Search PubMed⌕ Search

Biomedical subjects

E Frank

Publications and source records attributed to E Frank.

At least 127 records · Page 7Linked to original sources
PubMed1999

Religious characteristics of US women physicians.

Physicians' religious attributes are unknown, and may affect patient care. The Women Physicians' Health Study (WPHS) is a random sample (n = 4501 respondents, 59% response rate) of US women physicians aged 30-70; the first large, national study of US women physicians. In this study US women physicians were less likely to be Christian than were other Americans (61.2% of women physicians versus 85.1% of the general population), but were more likely to be Jewish (13.2% vs 2.0%), Buddhist (1.4% vs 0.3%), Hindu (3.9% vs 0.4%), or atheist/agnostic (5.9% vs 0.6%). Protestantism (29.3% of the population) and Catholicism (24.9%) were the most commonly reported religious identities. The strongest religious identity was claimed by Mormons and Seventh Day Adventists. Thus, women physicians' religious beliefs differ from those of the general population in the US. This may be particularly important for physicians practicing with patient populations with different religious affiliations, and in addressing clinical questions with ethical or religious dimensions.

Adult↗
PubMed1999

Effects of prior fluoxetine treatment on EEG sleep in women with recurrent depression.

We examined whether fluoxetine treatment has persistent effects on electroencephalographic sleep after drug discontinuation in patients with recurrent major depression. Age-matched groups of 23 women were treated with interpersonal psychotherapy alone (IPT) or fluoxetine plus interpersonal psychotherapy (IPT + FLU). Sleep studies were conducted when patients were depressed, and again at remission, at least four weeks after fluoxetine discontinuation. The groups did not differ in depression ratings pre- to post-treatment. Significant group*time interaction effects were noted for REM sleep (p = .04) and slow wave sleep (p = .02). REM percentage and phasic REM activity increased in the IPT + FLU group but decreased in the IPT group. The effects of fluoxetine treatment on electroencephalographic sleep can be observed for at least four weeks after drug discontinuation and appear to represent both drug discontinuation and neuroadaptation effects.

Adult↗
PubMed1999

Development and specification of muscle sensory neurons.

Although the response properties and synaptic projections of muscle sensory neurons have been studied extensively, relatively little is known about how these sensory neurons develop their unique phenotypes during embryonic life. The explosion of new information on neurotrophins, however, has revealed that neurotrophin 3 (NT3) is critically involved in several aspects of this development, including the initial differentiation, survival, and perhaps even the terminal arborizations of muscle sensory neurons within the spinal cord. The ETS family of transcription factors, recently shown to be expressed in these sensory neurons, may help specify their choice of synaptic targets in the central nervous system.

Afferent Pathways↗
PubMed1999

Adjunctive psychotherapy for bipolar disorder: effects of changing treatment modality.

In a randomized, controlled trial, the authors studied an adjunctive, individual psychotherapy, interpersonal and social rhythm therapy (IPSRT) for bipolar disorder. After stabilizing participants with episode appropriate pharmacotherapy and either IPSRT or intensive clinical management (CM), participants were reassigned to IPSRT or CM in conjunction with pharmacotherapy for 2 years of preventative treatment. Early results (n = 82) suggest that altering participants' treatment assignment at entry to the preventative phase is related to risk of recurrence. Participants remaining in the same treatment for both acute and preventative phases had lower rates of recurrence (< 20% vs. > 40%) and levels of symptomatology over the subsequent 52 weeks than those reassigned to the alternate modality. This finding, consistent with the authors' philosophy that bipolar patients benefit from stable routines, suggests that disruptions in the psychosocial treatment plan contribute to worse outcomes.

Adult↗
PubMed1999

Student loan debt does not predict female physicians' choice of primary care specialty.

