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Biomedical subjects

H Joffe

Publications and source records attributed to H Joffe.

15 recordsLinked to original sources
PubMed2001

Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women: a double-blind, randomized, placebo-controlled trial.

BACKGROUND: Results of previous studies suggest that estrogen improves somatic and mild depressive symptoms experienced by perimenopausal women. This study investigated the efficacy of 17beta-estradiol for the treatment of clinically significant depressive disorders in endocrinologically confirmed perimenopausal women. METHODS: Perimenopausal women (aged 40-55 years, with irregular menstrual periods and serum concentrations of follicle-stimulating hormone >25 IU/L), meeting criteria for major depressive disorder, dysthymic disorder, or minor depressive disorder, according to DSM-IV, were randomized to receive transdermal patches of 17beta-estradiol (100 microgram) or placebo in a 12-week, double-blind, placebo-controlled study. A 4-week washout period followed the 12-week treatment phase. Outcome measures were the Montgomery-Asberg Depression Rating Scale and Blatt-Kupperman Menopausal Index scores. RESULTS: Fifty women were enrolled in the study; 26 met DSM-IV criteria for major depressive disorder, 11 for dysthymic disorder, and 13 for minor depressive disorder. Remission of depression was observed in 17 (68%) women treated with 17beta-estradiol compared with 5 (20%) in the placebo group (P =.001). Subjects responded similarly to estradiol treatment, regardless of DSM-IV diagnosis. Patients treated with estradiol sustained antidepressant benefit of treatment after the 4-week washout period, although somatic complaints increased in frequency and intensity. Treatment was well tolerated and adverse events were rare in both groups. CONCLUSION: Transdermal estradiol replacement is an effective treatment of depression for perimenopausal women.

Administration, Cutaneous↗
PubMed2001

An open trial of mirtazapine in menopausal women with depression unresponsive to estrogen replacement therapy.

Treatment of major depression in menopausal women is controversial. Estrogen replacement therapy (ERT) treats mild depression but may not treat more severe depression in this population. Antidepressants are recommended as treatment for major depression in menopausal women, but the specific efficacy of antidepressants has not been examined in menopause-associated depression. Twenty-two perimenopausal and postmenopausal women aged 40-61 taking stable doses of ERT who met Structured Clinical Interview for DSM-IV (SCID-IV) criteria for major depression were accessioned into an open-label clinical trial of mirtazapine. Subjects were treated with 30-45 mg/day mirtazapine for 8 weeks and were assessed every 2 weeks with the Hamilton Depression Rating Scale-17 (HDRS-17), Beck Depression Inventory (BDI), and Clinical Global Impression (CGI) Scale. Remission of depression was defined as an HDRS-17 score < or =7 at the week 8 study visit. Sixteen (73%) of the enrolled subjects completed the 8-week study. The median HDRS-17 score declined from 20.5 (range 12-37) at baseline to 2 (range 0-9) at week 8 (Wilcoxon signed-rank test, p < 0.001). Remission of depression was achieved by 14 of 16 (87.5%) study completers. Subjects responded well to mirtazapine regardless of whether their depression preceded ERT use or developed after ERT was initiated. Therapeutic response also appeared independent of menopausal status (perimenopausal vs. postmenopausal), ERT preparation, and concomitant use of medroxyprogesterone. Mirtazapine is an effective treatment for major depression in perimenopausal and postmenopausal women whose depression precedes ERT use and does not respond to ERT or whose depression develops after ERT is initiated.

Adult↗
PubMed2000

Adherence to health messages: a social psychological perspective.

Non-adherence to regimes recommended by health practitioners is prevalent in the health and safety area. Even the most effective of interventions does not tend to lead to substantial improvements in adherence. This paper reviews models from the health psychology sphere that predict which factors might lead people to practice health-enhancing behaviours. In terms of health messages, the paper evaluates the methods of persuasion found to be most successful. It provides an analysis of a successful intervention, in which a target audience was motivated to adopt a health-enhancing choice. The paper concludes by examining the principles that can be drawn from successful interventions, in terms of changing a target audience's health behaviours. The focus is on those that can be applied to situations in which a health practitioner hopes to convince the patient to adhere to a preventive regime.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Estrogen, serotonin, and mood disturbance: where is the therapeutic bridge?

