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Biomedical subjects

I Grant

Publications and source records attributed to I Grant.

At least 91 records · Page 5Linked to original sources
PubMed1998

Progressive cerebral volume loss in human immunodeficiency virus infection: a longitudinal volumetric magnetic resonance imaging study. HIV Neurobehavioral Research Center Group.

OBJECTIVE: To compare rates and anatomical patterns of brain atrophy during 3 stages of human immunodeficiency virus (HIV) disease. DESIGN: Comparisons of multiple serial brain magnetic resonance images in men without HIV infection and HIV-infected men in Centers for Disease Control and Prevention (CDC, Atlanta, Ga) stages A, B, and C. SETTING: Longitudinal cohort study of the San Diego HIV Neurobehavioral Research Center, San Diego, Calif. PARTICIPANTS: Eighty-six HIV-1-positive (HIV-positive) and 23 HIV-negative men who were similar in age and risk group. The number of HIV-positive men in each CDC stage was as follows: A, 33; B, 19; C, 34. All HIV-positive men were free of clinically detectable opportunistic neurologic illness. MAIN OUTCOME MEASURES: Regional volumes of serial magnetic resonance images converted to standardized slope estimates of change in regional volumes of interest. RESULTS: Medically asymptomatic men (CDC stage A) and medically symptomatic men (CDC stage C) had more rapid loss of cortical tissues than did HIV-negative men as manifested by higher slopes (Tukey honestly significant difference test, P=.02 and P=.001, respectively) for cortical fluid volume. Accelerated ventricular volume enlargement occurred only in men with CDC stage C disease. Reduction in the volume of white matter was accelerated in participants with CDC stage C disease compared with participants with CDC stage A disease. Of the gray matter regions, only the caudate nucleus sustained accelerated volume loss during CDC stage C disease. Participants whose systemic disease progressed to a higher CDC stage had significantly accelerated ventricular volume increases and caudate atrophy. Rates of cortical and subcortical fluid volume increases and reductions in the volumes of white matter and the caudate nucleus were significantly related to the rate of decline in the CD4+ lymphocyte count. CONCLUSIONS: In the absence of cerebral opportunistic disease, HIV infection causes progressive atrophy within the gray and white matter in the brain. These changes were most severe in the most advanced stage of disease but were evident even in medically asymptomatic HIV-positive persons. Within the gray matter, the caudate nucleus exhibited progressive volume loss linked to disease stage and the rate of decline of the CD4+ cell count. Structural brain changes can begin in the early stages of HIV infection and accelerate during advanced illness.

Adult↗
PubMed1998

The contribution of job satisfaction to the transition from acute to chronic low back pain.

OBJECTIVE: To determine the extent to which job satisfaction predicts pain, psychological distress, and disability 6 months after an initial episode of low back pain (LBP). DESIGN: A longitudinal design was used to follow an inception cohort experiencing first-episode low back pain with assessment at 2 and 6 months after pain onset. SETTING: Urban medical center outpatient orthopedic clinic. PATIENTS: The consecutive sample was comprised of 82 men with initial-onset acute LBP (T6 or below, daily pain for 6 to 10 weeks). INTERVENTION: Usual orthopedic care. MAIN OUTCOME MEASURES: The primary study outcomes were pain (Descriptor Differential Scale, Visual Analog Scales); disability (Sickness Impact Profile, Quality of Well-Being); and psychological distress (Beck Depression Inventory, Hamilton Rating Scale for Depression, Automatic Thoughts Questionnaire); predictor variables were orthopedic impairment (Waddell Physical Impairment Index) and job satisfaction (Job Descriptive Index, Work APGAR). RESULTS: Measures of job satisfaction, pain, disability, and psychological distress at baseline and 6 months after pain onset were separately reduced into factors using principle components factor analysis. In hierarchical multiple regression analyses, baseline job satisfaction significantly predicted variance in outcome scores at 6 months after pain onset, beyond the variance explained by control factors (demographics; baseline pain, mood, and disability; orthopedic impairment). Zero-order correlations between job satisfaction and orthopedic impairment were small and nonsignificant, suggesting that these two variables act independently in predicting outcome. Although type of work performed (desk work or work requiring light, moderate, or heavy lifting) and social position were correlated with job satisfaction at baseline, neither contributed to the prediction of outcome at 6 months. CONCLUSIONS: Satisfaction with one's job may protect against development of chronic pain and disability after acute onset back pain and, alternatively, dissatisfaction may heighten risk of chronicity. Vocational factors should be considered in the rehabilitation of acute back injury.

