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Biomedical subjects

I Grant

Publications and source records attributed to I Grant.

At least 55 records · Page 3Linked to original sources
PubMed2000

Incidence of and risk factors for hallucinations and delusions in patients with probable AD.

OBJECTIVE: To examine the incidence of and risk factors for hallucinations and delusions associated with patients clinically diagnosed with probable AD. BACKGROUND: Estimates of the incidence of psychosis in AD range widely from 10% to 75%. The risk factors for psychosis of AD are not known, although multiple studies indicate that AD patients with psychosis demonstrate greater cognitive and functional impairment. METHODS: The authors conducted psychiatric evaluations of 329 patients with probable AD from the University of California at San Diego Alzheimer's Disease Research Center to determine the incidence of hallucinations and delusions. They examined data from annual clinical and neuropsychological evaluations to determine whether there were specific risk factors for the development of hallucinations and delusions. RESULTS: Using Cox survival analyses, the cumulative incidence of hallucinations and delusions was 20.1% at 1 year, 36.1% at 2, 49.5% at 3, and 51.3% at 4 years. Parkinsonian gait, bradyphrenia, exaggerated general cognitive decline, and exaggerated semantic memory decline were significant predictors. Age, education, and gender were not significant predictors. CONCLUSIONS: The authors found a relatively high incidence of hallucinations and delusions in patients diagnosed with probable AD and suggest that specific neurologic signs, cognitive abilities, and accelerated decline may be predictive markers for their occurrence.

Alzheimer Disease↗
PubMed2000

Cerebrospinal fluid HIV RNA originates from both local CNS and systemic sources.

OBJECTIVE: To identify the sources of HIV virions in CSF by modeling treatment-associated HIV dynamics. BACKGROUND: We postulated a model in which cell-free CSF virions originate from two major sources, namely, systemic non-CNS and CNS tissues, the latter including brain parenchyma and meninges. The model predicted that with initiation of antiretroviral therapy, the acute-phase decline in CSF HIV RNA levels would be controlled by the kinetics of the dominant virion source (systemic versus CNS). Based on prior observations, we hypothesized that the dominant source of CSF virions would shift from systemic to CNS in more advanced disease. METHODS: Three patient groups were studied: Group 1 (n = 5): nondemented, with early HIV disease (CD4+ lymphocytes > or = 400/microL) or pleocytosis (CSF leukocytes > or = 4/microL); Group 2 (n = 5): nondemented, with advanced HIV disease (CD4+ < 400/microL) and no pleocytosis; Group 3 (n = 2): patients with HIV-associated dementia (HAD). All patients began a new, highly active antiretroviral treatment regimen and underwent serial lumbar punctures and phlebotomies. RESULTS: For patients in Group 2, the rate of decline in CSF HIV RNA was slower than in plasma (p < 0.00001). For Group 1, the rate of decline in CSF was not different from plasma (p > 0.25). Patients with HAD showed high CSF HIV RNA after 5 to 6 weeks of treatment despite a 100-fold decrease in plasma HIV RNA. CONCLUSIONS: CSF and plasma HIV dynamics became increasingly independent in advanced HIV disease, and the compartmental discrepancy was largest in HAD. Our findings suggest that viral replication in CNS tissues may constitute a major, independent source of CSF HIV RNA. In patients with HAD, brain parenchyma itself may be the principal CNS tissue source, and CNS-targeted treatment strategies may be required to eradicate this infection.

Anti-HIV Agents↗
PubMed2000

Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults.