A growing body of literature describes the effects of estrogen and other gonadal steroids on the central nervous system. The ability of estrogen to modulate serotonergic function, in particular, raises the possibility that sex steroids may play a role in the mechanisms associated with depression and its treatment. This review will focus on those aspects of the estrogen-serotonin interaction that relate to possible increased vulnerability to affective disorders and on hormonal treatments that may be clinically applicable to women. After a discussion of the potential relationship between estrogen and mood disorders across the female life cycle, a model is proposed in which differential sensitivity to mood disorders explains the differential response by some women to periods of normal hormonal changes. Possible serotonin receptor-mediated and intracellular mechanisms by which estrogen may exert its effects on mood are also reviewed. These are compared to putative mechanisms of standard antidepressant effect. Lastly, treatment studies in which estrogen has been used as 1) monotherapy for depression, 2) an augmentation strategy, or 3) a prophylactic intervention against recurrence of depression are reviewed.

Antidepressive Agents↗
PubMed1998

Tuberous sclerosis complex and Wolff-Parkinson-White syndrome.

This report highlights the association between tuberous sclerosis and Wolff-Parkinson-White syndrome. Ten patients with concurrent diagnoses of Wolff-Parkinson-White syndrome and tuberous sclerosis were identified. Wolff-Parkinson-White syndrome presented early in life, nine cases being diagnosed in the first year. Eight of the 10 cases were male. In eight cases, the syndrome was associated with supraventricular tachycardias, and in nine with cardiac rhabdomyomata. One child died from cardiac failure secondary to obstruction of the left ventricular outflow tract by a rhabdomyoma. Five of nine survivors showed resolution of Wolff-Parkinson-White syndrome on follow up. The accessory pathway was localised in nine patients from surface electrocardiograms: six children had left sided pathways and three had right sided pathways.

Electrocardiography↗
PubMed1997

Juxtaposing positivist and non-positivist approaches to social scientific AIDS research: reply to Fife-Schaw's commentary.

Many academics argue that the AIDS-related debates are hackneyed, that the area has been oversubscribed and that most AIDS research merely reinvents the wheel. I disagree. The energy which continues to be dedicated to the area is invaluable not only in terms of the theoretical and preventive terrain which is still to be covered, but with regard to the future transfer of knowledge to other areas of health risk research. Fife-Shaw's commentary contributes to the vitality of the debate.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Enterocyte functional adaptation following intestinal resection.

Following massive small bowel resection, the remaining intestine undergoes compensatory adaptation to maintain absorptive capacity. The purpose of this study was to determine the relative importance of mucosal hyperplasia and functional adaptation by individual enterocytes in this process. Distal ileum was harvested from rats 2 weeks following 70% small bowel resection or transection with reanastomosis. Transport parameters were determined in Ussing chambers. Short-circuit current (Isc) responses to additions of 3-0-methylglucose were measured to assess Na+/glucose cotransporter kinetics. Microvillus absorptive surface areas were calculated with computer-assisted morphometric modeling. These surface area values were used to normalize transport parameters. Ileal absorptive surface area was 70% greater in resection tissues than in transection tissues (P < 0.05). Na+ and Cl- fluxes were generally lower in the resection group. Na+/glucose cotransporter delta Isc max (an index of cotransporter quantity) for resection and transection tissues were 0.3 +/- 0.1 and 1.8 +/- 0.3, respectively (P < 0.05). Km (an index of cotransporter affinity for substrate) did not differ significantly. Following intestinal resection, ileal surface area increases; however, transport parameters, when normalized to absorptive surface area values, diminish. During early postresection adaptation, expansion of ileal absorptive surface area due to hyperplasia seems to play a greater role than upregulation of enterocyte Na+, Cl- , and glucose absorption.

Adaptation, Physiological↗
PubMed1996

Dentistry on the couch.

This article outlines some of the occupational stresses in dental practice. In a profession which combines skillful precision with aesthetics many dentists are vulnerable to stress-yet most practitioners minimize or deny the suggestion that they face "burn-out'. Regular seminars on pressures pertaining to dental practice would provide support to practitioners (at risk).

Burnout, Professional↗
PubMed1996

AIDS research and prevention: a social representational approach.

The KABP paradigm (knowledge-attitude-belief-practice) dominates social scientific AIDS research and prevention programmes. This paper questions a number of the assumptions of the paradigm both theoretically and empirically. Having discussed a number of the paradigm's shortcomings, an alternative, a social representational approach, is proposed. The choice of an alternative approach is guided by theoretical concerns but its efficacy is demonstrated by way of a cross-cultural analysis of data. By way of contrast to the KABP paradigm, the methodology of the social representational approach calls for the sampling of the social representations held by individuals in parallel with those which circulate in their social environment. In addition, the alternative approach highlights the importance of identity and of emotional factors in AIDS-related thought and action. The shift in theory and methodology which is proposed provides an altered focus for efforts to control the spread of HIV.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Late ventricular arrhythmia is rare after early repair of tetralogy of Fallot.