Acute Disease↗
PubMed1998

Room oxygen enrichment improves sleep and subsequent day-time performance at high altitude.

We carried out a randomized, double-blind trial at 3800 m altitude to test whether a small degree of room oxygen enrichment at night improves sleep quality, and performance and well-being the following day. Eighteen sea-level residents drove from sea level to 3800 m in one day, and then slept one night in ambient air, and another night in 24% oxygen, the order being randomized. With oxygen enrichment the subjects had fewer apneas (P < 0.01) and spent less time in periodic breathing with apneas (P < 0.01) than when they slept in ambient air. Subjective assessments of sleep quality were also significantly improved. There was a lower acute mountain sickness score during the morning after oxygen-enriched sleep (P < 0.01) and a greater increase in arterial oxygen saturation from evening to morning (P < 0.05). The larger increases in arterial oxygen saturation from evening to morning suggest that the control of breathing may have been altered. Installing an oxygen-enriched room at high altitude is relatively simple and inexpensive, and shows promise for improving well-being of both commuters and residents.

Adult↗
PubMed1998

The cultural context of caregiving: a comparison of Alzheimer's caregivers in Shanghai, China and San Diego, California.

BACKGROUND: Systematic comparisons of the psychological and physical responses of caregivers of Alzheimer's disease (AD) patients in the US and China have not been previously reported. METHODS: Informal caregivers of community dwelling AD patients in Shanghai, China and demographically-matched non-caregiving Chinese controls were compared with a sample of American caregivers residing in San Diego, California and demographically-matched American controls. RESULTS: Despite some demographic discrepancies, caregivers from both China and the US were similar. Caregivers from both cultures reported more depressive symptoms and more physical symptoms when compared with non-caregivers. Both groups of caregivers reported that patients required similar amounts of care and help with activities of daily living (ADLs). However, Shanghai caregivers reported less access to emotional support when compared with the San Diego sample. A conceptual model, guided by the stress process model of Pearlin et al. (1990), was used to explore multivariate relationships between caregiver characteristics and the physical and psychological health of our sample of AD caregivers in Shanghai, China. Results from a path analytical procedure revealed that the relationships among these variables and health outcome did not differ significantly from those observed in the US sample. CONCLUSIONS: Although elderly family members are venerated in the stereotypical Chinese family unit, and informal caregiving of disabled family members is socially mandated, the negative health consequences of caregiving appear to be similar to those observed among caregivers in the US.

Aged↗
PubMed1998

Transition to chronic pain in men with low back pain: predictive relationships among pain intensity, disability, and depressive symptoms.

Pain intensity, disability, and depressive symptoms are hallmarks of chronic pain conditions, but little is known about the relationships among these symptoms in the transition from acute to chronic pain. In this study, an inception cohort of men with low back pain (N = 78) was assessed at 2, 6, and 12 months after pain onset. At 6 months, pain intensity, disability, and depressive symptoms were predicted only by their respective levels at 2 months after pain onset. At 12 months, pain intensity and depressive symptoms were predicted by heightened disability at 6 months after pain onset; 12-month depressive symptoms also were predicted by 2-month disability. Pain intensity was not predictive of changes in disability or depressive symptoms. These findings suggest that functional disability plays a more prominent role than pain intensity in the transition from acute to chronic pain. A "failure to adapt" conceptual model is presented to account for these results.

Adolescent↗
PubMed1998

Use of the Ottawa ankle rules by nurse practitioners.

