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Biomedical subjects

E Frank

Publications and source records attributed to E Frank.

At least 109 records · Page 6Linked to original sources
PubMed1999

Pharmacologic treatment of depression during pregnancy.

CONTEXT: Despite the frequency of depression in women of childbearing age, information to guide patients and physicians through a consideration of treatment during pregnancy is limited. OBJECTIVE: To identify risk factors associated with treatment of major depression during pregnancy to help physicians develop treatment plans that optimize clinical care. DATA SOURCES: Reports of prospective controlled trials in English were identified from MEDLINE and Health STAR using the search terms antidepressant during pregnancy and depression during pregnancy, by manually searching bibliographies of review articles, and through discussions with investigators for 1989-1999. STUDY SELECTION: We selected studies in which maternal and infant health outcomes associated with antidepressant exposure were compared with those of non-teratogen-exposed controls. Four studies published since 1993 were identified and included in the analysis. DATA EXTRACTION: We abstracted information about identification of subjects, comparison groups, pregnancy, and birth outcomes. We organized the data along 5 domains of reproductive toxicity: intrauterine fetal death, morphologic teratogenicity, growth impairment, behavioral teratogenicity, and neonatal toxicity. DATA SYNTHESIS: Data were available for tricyclic antidepressants (collectively), fluoxetine, and newer selective serotonin reuptake inhibitors (collectively). Exposure to these agents did not increase risk for intrauterine death or major birth defects. Decreased birth weights of infants exposed to fluoxetine in the third trimester were identified in 1 study. The development of children whose mothers took tricyclics or fluoxetine during gestation did not differ from that of controls. Direct drug effects and withdrawal syndromes occurred in some neonates whose mothers were treated with antidepressants near term. CONCLUSIONS: Although few in number, new information from prospective studies provides a welcome change from decision making based on nonprospective data. Monitoring and interventions for patients with identified risks (eg, poor weight gain) are recommended.

Abnormalities, Drug-Induced↗
PubMed1999

Career satisfaction of US women physicians: results from the Women Physicians' Health Study. Society of General Internal Medicine Career Satisfaction Study Group.

BACKGROUND: Despite major changes in health care, the prevalence and predictors of career satisfaction have not recently been comprehensively studied in either women or men physicians. METHODS: The Women Physicians' Health Study surveyed a nationally representative random sample (n = 4501 respondents; response rate, 59%) of US women physicians. Using univariate and logistic regression analyses, we examined personal and professional characteristics that were correlated with 3 major outcomes: career satisfaction, desire to become a physician again, and desire to change one's specialty. RESULTS: Women physicians were generally satisfied with their careers (84% usually, almost always, or always satisfied). However, 31% would maybe, probably, or definitely not choose to be a physician again, and 38% would maybe, probably, or definitely prefer to change their specialty. Physician's age, control of the work environment, work stress, and a history of harassment were independent predictors of all 3 outcomes, with younger physicians and those having least work control, most work stress, or having experienced severe harassment reporting the most dissatisfaction. The strongest association (odds ratio, 11.3; 95% confidence interval, 7.3-17.5; P<.001) was between work control and career satisfaction. Other significant predictors (P<.01) of outcomes included birthplace, ethnicity, sexual orientation, having children, stress at home, religious fervor, mental health, specialty, practice type, and workload. CONCLUSIONS: Women physicians generally report career satisfaction, but many, if given the choice, would not become a physician again or would choose a different specialty. Correctable factors such as work stress, harassment, and poor control over work environment should be addressed to improve the recruitment and retention of women physicians.

Adult↗
PubMed1999

Stimulation of aggrecan synthesis in cartilage explants by cyclic loading is localized to regions of high interstitial fluid flow.