OBJECTIVE: There has never been a conclusive test of whether there is a relation between ultimately choosing to be a primary care physician and one's amount of student loan debt at medical school graduation. DESIGN/SETTING/PARTICIPANTS: To test this question, we examined data from the Women Physicians' Health Study, a large, nationally representative, questionnaire-based study of 4,501 U.S. women physicians. MEASUREMENTS AND MAIN RESULTS: We found that the youngest physicians were more than five times as likely as the oldest to have had some student loan debt and far more likely to have had high debt levels (p <.0001). However, younger women physicians were also more likely to choose a primary care specialty (p <.002). There was no relation between being a primary care physician and amount of indebtedness (p =.77); this was true even when the results were adjusted for the physicians' decade of graduation and ethnicity (p =.79). CONCLUSIONS: Although there may be other reasons for reducing student loan debt, at least among U.S. women physicians, encouraging primary care as a specialty choice may not be a reason for doing so.

Adult↗
PubMed1999

Is premenstrual dysphoric disorder a distinct clinical entity?

Does the evidence now available support the concept of premenstrual dysphoric disorder (PMDD) as a distinct clinical disorder such that the relative safety and efficacy of potential treatment can be evaluated? In a roundtable discussion of this question, a wealth of information was reviewed by a panel of experts. The key characteristics of PMDD, with clear onset and offset of symptoms closely linked to the menstrual cycle and the prominence of symptoms of anger, irritability, and internal tension, were contrasted with those of known mood and anxiety disorders. PMDD displays a distinct clinical picture that, in the absence of treatment, is remarkably stable from cycle to cycle and over time. Effective treatment of PMDD can be accomplished with serotinergic agents. At least 60% of patients respond to selective serotonin reuptake inhibitors (SSRIs). In comparison with other disorders, PMDD symptoms respond to low doses of SSRIs and to intermittent dosing. Normal functioning of the hypothalamic-pituitary-adrenal (HPA) axis, biologic characteristics generally related to the serotonin system, and a genetic component unrelated to major depression are further features of PMDD that separate it from other affective (mood) disorders. Based on this evidence, the consensus of the group was that PMDD is a distinct clinical entity. Potential treatments for this disorder can now be evaluated on this basis to meet the clear need for effective therapy.

Comorbidity↗
PubMed1999

Domestic violence and sexual abuse in women physicians: associated medical, psychiatric, and professional difficulties.

Physicians have been called on to identify victims of domestic violence (DV) and sexual abuse (SA). Few data exist, however, on the prevalence of DV and SA in physicians themselves or on the personal or professional sequelae of such experiences. We determined the reported lifetime prevalence of DV and SA among women physicians and the personal characteristics, health-related factors, and work-related factors associated with these forms of abuse. We used data from the Women Physicians' Health Study, a large (n = 4501 respondents), nationally distributed questionnaire study that included questions on DV and SA histories, personal characteristics, and psychiatric, medical, and work-related histories. We compared the characteristics of women physicians with and without histories of DV or SA. The logistic models indicate that women physicians reporting DV histories (3.7% of the population) were significantly (p < 0.05) less likely to be single and significantly more likely to report depression histories, suicide attempts, substance abuse, current or past cigarette smoking, severe daily stress at home, chronic fatigue syndrome, and DV experienced by their mothers. Women physicians reporting SA histories (4.7% of the population) were significantly more likely to be younger than 60 years, identify themselves as homosexual or bisexual, to have specialized in psychiatry, obstetrics and gynecology, or emergency medicine, and to report histories of depression, suicide attempts, eating disorders, and fair or poor perceived health status. Although the reported lifetime prevalence of DV and SA among women physicians is below other reported figures, such experiences are associated with medical and psychiatric difficulties that could negatively affect them personally and professionally.

Adult↗
PubMed1999

Academic versus non-academic women physicians: data from the Women Physicians' Health Study.

