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Biomedical subjects

J B Williams

Publications and source records attributed to J B Williams.

At least 55 records · Page 3Linked to original sources
PubMed1998

Disease severity, physical limitations and depression in HIV-infected men.

Previous research has failed to identify a consistent relationship between HIV disease severity and depression. However, HIV/AIDS can lead to substantial physical limitations in those with advanced disease, which may influence mood. This study examined the extent to which HIV disease severity and physical limitations were associated with depressive symptoms in 49 HIV-infected men at the final stages of a 5-year prospective study. No differences were found in depression or quality of life among men who were asymptomatic, symptomatic, or diagnosed with AIDS. Forty-three percent of subjects reported substantial physical limitations, which were associated with higher depression scores and poorer quality of life. Degree of physical limitation predicted depression concurrently as well as depression 6 months later, after controlling for disease stage, physical symptoms, and CD4 cell counts. Findings suggest that physical limitations are more important than laboratory markers of disease progression in understanding psychological adjustment to illness in HIV-infected men.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Estimates of driving abilities and skills in different conditions.

OBJECTIVES: This research was a preliminary effort to determine whether various driving situations seemed to require different driving skills and abilities and to identify the relative demands of specific physical, perceptual, cognitive, behavioral, and operational skills and abilities in different driving situations. METHOD: Experienced driver evaluators and trainers estimated the magnitude of driving abilities and skills for different photographed driving situations. Pictures of driving scenarios were counterbalanced for road type, traffic condition, and weather condition. RESULTS: A multifactorial analysis of variance of the total score for each scenario revealed significant main effects for road type and traffic condition but not for weather condition. Highway and city driving were rated as significantly more demanding overall than residential driving, but no difference was found between city and highway driving. Estimates of the overall demands for driving in heavy traffic were significantly greater than in light traffic. However, driving in inclement weather was not regarded as significantly more demanding than driving in sunny weather. Additionally, significant interaction effects were found for road type by weather condition and traffic by weather condition but not for road type by traffic condition. Through multivariate methods to evaluate the significance of individual abilities and skills across conditions, significant main and interactive effects were found for road type, traffic condition, and weather condition. Post hoc analyses showed the impact of these effects on such abilities and skills as scanning, attention and concentration, information-processing speed, and others. CONCLUSION: Evaluators' quantified estimates of driving demands showed driving as a complex task that (a) requires high levels of abilities and skills in all situations; (b) demands greater abilities in some situations than in others; and (c) involves different kinds and various degrees of abilities and skills, depending on the demand characteristics of the situation.

Adult↗
PubMed1997

The human HNP36 gene is localized to chromosome 11q13 and produces alternative transcripts that are not mutated in multiple endocrine neoplasia, type 1 (MEN I) syndrome.

Multiple endocrine neoplasia, type 1 (MEN I), is an autosomal dominant syndrome of selected endocrine neoplasms whose causative gene, a suspected tumor suppressor, has been localized to chromosome 11q13, but has not been identified. Recently, the HNP36 cDNA was identified as a novel growth factor responsive gene of undetermined biological function that is expressed in the pituitary and parathyroid glands. In studies seeking the function of the HNP36 gene product, the gene was localized by fluorescence in situ hybridization within the 11q13 segment. Further analysis of radiation-reduced hybrid DNAs and chromosome 11-specific YAC clones established that the HNP36 gene is within 80 kb of D11S913, a marker tightly linked to the MEN1 gene. Consequently, the HNP36 gene was studied as a candidate for the MEN1 gene. The human HNP36 gene was cloned and determined to consist of 12 exons. Expression of the HNP36 gene from pituitary and parathyroid tissue and four patient tumors or lymphoblasts was confirmed by RT-PCR amplification of the coding sequences, and HNP36 transcripts were analyzed for mutations. All tissues expressed three HNP36 gene transcripts that result from alternative splicing and appear to encode related, but distinct, proteins. However, DNA sequence determination of the RT-PCR products from MEN I-associated tumors found no deletions and identified a single nucleotide difference that may be a polymorphism. Thus, mutations in the coding segments of the HNP36 gene are not the cause of the MEN I syndrome. Nevertheless, the assignment of the HNP36 gene to 11q13 and identification of new potential gene products provides a novel growth-regulated genetic candidate for other disorders whose genes map to this locus.