OBJECTIVE: To determine the ability of nurse practitioners to use the Ottawa ankle rules by comparing their requests for radiography with those of senior house officers (SHOs). METHOD: 1365 patients were assessed by a nurse trained in the use of the Ottawa ankle rules. Where indicated the nurse sent the patient for radiography. 700 patients in the same period were seen by SHOs who had not received training in these rules. After three months the SHOs were similarly trained in the use of the rules and a further 700 patients were seen. RESULTS: Nurse practitioners assessed 1365 patients; 72.6% had radiography. 1398 patients were seen only by an SHO. Before their use of the Ottawa ankle rules SHOs requested radiography in 91.0% (p = 0.001); using the rules this fell to 74.2% (p = 0.001). CONCLUSION: Nurse practitioners trained to use the Ottawa ankle rules are as effective as SHOs in the implementation of the rules. Moreover the sensitivity and specificity of the Ottawa ankle rules was similar to that seen in other studies.

Adult↗
PubMed1998

Validity of the Quality of Well-Being Scale for patients with Alzheimer's disease.

The Quality of Well-Being (QWB) Scale is a utility-weighted measure of health-related quality of life that can be used in clinical trials, population studies, and cost/utility analyses. This article reports evidence for the validity of the QWB in patients with Alzheimer's disease. The subjects were 211 patient-spouse dyads and control dyads recruited from the University of California, San Diego, Alzheimer's Disease Research Center (ADRC) and from community referrals. Among these, three quarters were patients, and one quarter were age- and gender-matched controls. Patient data were obtained by caregiver proxy. Analyses demonstrated that the QWB was strongly associated with dementia ratings and behavioral problems. Caretakers of patients with low QWB scores also reported using more respite time. The authors conclude that the general QWB score allows data from Alzheimer's disease studies to be used in comparative cost/utility analysis.

Aged↗
PubMed1998

The Paced Auditory Serial Addition Task (PASAT): norms for age, education, and ethnicity.

The Paced Auditory Serial Addition Task (PASAT) is often used to measure attention, concentration, working memory, and speed of information processing. Using a modified 200-item version of the PASAT with presentation rates of 3.0, 2.4, 2.0, and 1.6 items per second, we analyzed demographic influences on test performance in a large sample (N = 566) of healthy North American adults. We found that age, education, and ethnicity were significant predictors, accounting for nearly 23% of the variance in test performance. We discuss these results in comparison to previous normative studies, and present a formula and tables for computing age, education, and ethnicity-adjusted T scores for performance on the PASAT 200.

Adult↗
PubMed1998

Predictors of relapse in long-term abstinent alcoholics.

OBJECTIVE: The goals of this study were to examine the hazard of relapse during an average 11 years of follow-up in alcoholics who had achieved long-term abstinence and to determine predictors of later relapse. METHOD: Male alcoholics (N = 77) with at least 18 months of stable abstinence at time of entry were followed for 2 to 17 years (mean follow-up = 10.9 years). During follow-up, detailed information regarding relapse/abstinence and interim drinking behavior was recorded. Potential predictors of relapse collected at enrollment included past drinking history, severity of alcohol-related life problems, degree of neurocognitive impairment based on neuropsychological (NP) tests, psychological distress (MMPI) and past medical health. RESULTS: Twenty-four of 77 (31%) long-term abstainers relapsed during the follow-up period. The average annual hazard rate of relapse was 3.8% in the first 5 years of follow-up and 2.6% over the next 6-11 years. Based on Cox proportional hazard regression analyses, the only significant variables to predict relapse were MMPI Scale 4 (Psychopathic Deviate, relative risk = 3.16, 95% CI = 1.19-8.38) and prior history of alcohol-related life difficulty (i.e., citation for driving while intoxicated, relative risk = 2.64, 95% CI = 1.05-6.64) (chi2 = 14.2, 2 df, p < .001). CONCLUSIONS: There is approximately a 3% annual risk of relapse in alcoholics who have been able to achieve long-term abstinence, even after 5 years of abstinence. Alcoholics who resumed drinking had greater indicators of longer standing psychological trait disturbance, reflected in elevated MMPI Scale 4 and history of more alcohol-related social difficulties. Placing the present study in the context of previous research that focused primarily on predictors or relapse in the shorter term, it appears that, whereas mood disturbance predicts short-term outcome, more enduring personality traits predict long-term success in remaining abstinent.