BACKGROUND: Stress reaction in bone, which may proceed to a fracture, is a significant problem in military recruits and in athletes, particularly long distance runners. OBJECTIVES: To evaluate the evidence from controlled trials of treatments and programmes for prevention or management of lower limb stress fractures and stress reactions of bone in active young adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group Trials Register, The Cochrane Library, MEDLINE, EMBASE, Current Contents, Dissertation Abstracts, Index to UK Theses and the bibliographies of identified articles. Date of last search: December 1997 SELECTION CRITERIA: Any randomised or quasi-randomised trial evaluating a programme or treatment to prevent or treat lower limb stress reactions of bone or stress fractures in active young adults. DATA COLLECTION AND ANALYSIS: Searching, a decision on inclusion or exclusion, methodological assessment, and data extraction were carried out according to a predetermined protocol included in the body of the review. Analysis using Review Manager software allowed pooling of data and calculation of Peto odds ratios and absolute risk reductions, each with 95% confidence intervals. MAIN RESULTS: The use of "shock absorbing" insoles, evaluated in four trials, appears to reduce the incidence of stress fractures and stress reactions of bone (Peto odds ratio 0.47, 95% confidence interval 0. 30 to 0.76). Incomplete data from one trial indicated that reduction of running and jumping intensity may also be effective. The use of pneumatic braces in the rehabilitation of tibial stress fractures significantly reduces the time to recommencing training (weighted mean difference -42.6 days, 95% confidence interval -55.8 to -29.4 days). REVIEWER'S CONCLUSIONS: The use of shock absorbing insoles in footwear reduces the incidence of stress fractures in athletes and military personnel. Rehabilitation after tibial stress fracture is aided by the use of pneumatic bracing.

Adult↗
PubMed2000

Alcoholics' initial organizational and problem-solving skills predict learning and memory performance on the Rey-Osterrieth Complex Figure.

This study was undertaken to investigate whether alcoholics differ qualitatively from controls in their organizational approach to the Rey-Osterrieth Complex Figure (ROCF) and to examine the effects of problem-solving and organizational ability on learning and retention. Data were collected on 3 groups of neuromedically healthy, middle-aged men: 29 recently detoxified alcoholics (RDA) abstinent at least 2 weeks, 29 long-term abstinent alcoholics (LTA) abstinent at least 18 months, and 29 nonalcoholic controls (NAC). Groups were comparable in age, education, WAIS-R Vocabulary score, and ANART IQ. Three indices of problem-solving approach were used to score how participants produce the ROCF during the copy condition: perceptual clustering, organization, and constructional accuracy. Learning and retention were measured by immediate recall, 20-min delayed recall, and recognition performance. RDAs had significantly impaired immediate recall, delayed recall, and recognition scores compared to NACs. RDAs also had significantly lower perceptual clustering, organization, and constructional accuracy scores than their long-term abstinent and nonalcoholic counterparts. Multiple regression analyses revealed that problem-solving ability at copy accounted for a significant proportion of the variance in immediate recall, delayed recall, and recognition. Further investigation of memory performance using a repeated measures design revealed that across the 3 groups, little forgetting occurred between immediate and delayed recall, while performance improved significantly on the recognition trial. Use of less efficient problem-solving strategies appears to affect RDAs' ability to learn and retrieve complex figural information.

Adult↗
PubMed2000

Neurobehaviors and psychotic symptoms in Alzheimer's disease.

Psychotic symptoms are common in Alzheimer's disease (AD) and clinicoanatomical and neuropsychological evidence indicate an association between these symptoms and frontal lobe dysfunction. Neuro-behaviors associated with frontal dysfunction were assessed in Alzheimer's disease (AD) patients with (n = 20) and without psychotic symptoms (n = 21) matched for mean age, education, gender, and dementia severity. The Frontal Lobe Personality Scale (FLOPs) was completed by patient caregivers to measure behaviors typically associated with frontal dysfunction. Findings indicated that AD patients with psychotic symptoms exhibited significantly greater neurobehavioral dysfunction (FLOPs M = 130.69, SD = 24.70) than AD patients without psychotic symptoms (FLOPs M = 111.10, SD = 25.83). Subscale analyses indicated that psychotic AD patients were more dis-inhibited (M = 28.28, SD = 7.54) than patients without psychotic symptoms (M = 20.92, SD = 4.9). Findings are consistent with and contribute to previous neuropsychological and clinicoanatomical research suggesting increased frontal dysfunction in AD with psychotic symptoms and lend additional empirical support to subtyping AD based on the presence of psychotic symptoms. Furthermore, findings provide preliminary evidence indicating which specific type of neurobehavioral abnormalities are related to the presence of distressing psychotic symptoms.

Aged↗
PubMed2000

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Journal Article↗
PubMed2000

Injuries to the hand from dog bites.

A review of dog bite injuries referred to one surgeon over a 12 month period demonstrated a significant association between a delay in referral and a prolonged period of subsequent in-patient treatment. Two patients sustained injuries when delivering material through a letter-box.