Alternative Splicing↗
PubMed1997

Psychopathology in male and female HIV-positive and negative injecting drug users: longitudinal course over 3 years.

OBJECTIVE: To evaluate the impact of HIV illness on psychiatric and psychosocial functioning over 3 years in a sample of male and female HIV-positive injecting drug users (IDU), with a comparison group of HIV-negative male and female IDU. DESIGN: As part of a multidisciplinary study, 121 men (69 HIV-positive, 52 HIV-negative) and 66 women (36 HIV-positive, 30 HIV-negative) were evaluated semiannually for seven visits. Attrition, unrelated to sex or serostatus, was 33%. RESULTS: At baseline, rates of major depression and dysthymia ranged from 15% (HIV-negative men) to 33% (HIV-positive men and HIV-negative women). Global impairment was in the range found in psychiatric patients (mean Global Assessment of Functioning scores, 46-51). Higher levels of social support and less social conflict were independently associated with decreased distress and improved global functioning among both men and women. For both HIV-positive groups, degree of improvement over time was related to degree to HIV progression: those who remained healthier in terms of CD4 count and illness stage showed more improvement. HIV-seronegative status was associated with less distress for men but not for women. Overall, women reported higher levels of psychiatric distress than men. CONCLUSIONS: High rates of psychopathology were found in this IDU cohort, independent of HIV status and sex. Although rates of psychopathology, injecting drug use and distress declined slightly during the study, they remained elevated; accordingly, psychiatric services are indicated for this population.

Cohort Studies↗
PubMed1997

Multisomatoform disorder. An alternative to undifferentiated somatoform disorder for the somatizing patient in primary care.

BACKGROUND: For clinical or research use in primary care, the DSM-IV diagnostic criteria for somatization disorder are too restrictive, while the criteria for undifferentiated somatoform disorder are overly inclusive. In this article, we examine the validity of multisomatoform disorder, defined as 3 or more medically unexplained, currently bothersome physical symptoms plus a long (> or = 2 years) history of somatization. METHODS: Data from the Primary Care Evaluation of Mental Disorders Study of 1000 patients from 4 primary care sites were analyzed. The outcomes assessed were 6 domains of health-related quality of life, using the 20-item Short-Form General Health Survey; self-reported disability days and health care use; satisfaction with care; and physician-rated difficulty of the encounter. RESULTS: Multisomatoform disorder was diagnosed in 82 (8.2%) of the 1000 patients who were enrolled in the Primary Care Evaluation of Mental Disorders Study. Compared with mood and anxiety disorders, multisomatoform disorder was associated with comparable impairment in health-related quality of life, more self-reported disability days and clinic visits, and greater clinician-perceived patient difficulty. CONCLUSIONS: Multisomatoform disorder may be a valid diagnosis and potentially more useful than the DSM-IV diagnosis of undifferentiated somatoform disorder. Also, because multisomatoform disorder has a large and independent effect on impairment, its diagnosis should not be precluded simply because of a coexisting mood or anxiety disorder.

Adolescent↗
PubMed1997

Stability and change in personality disorder symptomatology: findings from a longitudinal study of HIV+ and HIV- men.

A longitudinal study was conducted to investigate the stability of personality disorders (PDs) over a 2-year interval, as well as the association between change in PD symptomatology and change in psychological distress. Structured clinical interviews and questionnaires assessing PDs and psychological distress were administered to a community sample of 118 gay men (80 HIV seropositive men and 38 HIV seronegative men) at a baseline session and readministered 2 years later. Results indicated that PD symptom levels tended to be moderately stable, that PD diagnoses had low stability and that changes in PD symptom levels were associated with changing levels of psychological distress but not with progression of HIV infection.