OBJECTIVES: This study was conducted to describe the incidence of ventricular arrhythmia during prospective long-term follow-up in a group of patients who had repair of tetralogy of Fallot during early childhood. BACKGROUND: Ventricular arrhythmia has been a common finding in patients who have undergone repair of tetralogy of Fallot in late childhood or as adults. Whether earlier repair lowers the incidence of late ventricular arrhythmia or late sudden death is unknown. METHODS: Twenty-nine asymptomatic patients who underwent repair at age 1.2 to 7.7 years (mean [+/- SD] age 4 +/- 1.4 years) between 1979 and 1984 were studied. Twenty-one patients had simple repair (Group A), and eight had complex or multiple operations (Group B). All had ambulatory electrocardiographic monitoring preoperatively, postoperatively, at early follow-up (after 4.2 +/- 1.3 years) and again at late follow-up (after 11.8 +/- 1.3 years). At late follow-up, 28 subjects also underwent echocardiography, and 26 had an exercise test. RESULTS: No patient had significant ventricular arrhythmia (> or = modified Lown grade 2) before or immediately after repair. There was no significant increase in the incidence of arrhythmia at early and late follow-up (14% to 28%), but at each of these periods the incidence of ventricular arrhythmia was higher in Group B patients (3 [43%] of 7 vs. 1 [5%] of 22 with early repair, p = 0.03; 6 [75%] of 8 vs. 2 [10%] of 21 with late repair, p = 0.001). No patient had symptoms of arrhythmia, and there were no sudden deaths. Late ventricular arrhythmia did not correlate with estimated right ventricular systolic pressure, outflow tract gradient or degree of pulmonary incompetence or right ventricular dilation. On exercise, 5 (19%) of 26 patients had ventricular premature complexes at low levels of exercise that were suppressed at maximal exercise in all patients. CONCLUSIONS: Late ventricular arrhythmia is rare in patients with successful early correction of tetralogy of Fallot, unless complex or multiple operations are performed.

Adolescent↗
PubMed1989

Emotional factors in pregnancy.

Most writings on pregnancy detail the physical changes a woman undergoes during this period. This review shifts the focus to look specifically at emotional factors involving both the mother and father. Many general practitioners, obstetricians and paediatricians are unaware of and therefore insensitive to the development crisis ushered in by the state of pregnancy and so cannot offer emotional support to the couple at a time when they may require assistance.

Emotions↗
PubMed1982

The admission of the elderly to places of care: a socio-psychiatric community survey.

Elderly persons over the age of 60 who were admitted for psychiatric care were compared with a random sample of persons living in the same community in respect of psychiatric, medical and socio-economic variables. The group admitted to hospital for psychiatric reasons was very similar to the latter in general characteristics. However, those people admitted to old age homes, which are the other major resource of psychiatric illness, constitute a distinctly separate population, being older and having considerably more physical illnesses and socio-economic problems. Factors predicting admission to an old age home were largely irremediable age-related conditions (dementia, physical infirmity, etc.), but there were also adverse social circumstances, including marked isolation and a lack of social and emotional support. A comparative analysis of the many psychiatric, social and medical factors is presented, with particular reference to reasons for referral and prevention of admission.

Aged↗
PubMed1981

Reasons for referral of the elderly for psychiatric hospitalization.

The reasons for referral of elderly persons to a psychiatric hospital in Cape Town were investigated in respect of behavioural difficulties, impairment of function, psychiatric diagnosis and the attitudes and understanding of relatives and caring agents. Confused behaviour was the most common reason for admission, followed by depression, and anxiety symptoms were frequent. An impaired ability to manage their daily lives was a factor in 90% of cases. In general, referrals were appropriate and families showed a considerable ability to put up with disturbed behaviour. However, manifestations of anxiety and depression often went unrecognized and skill in handling difficult behaviour in old-age homes was often lacking. It was considered that a better level of general medical care would have obviated the need for admission in several cases. Response to a short period of hospitalization reduced the degree of impairment very considerably, even in patients with organic brain damage.

Aged↗