PURPOSE: To help encourage women physicians to enter academe, the authors gathered information about how academic and non-academic women physicians (AWPs and NAWPs) differed demographically, personally, and professionally. METHOD: The authors examined data from the Women Physicians' Health Study, a nationally representative questionnaire-based study conducted in 1993-1994. RESULTS: The 453 AWPs were more likely to be U.S.-born, white, and self-defined as liberal than were the 3,986 NAWPs. The AWPs were more likely to be board-certified and to work in urban areas, reported fewer clinical and more non-clinical hours, earned less, and performed more continuing medical education. The AWPs reported less work control and were more likely to report working too much, but were also less likely, if they could relive their lives, to want to change specialty. AWPs and NAWPs had similar career satisfaction, work stress, and personal health habits. CONCLUSION: AWPs who come from a somewhat narrow demographic group, may not provide the variety of role models necessary for encouraging ethnic diversity in medical schools. Despite somewhat greater reported work hardships, AWPs are a very professionally satisfied and motivated group.

Academic Medical Centers↗
PubMed1999

Prevalences and correlates of ethnic harassment in the U.S. Women Physicians' Health Study.

PURPOSE: To describe lifetime prevalences and correlates of ethnic harassment in U.S. women physicians. METHOD: The authors analyzed responses to questions about ethnic harassment that appeared in the Women Physicians' Health Study, a 1993-94, nationally distributed survey of 4,501 female physicians. RESULTS: Of the responding physicians, 62% of blacks reported having experienced ethnic harassment, twice the rate of Asians and "others," three times that of Hispanics, and ten times that of whites. Twenty-five percent of black physicians reported experiencing harassment in at least three phases of their careers (before medical school, during medical school, during training, in practice), compared with 6% of "others," 2% of Hispanics and Asians, and less than 0.5% of whites. U.S.-born and foreign-born doctors reported similar rates of harassment before and during medical school, while foreign-born doctors reported significantly more harassment during training and practice. Reports of harassment during medical school were higher for blacks under 50 than for those over 50 (38% vs 10%, p = .0101). In white physicians, harassment was significantly associated with religion. For certain ethnic groups, control of work environment, dissatisfaction with profession, and stress at work and home were associated with reported harassment. CONCLUSIONS: The prevalences of ethnic harassment at various stages of medical training and practice are high, and not decreasing. This has serious potential ramifications for the medical profession's goal of a diverse physician workforce.

Adult↗
PubMed1999

Firearm ownership among female physicians in the United States.

BACKGROUND: Physicians have been called upon to counsel patients about firearm safety, but the personal prevalence of firearm ownership among physicians is poorly established. METHODS: We examined responses to the question "Do you keep a gun/firearm in your home?" from the Women Physicians' Health Study, a nationally representative survey of US female physicians (n = 4,501). RESULTS: Among female physicians, 16.5% reported having a firearm in their homes. Those who were older, married, practicing in a rural region, and residing in the South Central or Mountain states were more likely to report having a firearm in the home. Emergency medicine specialists, Protestants, physicians reporting a history of depression, and those on call more than six times per month were also more likely to report keeping a firearm in their home. Female physicians residing on the East Coast, Hindus, and Jews were least likely to report keeping a firearm in the home. CONCLUSIONS: In the United States, the proportion of female physicians who report having a firearm in the home was about half that reported by other women and one third that reported by men. This observation may have important implications for encouraging female physicians to counsel their patients about firearm ownership and storage.

Adult↗
PubMed1999

The art of clinical management in pharmacologic trials with depressed elderly patients: lessons from the Pittsburgh Study of Maintenance Therapies in Late-Life Depression.

The authors outline the clinical management methods used in a long-term study of depressed elderly patients and comment on the positive aspects of such interventions on the successful recruitment and retention of subjects. Psychosocial or clinical management (CM) is the "glue" that holds a successful drug trial together. CM is recognized to be an essential element for success in drug trials for geriatric depression. The authors also discuss potentially negative aspects of comprehensive CM, such as those obscuring a psychotherapeutic effect in comparative studies.