Adolescent↗
PubMed2000

Six percent oxygen enrichment of room air at simulated 5,000 m altitude improves neuropsychological function.

Cognitive and motor function are known to deteriorate with the hypoxia accompanying high altitude, posing a substantial challenge to the efficient operation of high altitude industrial and scientific projects. To evaluate the effectiveness of enriching room air oxygen by 6% at 5,000 m altitude in ameliorating such deficits, 24 unacclimatized subjects (16 males, 8 females; mean age 37.8, range 20 to 47) underwent neuropsychological testing in a specially designed facility at 3,800 m that can simulate an ambient 5,000 m atmosphere and 6% enrichment at 5,000 m. Each subject was tested in both conditions in a randomized, double-blinded fashion. The 2-h test battery of 16 tasks assessed various aspects of motor and cognitive performance. Compared with simulated breathing air at 5,000 m, oxygen enrichment resulted in higher arterial oxygen saturations (93.0 vs. 81.6%), quicker reaction times, improved hand-eye coordination, and more positive sense of well-being (on 6 of 16 scales), each significant at the p < 0.05 level. Other aspects of neuropsychological function were not significantly improved by 6% additional oxygen.

Adult↗
PubMed2000

Use of community support services by middle-aged and older patients with psychotic disorders.

OBJECTIVE: The study sought to determine the degree to which use of community services is related to predisposing, enabling, and need factors among older patients with psychotic disorders who live in the community and to assess whether high use of community services is associated with improving or declining psychopathology. METHODS: The sample consisted of 89 middle-aged and elderly community-dwelling patients with schizophrenia or other psychotic disorders. Assessments at baseline and two follow-ups at six-month intervals included measures of psychopathology, well-being, and social adjustment, in addition to the frequency of use of 17 formal community services in three categories-psychological, social, and daily living services. RESULTS: Ninety-two percent of patients reported use of community support services. The mean number of annual service contacts per patient was 36.6 for psychological services, 81 for social services, and 39.7 for daily living services. High users of psychological services were younger and experienced more severe positive psychotic symptoms and depressive symptoms. High users of social services were of higher socioeconomic status, more likely to be female, and had a longer history of psychosis, more cognitive deficits, and more severe negative psychotic and depressive symptoms. Patients who used daily living services were older, had poorer functional health status and more cognitive deficits, and had more severe negative psychotic and depressive symptoms. A trend was noted for high users of social services to experience relief from depressive symptoms over time. CONCLUSIONS: Use of community services is common among older outpatients with psychotic disorders, but its frequency varies as a function of patient characteristics.

Aged↗
PubMed2000

Elevated myo-inositol in gray matter of recently detoxified but not long-term abstinent alcoholics: a preliminary MR spectroscopy study.

BACKGROUND: Individuals in short-term abstinence from chronic alcohol consumption commonly have neuropsychological impairments with parallel abnormalities in brain structure. Stable, long-term sobriety often results in improvements in both brain structure and function, although the mechanisms underlying these changes are currently not well understood. METHODS: To investigate further the neurobiological underpinnings of alcohol-associated brain abnormalities in short-term and long-term abstinence from alcohol, proton magnetic resonance spectroscopy (echo time, 35 msec; repetition time, 1.5 sec) was used to assay metabolites in the anterior centrum semiovale, anterior cingulate gyrus, and right thalamus of two groups of non-Korsakoff alcoholic men, at different stages of abstinence, compared with a control group of alcohol-nonabusing men. Absolute concentrations of N-acetylaspartate, choline, myo-inositol, and creatine were measured in four recently detoxified alcoholics (mean age, 48.7 years; median abstinence, 41.5 days), five long-term abstinent alcoholics (mean age, 45.1 years; median abstinence, 1.7 years), and five nonalcoholic controls (mean age, 45.0 years). RESULTS: Although there were no between-group differences in concentrations of N-acetylaspartate, choline, or creatine, recently detoxified alcoholics had significantly higher myo-inositol in the thalamus, compared with controls and long-term abstinent alcoholics, and significantly higher myo-inositol in the anterior cingulate gyrus, compared with the controls. CONCLUSIONS: Elevations in myo-inositol in recently detoxified alcoholics are compatible with an acute alcohol cytotoxicity model. myo-Inositol is elevated in hyperosmolar states such as hypernatremia, renal failure, and diabetes; alcohol-induced hyperosmolarity may trigger accumulation of myo-inositol to stabilize the intracellular environment. Increases in myo-inositol may also reflect proliferation or activation of glia. The reduction of myo-inositol to control group levels in long-term abstinent alcoholics may reflect osmolar stability in abstinent alcoholics and/or a reduction in glial cell activation.