Chondrogenesis in cartilage development and repair and cartilage degeneration in arthritis can be regulated by mechanical-load-induced physical factors such as tissue deformation, interstitial fluid flow and pressure, and electrical fields or streaming potentials. Previous animal and tissue explant studies have shown that time-varying dynamic tissue loading can increase the synthesis and deposition of matrix molecules in an amplitude-, frequency-, and spatially dependent manner. To provide information on the cell-level physical factors which may stimulate chondrocytes to increase production and export of aggrecan, the main proteoglycan component of the cartilage matrix, we characterized local changes in aggrecan synthesis within cyclically loaded tissue explant disks and compared those changes to values of predicted local physical factors. Aggrecan synthesis following a 23-h compression/radiolabel protocol was measured with a spatial resolution of approximately 0.1 mm across the 1.5-mm radius of explanted disks using a quantitative autoradiography method. A uniform stimulation of aggrecan synthesis was observed at an intermediate frequency of 0.01 Hz, while, at a higher frequency of 0.1 Hz, stimulation was only seen at peripheral radial positions. Profiles of radial solid matrix deformation and interstitial fluid pressure and velocity predicted to be occurring across the radius of the disk during sinusoidal loading were estimated using a composite poroelastic model. Tissue regions experiencing high interstitial fluid velocities corresponded to those displaying increased aggrecan synthesis. These results reinforce the role of load-induced flow of interstitial fluid in the stimulation of aggrecan production during dynamic loading of cartilage.

Aggrecans↗
PubMed1999

Relationship between social rhythms and mood in patients with rapid cycling bipolar disorder.

Disruptions in the sleep-wake cycle frequently characterize affective illness and have led to a number of theories linking sleep-wake and/or circadian rhythm disturbance to affective illness. Recently, researchers have expanded these chronobiological theories to include the role of lifestyle regularity, or daily social rhythms. In this study, the Social Rhythm Metric (SRM) was used to explore the relationship between social rhythms and mood in patients with rapid cycling bipolar disorder and to compare the social rhythms of patients with those of healthy control subjects. Patients' SRM scores and activity level indices were significantly lower than those of control subjects. In addition, the timing of five, mostly morning, activities was phase delayed in patients compared to control subjects. Patients also demonstrated a phase delay in the timing of morning activities during depression compared to hypomania or euthymia. The phase changes in the timing of morning activities are consistent with other data implicating morning zeitgebers in the pathophysiology of rapid cycling bipolar disorder.

Adult↗
PubMed1999

Platelet membrane phospholipids in euthymic bipolar disorder patients: are they affected by lithium treatment?

BACKGROUND: Abnormalities in cell membrane processes and intracellular signal transduction pathways may be implicated in the pathophysiology of bipolar disorder. In this study, we attempted to investigate, in euthymic bipolar patients: 1) in vivo signal transduction abnormalities of the phosphatidylinositol pathway in platelets; and 2) possible in vivo effects of lithium treatment on platelet membrane phospholipids. METHODS: We determined the relative absorbances of eight individual classes of platelet membrane phospholipids, using two-dimensional thin-layer chromatography in high-performance plates, followed by scanning laser densitometry, in a group of 10 lithium-treated euthymic bipolar patients and 11 normal controls. RESULTS: The mean relative absorbance of phosphatidyl-inositol-4,5-bisphosphate (PIP2) was lower in the patient group (0.29 +/- 0.08% vs. 0.39 +/- 0.12%; t = 2.35, df = 19, p = .03); no significant differences between patients and controls were found for the other phospholipids. CONCLUSIONS: This study provides in vivo evidence that bipolar patients on lithium treatment exhibit a decreased relative amount of PIP2 in the platelet cell membranes compared to normal controls.

Adult↗
PubMed1999

Pretreatment REM sleep and subjective sleep quality distinguish depressed psychotherapy remitters and nonremitters.

BACKGROUND: We compared pretreatment subjective and electroencephalographic sleep measures among depressed patients who remitted with psychotherapy alone and those who did not remit. METHODS: Patients were 111 midlife women with recurrent major depressive disorder. Baseline psychiatric ratings and sleep studies were conducted prior to treatment with weekly interpersonal psychotherapy. Remission was defined as a score of < or = 7 for 3 consecutive weeks on the Hamilton Depression Rating Scale. Clinical and sleep measures were compared between remitters (n = 62) and nonremitters (n = 49) using t tests and random regression. Linear discriminant function analyses were used to categorize remitters and nonremitters on the basis of sleep measures. RESULTS: Treatment nonremitters had significantly worse subjective sleep quality and significantly elevated phasic REM sleep as measured by multivariate and univariate analyses. The linear accumulation of REM activity during sleep occurred at a significantly higher rate in nonremitters than in remitters. Linear discriminant function analyses based on subjective sleep quality and REM activity correctly identified 68.3% of nonremitters and 68.5% of remitters. CONCLUSIONS: These findings highlight the role of subjective and REM sleep measures as correlates of short-term psychotherapy treatment response in major depressive disorder. Disturbed sleep may be a physiological indicator of increased limbic and brain stem arousal.