Aged↗
PubMed1999

Natural history and preventative treatment of recurrent mood disorders.

This chapter focuses on recent developments in our understanding of the etiology, epidemiology, and treatment of recurrent mood disorders. It addresses the changing relationship between endogenous and exogenous factors over time in the etiology of mood episodes. In the area of epidemiology, the chapter presents new information on the prevalence of various subtypes and male/female differences in lifetime risk. Complications of the mood disorders, such as suicide, and important comorbidities, including alcoholism and substance abuse, are discussed. In the area of treatment, the life-long nature of many of the mood disorders is described, as is the consequent role of the primary care physician in their management. The evidence for the efficacy of the depression-specific psychotherapies, cognitive therapy and interpersonal therapy, is reviewed. Current issues in the pharmacotherapy of mood disorders are discussed, including the relative efficacy of the older antidepressants versus the newer selective serotonin reuptake inhibitors (SSRIs) and the treatment of various subtypes of mood disorders, including dysthymia, chronic depression, and atypical depression. Finally, the chapter describes recent advances in the treatment of bipolar disorder.

Alcoholism↗
PubMed1999

Self-reported depression and suicide attempts among U.S. women physicians.

OBJECTIVE: Studies examining suicide rates for U.S. women physicians and other U.S. women have found odds ratios as high as 4 to 1. Although such reports are controversial and are based on small groups (N = 17 to 49 suicides), they are often cited as evidence of a high prevalence of psychopathology among women physicians. METHOD: The authors used the results of the Women Physicians' Health Study (N = 4,501), a large, nationally distributed questionnaire, to assess the lifetime prevalence of self-identified depression and suicide attempts among U.S. women physicians. RESULTS: An estimated 1.5% (N = 61) of U.S. women physicians have attempted suicide, and 19.5% (N = 808) have a history of depression. Those who were born in the United States, were not Asian, had histories of cigarette smoking, alcohol abuse or dependence, sexual abuse, domestic violence, poor current mental health, more severe harassment, or a family history of psychiatric disorders were significantly more likely to report suicide attempts or depression. Depression was more common among those who were not partnered, were childless, had a household gun, had more stress at home, drank alcohol, had worse health, or had a history of obesity, chronic fatigue syndrome, substance abuse, an eating disorder, or another psychiatric disorder and among those who reported working too much, career dissatisfaction, less control at work, and high job stress. Strata reporting higher rates of depression tended to show higher (although usually nonsignificant) rates of suicide attempts. CONCLUSIONS: Depression is approximately as common among U.S. women physicians as among other U.S. women, but suicide attempts may be fewer. A number of conditions may help identify women physicians at high risk for suicide attempts and depression.

Adult↗
PubMed1999

Treatment of bereavement-related major depressive episodes in later life: a controlled study of acute and continuation treatment with nortriptyline and interpersonal psychotherapy.

OBJECTIVE: The authors tested the hypothesis that nortriptyline and interpersonal psychotherapy, alone and in combination, are superior to placebo in achieving remission of bereavement-related major depressive episodes. METHOD: Eighty subjects, aged 50 years and older, with major depressive episodes that began within 6 months before or 12 months after the loss of a spouse or significant other were randomly assigned to a 16-week doubleblind trial of one of four treatment conditions: nortriptyline plus interpersonal psychotherapy (N = 16), nortriptyline alone in a medication clinic (N = 25), placebo plus interpersonal psychotherapy (N = 17), or placebo alone in a medication clinic (N = 22). The protocol required that the acute-phase double-blind treatment be ended after 8 weeks if Hamilton depression scale ratings had not improved by 50%. Remission was defined as a 17-item Hamilton scale score of 7 or lower for 3 consecutive weeks. RESULTS: The rate of remission for nortriptyline plus interpersonal psychotherapy was 69% (N = 11); for medication clinic, nortriptyline, 56% (N = 14); for placebo plus interpersonal psychotherapy, 29% (N = 5); and for medication clinic, placebo, 45% (N = 10). In a generalized logit model, there was a significant effect of nortriptyline over placebo but no interpersonal psychotherapy effect and no nortriptyline-by-interpersonal psychotherapy interaction. Rates of all-cause attrition were lowest in the nortriptyline plus interpersonal psychotherapy group. CONCLUSIONS: Nortriptyline was superior to placebo in achieving remission of bereavement-related major depressive episodes. The combination of medication and psychotherapy was associated with the highest rate of treatment completion. These results support the use of pharmacologic treatment of major depressive episodes in the wake of a serious life stressor such as bereavement.