Adult↗
PubMed1998

Treatment of major depression in HIV-seropositive men. HIV Neurobehavioral Research Center Group.

BACKGROUND: The purpose of this randomized double-blind, placebo-controlled study was to compare the efficacy and safety of fluoxetine plus group psychotherapy versus group psychotherapy alone in HIV-seropositive men (based on 1986 CDC classes II, III, and IV.C.2) who had been diagnosed with major depressive disorder (DSM-III-R). METHOD: During a 7-week trial, patients were treated with fluoxetine 20-60 mg or placebo 1-3 capsules per day and were seen in weekly supportive group psychotherapy. In addition, subjects were rated on the 17-item Hamilton Rating Scale for Depression (HAM-D-17), Clinical Global Impressions scales for Improvement (CGI-I) and Severity of Illness (CGI-S), and the short version of the Beck Depression Inventory (BDI-13). Of the 47 patients enrolled in the study, 25 were administered fluoxetine and 22 were given placebo. RESULTS: Subjects who received fluoxetine began to show significantly more improvement than patients who received placebo on both self- and observer-rated scales by the end of the first week of treatment. By endpoint, patients treated with fluoxetine experienced greater mean changes from baseline compared with placebo-treated patients on the HAM-D-17 (12.1 vs. 6.6; F = 6.53, df = 1,45; p < .05) and BDI-13 (5.9 vs. 1.2; F = 5.73, df = 1,45; p < .05), and a greater percentage of fluoxetine-treated patients experienced a > or = 50% in HAM-D-17 scores (64% vs. 23%; chi2= 8.60, df = 1, p < .01). Differences were particularly apparent in subjects whose initial depressive episodes were rated as severe (i.e., HAM-D-17 score > or = 24). Severely depressed patients treated with fluoxetine had an endpoint CGI-I of 1.4 compared with an endpoint CGI-I of 2.7 for patients treated with placebo (F = 6.02, df = 1,11; p < .05). Further, side effects were generally mild and transient. The most frequently noted effects reported by subjects treated with fluoxetine were nausea, dry mouth, headache, and diarrhea, in decreasing order of frequency. CONCLUSION: This study supports the efficacy and safety of fluoxetine over and above group psychotherapy for the treatment of HIV-associated major depression.

Adult↗
PubMed1998

The effect of African-American acculturation on neuropsychological test performance in normal and HIV-positive individuals. The HIV Neurobehavioral Research Center (HNRC) Group.

Two studies were conducted to examine the relationship of acculturation to neuropsychological test performance among (1) medically healthy, neurologically normal African Americans (N = 170); and (2) HIV positive (HIV+) subgroups of African Americans and Whites (Ns = 20) matched on age, education, sex, and HIV disease stage. Acculturation was measured through self report for all participants, and linguistic behavior (Black English use) was assessed in a subset of medically healthy individuals (N = 25). After controlling for the effects of age, education, and sex, medically healthy African Americans who reported less acculturation obtained lower scores on the WAIS-R Information subtest and the Boston Naming Test than did more acculturated individuals. Black English use was associated with poor performance on Trails B and the WAIS-R Information subtest. HIV+ African Americans scored significantly lower than their HIV+ White counterparts on the Category Test, Trails B, WAIS-R Block Design and Vocabulary subtests, and the learning components of the Story and Figure Memory Tests. However, after accounting for acculturation, ethnic group differences on all measures but Story Learning became nonsignificant. These results suggest that there are cultural differences within ethnic groups that relate to neuropsychological test performance, and that accounting for acculturation may improve the diagnostic accuracy of certain neuropsychological tests.

Acculturation↗
PubMed1998

Verbal learning and memory in alcohol abusers and polysubstance abusers with concurrent alcohol abuse.