Adult↗
PubMed1999

Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression: a randomized controlled trial in patients older than 59 years.

CONTEXT: Elderly patients with major depression are at high risk for recurrence, increased mortality, and chronic disability. OBJECTIVE: To determine the efficacy of maintenance nortriptyline hydrochloride and interpersonal psychotherapy (IPT) in preventing recurrence of major depressive episodes in patients older than 59 years. DESIGN: A 2 x 2 randomized, double-blind, placebo-controlled clinical trial, stratified by therapist. SETTING: University-based psychiatric research clinic. PATIENTS: Of a total of 187 patients with recurrent nonpsychotic unipolar major depression (average age, 67 years; one third aged > or =70 years) recruited through clinical referral and media announcements, 107 were fully recovered after open acute and treatment continuation with nortriptyline and IPT. These patients were randomly assigned to 1 of 4 maintenance therapy conditions. INTERVENTIONS: Monthly medication clinic with nortriptyline hydrochloride (80-120 ng/mL steady-state levels) (n = 24); medication clinic with placebo (n = 29); monthly maintenance IPT with placebo (n = 21); and monthly maintenance IPT with nortriptyline (n = 22). MAIN OUTCOME MEASURE: Recurrence of major depressive episode. RESULTS: The time to recurrence of a major depressive episode for all 3 active treatments was significantly better than for placebo. Recurrence rates over 3 years were as follows: nortriptyline and IPT, 20% (95% confidence interval [CI], 4%-36%); nortriptyline and medication clinic visits, 43 % (95% CI, 25%-61%); IPT and placebo, 64% (95% CI, 45%-83%); and placebo and medication clinic visits, 90% (95% CI, 79%-100%). Combined treatment with nortriptyline and IPT was superior to IPT and placebo and showed a trend to superior efficacy over nortriptyline monotherapy (Wald chi2 = 3.56; P = .06). Subjects aged 70 years and older had a higher and more rapid rate of recurrence than those aged 60 to 69 years. CONCLUSION: In geriatric patients with recurrent major depression, maintenance treatment with nortriptyline or IPT is superior to placebo in preventing or delaying recurrence. Combined treatment using both appears to be the optimal clinical strategy in preserving recovery.

Adrenergic Uptake Inhibitors↗
PubMed1999

Peripheral specification of Ia synaptic input to motoneurons innervating foreign target muscles.

Muscle sensory neurons, called Ia afferents, make monosynaptic connections with functionally related sets of motoneurons in the spinal cord. Previous work has suggested that peripheral target muscles play a major role in determining the central connections of Ia afferents with motoneurons. Here, we ask whether motoneurons can also be influenced by their target muscles in terms of the monosynaptic input they receive from Ia afferents, by transplanting thoracic motoneurons into the lumbosacral spinal cord so that they innervate foreign muscles. Three or four segments of thoracic neural tube from stage 14-15 chicken embryos were transplanted to the lumbosacral region of stage 16-17 embryos, and electrophysiological recordings were made from transplanted motoneurons after the embryos had reached stage 38-40. Transplanted thoracic motoneurons innervated limb muscles and received monosynaptic inputs from Ia afferents. These connections were not random: Most of the connections were formed between Ia afferents and motoneurons projecting to the same muscle (homonymous connections). Few aberrant connections were found although the anatomical distribution of afferents in the transplant indicated that they had ample opportunity to contact inappropriate motoneurons. We conclude that although peripheral target cues are not sufficient to respecify an already committed motoneuron (turn a thoracic motoneuron into a lumbosacral motoneuron), they do provide sufficient information for Ia afferent input to be functionally correct.

Afferent Pathways↗
PubMed1999

Contraceptive use by female physicians in the United States.

