-5-HTP discrimination and antagonists at a 5-HT2 receptor in the quipazine discrimination in pigeons.

5-Hydroxytryptophan↗

PubMed1991

Discriminative-stimulus effects of quipazine and l-5-hydroxytryptophan in relation to serotonin binding sites in the pigeon.

The 5-hydroxytryptamine (serotonin; 5-HT) agonists, RU-24969 [5-methoxy 3-(1,2,3,6-tetrahydro-4-pyridinyl)1H-indole, succinate], ipsapirone [2-(4-[4-(2-pyrimidinyl)-1-piperazinyl]butyl)-1,2- benzisothiazol-3-(2H)one-1,1-dioxidehydrochloride], 8-hydroxy-N,N-dipropyl-2-aminotetralin, lysergic acid diethylamide, fenfluramine and N,N-dimethyltryptamine were studied in pigeons trained to discriminate quipazine (1.0 mg/kg) from saline and in pigeons trained to discriminate I-5-HTP (18.0 mg/kg) from saline. Lysergic acid diethylamide, quipazine and fenfluramine generalized to the training stimulus in both groups of pigeons. N,N-dimethyltryptamine generalized to quipazine in all pigeons tested whereas N,N-dimethyltryptamine generalized to I-5-HTP in most pigeons tested. The natural substrate 5-HT and agonists with affinities for the 5-HT1 receptor and its subtypes (8-hydroxy-N,N-dipropyl-2-aminotetralin, ipsapirone, and RU-24969) only generalized in the I-5-HTP-trained pigeons. Equilibrium binding experiments using the ligands [3H]-5-HT and [3H]ketanserin were performed with six areas of pigeon brain and six homologous areas of rat brain. Two populations of 5-HT binding sites were found in brains of both species; one defined by high-affinity binding of [3H]-5-HT and the other defined by high-affinity binding of [3H]ketanserin. Kd values were similar for the two ligands in brains of both species. 5-HT, RU-24969 and ipsapirone displaced [3H]-5-HT but not [3H]ketanserin from pigeon brain membranes. The present study suggests that, in the pigeon, the 5-HT2 receptor might mediate the discriminative-stimulus effects of quipazine, whereas the 5-HT1 receptor might mediate the effects of I-5-HTP.

5-Hydroxytryptophan↗