To define the combined effects of drug and alcohol abuse on verbal learning and memory, 70 alcoholic and 80 polysubstance abuse (PSA) individuals with concurrent alcohol abuse were compared on a list learning task, the California Verbal Learning Test (CVLT). Despite demonstrating similar learning strategies, response styles, and error patterns, the PSA group nontheless exhibited significantly greater recall deficits than the alcoholic group on the CVLT. These deficits were particularly evident in those who were heaviest abusers of cocaine. PSA participants did not, however, evidence greater recognition memory deficits. This pattern of greater deficits on recall than on recognition memory, as well as poor consolidation, is consistent with the initiation-retrieval difficulties of patient groups with subcortical dysfunction. It is concluded that the combined use of alcohol and drugs, cocaine in particular, may compound memory difficulties beyond what is typically observed in alcoholic individuals.

Adult↗
PubMed1997

Self-reported social functioning among older patients with schizophrenia.

The purpose of this study was to evaluate the utility of a self-report measure of social functioning as an outcome measure for older schizophrenia patients. Sixty-five schizophrenia patients and 39 healthy controls, ranging in age from 45 to 81 years, were evaluated using a modified Social Adjustment Scale (SAS-M), Scales for Assessment of Positive and Negative Symptoms, Depression Subscale of the Brief Symptom Inventory, Mini-Mental State Examination, Dementia Rating Scale, measures of social support, and measures of background variables. Compared with controls, fewer patients with schizophrenia engaged in social roles, were married, were parents, or held jobs. Moreover, patients were more impaired in overall functioning, specifically in the domains of social/leisure, extended family, and marital roles than controls. Impairments in most roles were correlated with greater severity of symptoms, but not with degree of cognitive impairment, social environment, or background characteristics. The SAS-M is a useful addition to psychosocial batteries; however, the self-report format may not reflect others' perception of functioning.

Activities of Daily Living↗
PubMed1997

Evaluating the neurocognitive complications of SLE. Lessons from HIV disease.

In this paper, we have attempted to define some of the theoretical, methodological, and practical issues involved in the use of NP testing to detect, classify, and monitor neurocognitive impairment secondary to systemic lupus erythematosus. We have drawn on experience with other clinical entities-primarily HIV disease-to inform this discussion. We have argued that for the purposes of studying NP-SLE, NP testing remains the gold standard and is also the most practicable approach in most settings, be they clinical or research. At the same time, the selection of NP tests must be carefully considered, particularly in a disease such as SLE in which the neurocognitive complications arise from several etiological mechanisms, affect people at various points in the course of disease, and in which the anatomic distribution of pathology in the brain varies from patient to patient. In this context, it is safest to select a test procedure that assesses all major areas of cognitive functioning with tests for which adequate demographically adjusted norms exist. In this way, a more reliable diagnosis of neurocognitive impairment, mild neurocognitive disorder, or dementia may be made. A reliable and valid neurocognitive diagnosis is the first step in monitoring patients clinically, in designing research aimed at neuropathogenesis, or in the design of treatment trials geared toward neuroprotection or neuroremediation.

Cognition Disorders↗
PubMed1997

Neurocognitive impairment is an independent risk factor for death in HIV infection. San Diego HIV Neurobehavioral Research Center Group.

OBJECTIVE: To determine if mortality is increased in individuals with human immunodeficiency virus type 1 (HIV-1)-associated neurocognitive disorders less severe than frank dementia. DESIGN: A prospective cohort study; median duration of follow-up was 2.4 years. Kaplan-Meier analysis and Cox proportional hazards models were used to compare survival times according to neurocognitive classification. SETTING: University-based research unit. PARTICIPANTS: A volunteer sample of 414 individuals seropositive for HIV-1. Subjects were classified at their baseline evaluation as neuropsychologically (NP) normal or abnormal (impaired in > or = 2 NP test domains). A subgroup of NP abnormal subjects met operational criteria for HIV-associated minor cognitive motor disorder; the remaining subjects were designated NP impaired. Subjects with frank dementia were excluded. MAIN OUTCOME MEASURE: Mortality. RESULTS: At the baseline evaluation, 256 (62%) of 414 subjects were designated normal; 109 (26%). NP impaired; and 49 (12%), minor cognitive motor disorder. One hundred six participants (26%) died during follow-up. Compared with the NP normal group, the unadjusted relative risk (RR) of death for all NP abnormal subjects (minor cognitive motor disorder and NP impaired) was significantly increased (RR, 1.7; 95% confidence interval [CI], 1.2-2.6; P < .005). After adjusting for concurrently measured predictors of survival (CD4 lymphocyte counts, Centers for Disease Control and Prevention HIV disease classification, hemoglobin concentration, and serum beta 2-microglobulin) in proportional hazards models, mortality for all NP abnormal subjects remained elevated (RR, 1.8; 95% CI, 1.2-2.8; P < .01). The elevation in mortality risk for subjects with minor cognitive motor disorder was statistically significant (RR, 2.2; 95% CI, 1.2-3.8; P < .01); for NP impaired subjects it was marginally significant (RR, 1.6; 95% CI, 1.0-2.8; P = .06). CONCLUSIONS: The HIV-infected individuals with NP impairment had a higher risk of dying than those without impairment. This was particularly true for those meeting syndromic diagnostic criteria.