OBJECTIVE: Little is known about female physicians' personal contraceptive use, and such usage could influence their prescribing patterns. METHODS: We used data from the Women Physicians' Health Study, a large (n = 4501) national study, administered in 1993-1994, on characteristics of female physicians in the United States. RESULTS: These female physicians (ages 30-44 years) were more likely to use contraception than women in the general population (ages 15-44 years); this was true even when the physicians were compared with only other women of high socioeconomic status and when stratified by ethnicity, age, and number of children. Physicians were also more likely to use intrauterine devices, diaphragms, or condoms, and less likely to use female or male sterilization than were other women. Younger female physicians were especially unlikely to use permanent methods, particularly when compared with their age-matched counterparts in the general population. One fifth of contracepting physicians used more than one type of contraceptive; the most frequently used combination was spermicide with a barrier method. CONCLUSION: Female physicians contracept differently than do women in the general population, in ways consistent with delaying and reducing total fertility. Physicians' personal characteristics have been shown to influence their patient counseling practices, including their contraception-related attitudes and practices. Although female physicians' clinical advice might differ from their personal practices, as women physicians become more prevalent, their contraceptive choices could influence those of their patients.

Adult↗
PubMed1999

Characteristics of female obstetrician-gynecologists in the United States.

OBJECTIVE: To describe characteristics of United States female obstetrician-gynecologists, a large and growing group, and to contrast them with other female physicians. METHODS: We contrasted data from 313 obstetrician-gynecologists to data from 4132 other female physician respondents to the Women Physicians' Health Study, a national questionnaire-based study. RESULTS: Obstetrician-gynecologists assumed fewer domestic responsibilities, reported higher personal and household incomes, and were more likely to be in a group practice than other female physicians. Female obstetrician-gynecologists' personal health behaviors and other personal characteristics, career satisfaction, and desire to remain in their specialty were similar to those of other female physicians. Obstetrician-gynecologists did more counseling and screening than primary care physicians (family and general practitioners and internists) with respect to breast cancer and hormone replacement therapy (HRT). Obstetrician-gynecologists performed equivalently to primary care physicians with respect to human immunodeficiency virus (HIV), colorectal cancer, blood pressure, weight, exercise, and smoking, performed like other specialists with respect to cholesterol, skin cancer, and flu vaccine, and between these two groups with respect to nutrition and alcohol. Obstetrician-gynecologists' perceived relevance of, training in, and confidence regarding counseling were higher for HRT and breast cancer compared with other physicians. CONCLUSION: Obstetrician-gynecologists have many similarities with other female physicians, including level of career satisfaction, but earned more and assumed fewer domestic responsibilities. Although obstetrician-gynecologists counseled more than other specialists, with the increasing role of obstetrician-gynecologists as primary care doctors, it is noteworthy that female obstetrician-gynecologists frequently provide gynecologic-specific preventive care, but are less likely to address other non-obstetric-gynecologic areas of prevention. This finding could be transformed by continued changes in the education of residents and practicing physicians.

Female↗
PubMed1999

Standardization of Alternaria alternata: extraction and quantification of alt a 1 by using an mAb-based 2-site binding assay.

BACKGROUND: Alternaria alternata is recognized as an important cause of allergic disease. As with other molds, the extracts of A alternata used for diagnosis and therapy are highly heterogeneous, and there is a need for improved standardization. The major allergen Alt a 1 is well characterized and has been produced as a recombinant protein, but very few data are available on the Alt a 1 content in extracts. OBJECTIVE: An assay for the quantification of Alt a 1 was developed and used for monitoring batch-to-batch consistency of A alternata extracts, and the correlation between skin prick test responses and Alt a 1 concentrations was studied. METHODS: A 2-site binding assay based on an Alt a 1-specific mAb was developed and used for the quantification of Alt a 1 in allergen extracts. Quantitative skin prick tests were performed on 16 A alternata-sensitive patients and correlated with the Alt a 1 concentration. RESULTS: The Alt a 1-specific mAb was found to be suitable for affinity purification, as well as for a 2-site binding quantification assay. In allergen extracts the Alt a 1 content was estimated as 2% to 4.7% of total protein. Quantitative skin prick tests showed an Alt a 1 concentration-dependent response. CONCLUSION: Quantification of Alt a 1 in A alternata extracts reflects their batch-to-batch consistency. Skin prick test responses to a standardized A alternata extract correlate with the Alt a 1 contents. An extract containing 3.7 microgram/mL Alt a 1 caused a response equal to that of a 1% histamine dihydrochloride solution.

Allergens↗
PubMed1999

The bipolar spectrum: a clinical reality in search of diagnostic criteria and an assessment methodology.