Adult↗
PubMed2000

Partner type and sexual risk behavior among HIV positive gay and bisexual men: social cognitive correlates.

This study used elements of social cognitive theory to examine the relationship between partner type and sexual risk behavior in a sample of HIV positive gay and bisexual men. Self-efficacy captures one's perceived ability to perform a behavior; outcome expectancies are estimations that a behavior will result in a given outcome. An examination of sexual risk behavior revealed that men with steady partners and men with anonymous partners had the most unprotected anal intercourse (UAI), while men with casual partners had the least. Men with anonymous partners had the lowest scores on self-efficacy and outcome expectancies for condom use, negotiation, and disclosure. Outcome expectancies for negotiation of safer sex were inversely related to UAI for men with steady partners. Self-efficacy for condom use and negotiation were inversely related to UAI for men with casual partners. These findings suggest the need to consider partner type in the development of sexual risk reduction interventions.

Adult↗
PubMed2000

Psychosocial predictors of unprotected anal intercourse in a sample of HIV positive gay men who volunteer for a sexual risk reduction intervention.

This study used logistic regression analysis to identify psychosocial predictors of unprotected anal intercourse in a sample of 212 HIV positive gay men who were enrolled in a sexual risk reduction intervention. A combination of five psychosocial variables (i.e., age, avoidant coping, loneliness, depressive symptoms, and impulsivity) reliably discriminated between men who had engaged in unprotected anal intercourse (UAI) with HIV negative or serostatus unknown partners and those who had not engaged in this high risk behavior. Avoidant coping emerged as the best psychosocial predictor that distinguished between the two groups. Men who had UAI during the previous 4 months had significantly higher scores on avoidant coping as compared with the no-UAI group. These findings suggest the need to design intervention programs for HIV positive gay men that addresses coping strategies in the context of high-risk sexual behaviors.

Adaptation, Psychological↗
PubMed2000

The sexual negotiation behavior of HIV-positive gay and bisexual men.

This study describes the sexual negotiation practices of 256 HIV-positive gay and bisexual men enrolled in a sexual risk reduction intervention. Negotiation behavior was associated with sexual risk practices. Men who abstained from anal sex and those who had unprotected anal sex had the lowest negotiation scores. Negotiations occurred most often with steady partners and least often with anonymous partners. A logistic regression to predict high versus low frequency negotiators revealed the significance of self-efficacy for condom use and number of months HIV-positive. Findings are discussed in terms of the development of sexual risk reduction interventions for HIV-positive gay and bisexual men.

Adult↗
PubMed1999

Pattern of early visual field loss in HIV-infected patients.

OBJECTIVE: To determine the topographic pattern of visual field loss, if any, and its relationship to the stage of disease in human immunodeficiency virus-positive patients without infectious retinopathy. METHODS: A total of 151 eyes from 81 alert and cooperative patients with human immunodeficiency virus were evaluated with visual field testing. Results were analyzed relative to the associated underlying nerve fiber layer patterns associated with retinal ganglion cell axons as they traverse the retina to the optic nerve. The stage of visual field loss was analyzed relative to the length of survival using Kaplan-Meier survival analysis. RESULTS: No correlation of CD4 cell count with visual field mean defect (r2 = 0.23) or corrected pattern standard deviation (r2 = 0.00) was found. A pattern of visual field loss, consistent with sparing of the papillomacular bundles and associated with damage primarily to the inferior retina external to the posterior pole, was found. Survival analysis indicated a significant difference in time of survival between individuals with normal visual fields and those with a diffuse visual field loss, with a trend to less survival with increasing field loss severity. CONCLUSIONS: These results are consistent with disease at the level of the optic nerve. The relationship of stage of visual field loss to survival has important implications for early detection of field loss and appropriate therapeutic intervention to maintain function and quality of life.

Adult↗