Aged↗
PubMed1999

Three-year outcomes of maintenance nortriptyline treatment in late-life depression: a study of two fixed plasma levels.

OBJECTIVE: This study compared the long-term efficacy of two fixed plasma levels of nortriptyline in preventing or delaying recurrence of major depression in elderly patients and in minimizing residual depressive symptoms and somatic complaints. METHOD: The authors randomly assigned 41 elderly patients with histories of recurrent major depression to 3-year, double-blind maintenance pharmacotherapy using nortriptyline, with controlled plasma concentrations of 80-120 ng/ml versus 40-60 ng/ml. The authors compared times to, and rates of, recurrence of major depression. They also compared frequencies of side effects, noncompliance episodes, and subsyndromal symptomatic flare-ups. RESULTS: Major depressive episodes recurred for six (29%) of 21 subjects in the 80-120-ng/ml condition and eight (40%) of 20 subjects in the 40-60-ng/ml condition, a nonsignificant difference. Most recurrences took place in the first year of maintenance treatment. Hamilton depression scores in the subsyndromal range (higher than either 10 or 7) occurred significantly more often at 40-60 ng/ml, while constipation occurred significantly more often at 80-120 ng/ml. The proportions of patients reporting missed doses did not differ. CONCLUSIONS: Maintenance pharmacotherapy with nortriptyline at 80-120 ng/ml is associated with fewer residual depressive symptoms, that is, a less variable long-term response, than pharmacotherapy at 40-60 ng/ml, but constipation is more frequent and there is no difference in recurrence of syndromal major depressive episodes. Treatment at 80-120 ng/ml may be preferable, because of fewer residual symptoms and less variability of response, as long as side effect burden can be managed successfully.

Aged↗
PubMed1999

Competence of depressed patients for consent to research.

OBJECTIVE: The capacities of depressed patients to consent to research have been questioned by commentators who fear that the cognitive effects of a disorder may impair subjects' abilities to protect their interests. This study used a new instrument for assessing depressed patients' capacities to consent to research and examined their performance, including the relation between severity of depression and extent of impairment. METHOD: Twenty-six female outpatients with major depression (assessed with the Schedule of Affective Disorders and Schizophrenia-Lifetime Version) enrolled in a study of maintenance psychotherapy were recruited for this project. Consent-related abilities were measured with the MacArthur Competence Assessment Tool-Clinical Research (MacCAT-CR) 1 week after intake and again 8-10 weeks later. Depressive symptoms were measured by the Hamilton Depression Rating Scale. RESULTS: Almost all subjects performed quite well on the capacity measures and maintained that level of performance over time. There was no correlation between performance and degree of depressive symptoms and little relation to prior research experience. Some subjects appeared confused about the extent to which decisions about assignment to treatment groups would be made on the basis of their clinical condition rather than randomly. CONCLUSIONS: This outpatient group with major depression showed few impairments in their decision-making capacities related to research. As in other studies, some concerns were raised about subjects' appreciation that treatment assignments would not be individualized for their needs. Examination of hospitalized patients and those with psychotic depression would help to determine whether they show greater degrees of impairment. The MacCAT-CR was easily adapted for use with this depressed group.

Adult↗