Failure to recognize subthreshold expressions of mania contributes to the frequent under-diagnosis of bipolar disorder. There are several reasons for the lower rate of recognition of subthreshold manic symptoms, when compared to the analogous pure depressive ones. These include the lack of subjective suffering, enhanced productivity, ego-syntonicity, and diurnal and seasonal rhythmicity associated with many of the manic and hypomanic symptoms, and the psychiatrists' tendency to subsume persistent or even alternating symptoms among personality disorders. Furthermore, the central diagnostic importance placed on alterations in mood distracts clinicians from paying attention to other more subtle but clinically meaningful symptoms, such as changes in energy, neurovegetative symptoms and distorted cognitions. Although officially accepted in both ICD-10 and DSM-IV, we believe bipolar II disorder is underdiagnosed because of inattention to symptoms of hypomania. Moreover, by requiring the presence of both full-blown hypomanic and major depressive episodes, current nosology fails to include symptoms or signs which are mild and do not meet threshold criteria. There is already agreement in the field that such symptoms are important for depression. We now propose that attention should also be devoted to mild symptomatic manifestations of a manic diathesis, even if such manifestations may sometimes enhance quality of life. The term 'spectrum' is used to refer to the broad range of such manifestations of a disorder from core symptoms to temperamental traits. Spectrum manifestations may be present during, between, or even in the absence of, an episode of full-blown disorder. We have developed a structured clinical interview to assess the mood spectrum (SCI-MOODS) to evaluate the whole range of depressive and manic symptoms. This instrument is currently undergoing psychometric testing procedures. Similar to the SCID interview, the SCI-MOODS interview provides a separate rating for each of the major DSM-IV symptoms, but the latter also identifies and rates subthreshold and atypical manifestations. This paper presents the concept of a subthreshold bipolar disorder and discusses the potential epidemiological, diagnostic and therapeutic relevance of such a spectrum conditions. We also describe the SCI-MOODS interview used reliably to identify the occurrence of a bipolar spectrum condition. Obviously a great deal of systematic research needs to be conducted to ascertain the reliability and validity of subthreshold bipolarity as summarized in this paper and embodied in our instrument.

Bipolar Disorder↗
PubMed1999

Adjunctive antipsychotic use in bipolar patients: an open 6-month prospective study following an acute episode.

BACKGROUND: We examined the use of adjunctive antipsychotics in the treatment of bipolar patients. METHODS: A total of 88 bipolar type I patients (DSM-IV diagnosis) were included. The patterns of adjunctive antipsychotic use in the first 6 months after an index episode were examined. RESULTS: A total of 34 patients (39%) received at least one antipsychotic during the follow-up period. At time 0, 23 subjects (26%) were on antipsychotics; at 3 months, 10 subjects (11%); and at the end of the 6 month period, 11 subjects (12%). Prolonged use of antipsychotics (more than 15 weeks) was found in eight patients (9%). No significant differences were found in demographic characteristics or baseline clinical variables between the patients who received or did not receive antipsychotics, except that the use of adjunct antipsychotics in the 6-month period was significantly more common after an index manic than depressive episode (68 versus 17%, respectively, P = 0.001; Fisher's exact test). LIMITATIONS: This report presents a secondary analysis of follow-up data from a prospective study, and therefore the hypotheses here examined were not originally part of the primary hypotheses that led to the design of the study. A larger sample size could eventually reveal small differences among the patient sub-groups not presently found. CONCLUSIONS: The use of adjunctive antipsychotics among bipolar patients was less extensive than previously reported, and mostly related to an index manic episode. Our findings suggest that in samples of carefully diagnosed bipolar type I patients the group that may need continued antipsychotic treatment is relatively small.

Acute Disease↗
PubMed1999

Political self-characterization of US women physicians.

The political self-characterization of US physicians, especially including women physicians, has been poorly described. We used data from the 4,501 respondents to the Women Physicians' Health Study (WPHS), a stratified random sample of US women M.D.s surveyed in 1993-1994, to assess US women physicians' political characteristics. US women physicians were most likely to consider themselves politically moderate (36.6% of respondents). More considered themselves liberal (28.4%) or very liberal (8.8%) than considered themselves conservative (20.5%) or very conservative (5.8%). US women physicians predominantly bring moderate and liberal voices to political discourse. Organizations that wish to attract US women physician members should consider promoting less conservative policies.

Adult↗