Adult↗
PubMed1997

Health-related quality of life in older patients with schizophrenia and other psychoses: relationships among psychosocial and psychiatric factors.

OBJECTIVE: Few multivariate studies relating psychosocial factors to symptoms of psychosis among older patients exist. We assessed environmental stressors, satisfaction with emotional support, coping responses and psychiatric symptoms, and sought to relate these factors to quality of well-being among older patients with schizophrenia and other psychoses. METHOD: Subjects were 70 psychosis patients with a mean age of 58. Predictors included measures of stressors (number of negative life events), satisfaction with emotional support, coping responses, positive and negative symptoms, depressive symptoms, social adjustment and a general quality of well-being (QWB) score. RESULTS: A conceptual model was tested and modified using path analytic techniques. Preliminary analyses suggested that psychosocial environment (life events, coping and emotional support) was primarily a product of psychiatric symptoms. Therefore, psychiatric symptoms preceded psychosocial environment variables in the proposed model. Further results suggested that depression mediated all of the effects of psychotic symptoms on social maladjustment, but not all of their effects on well-being. CONCLUSIONS: In older patients with schizophrenia and other psychoses, health-related quality of well-being is influenced by symptoms of psychoses, psychosocial factors and social maladjustment.

Adaptation, Psychological↗
PubMed1997

Cerebrospinal fluid human immunodeficiency virus type 1 RNA levels are elevated in neurocognitively impaired individuals with acquired immunodeficiency syndrome. HIV Neurobehavioral Research Center Group.

To determine whether cerebrospinal fluid (CSF) viral burden measurements can assist in the evaluation of human immunodeficiency virus (HIV)-associated neurocognitive disorders, we quantified HIV type 1 (HIV-1) RNA in CSF. Because previous findings suggested that disease stage, lymphocytic pleocytosis, and HIV-1 RNA levels in plasma may influence CSF viral burden, these variables were examined as potential modifying factors. HIV-1 RNA levels were quantified by using a reverse transcriptase-polymerase chain reaction assay. Performance on a comprehensive neuropsychological (NP) battery was noted in 97 prospectively enrolled, HIV-infected subjects. Among subjects with acquired immunodeficiency syndrome (AIDS) (<200 CD4+ lymphocytes), NP impairment was associated with significantly higher CSF RNA levels (3.1 vs 1.8 log10 copies/ml; p = 0.02); most impaired subjects met criteria for HIV-associated dementia or minor cognitive-motor disorder. In subjects without AIDS, CSF RNA and NP impairment were unrelated. Before AIDS, CSF RNA was strongly correlated to plasma RNA and to pleocytosis, but in AIDS, CSF and plasma RNA were independent. In conclusion, we found elevated CSF HIV-1 RNA levels in NP impaired subjects with AIDS. Before AIDS, systemic viral replication, possibly through CD4+ mononuclear cell trafficking, may govern virus levels in CSF, whereas in AIDS, CD4 cell depletion may unmask a correlation between increased productive central nervous system HIV infection and clinical neurocognitive disorders.

Acquired Immunodeficiency Syndrome↗