Adult↗
PubMed1997

Stability of mood despite HIV illness progression in a group of homosexual men.

OBJECTIVE: The authors investigated the association between mood status and progression of HIV illness. METHOD: In a research clinic at a university medical center, 112 HIV-positive and 52 HIV-negative homosexual men were enrolled in a 4-year prospective study with semi-annual assessments. The main study measures were psychiatric diagnoses according to the Structured Clinical Interview for DSM-III-R; level of functioning and psychiatric symptoms according to the Global Assessment of Functioning Scale (axis V, DSM-III-R), the Hamilton depression and anxiety scales, the Brief Symptom Inventory, and the Beck Hopelessness Scale; stage of HIV illness; and CD4 cell count. RESULTS: Among the HIV-positive men, there was no increase in rates of syndromal depression and anxiety over the 4 years despite substantial HIV illness progression. On all occasions, mean psychopathology symptom ratings were within the normal or not depressed range. However, compared to the HIV-negative men, the HIV-positive men had slightly more anxiety and somatic depressive symptoms throughout. The only measure that showed an increase in distress over time was orientation to the future; among the HIV-positive men, hopes for the future waned across assessments. Attrition in the group was largely attributable to the loss of men with lower CD4 cell counts and more advanced HIV illness. However, study dropouts did not differ on any psychiatric measure from subjects who remained during the first 3 years. CONCLUSIONS: In this group no significant increase in syndromal or symptomatic depression or anxiety over nine semiannual assessments was found, despite substantial HIV illness progression and some deaths. Psychopathology did not predict dropout or death.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Adverse effects of thyroid hormones.

The adverse health effects of thyrotoxicosis have been carefully documented and most practitioners are familiar with the clinical consequences for the patient. Until recently, many patients experienced the adverse effects of excessive thyroxine dosages. Which can now be avoided by the application of highly sensitive immunometric assays for monitoring serum thyrotrophin (thyroid-stimulating hormone; TSH) levels. However, sensitive monitoring of serum thyrotrophin levels has led to the frequent recognition of biochemical subclinical hyperthyroidism (isolated suppression of thyrotrophin). Because of the increased recognition of this condition, the adverse effects of thyroxine therapy can be divided into those associated with subclinical hyperthyroidism and those associated with the euthyroid state. Investigation of the potential clinical consequences of thyrotrophin-suppressing dosages of thyroxine has dominated studies over the last decade, with less attention being given to euthyroid patients. It appears that the adverse effects of thyroxine are considerably more common when serum thyrotrophin has been suppressed. They are usually manifested in older patients as increased bone mineral loss in postmenopausal women and as cardiac effects in patients with intrinsic heart disease. These patients may have subtle behavioural alterations and other clinically silent organ effects that occur infrequently. Children who are euthyroid while taking thyroxine occasionally develop pseudotumour cerebri shortly after starting hormone replacement for hypothyroidism. Otherwise, thyroxine dosages that render patients euthyroid, as evidenced by thyrotrophin values that are within the normal range, rarely cause adverse effects. Thus, avoidance of dosages that cause thyrotrophin suppression, when not clinically indicated, is the primary approach to the management of these adverse effects.

Aging↗
PubMed1997

MR imaging of skeletal muscle metastases.

OBJECTIVE: The purpose of this article is to describe the MR imaging appearance of skeletal muscle metastases. CONCLUSION: Skeletal muscle metastasis must be considered in patients with a known primary carcinoma who present with a painful muscle mass. Muscle metastasis may be the initial presentation of carcinoma. The MR imaging appearance, although not specific, may provide clues to the diagnosis.

Female↗
PubMed1997

Off-road driving evaluations for persons with cerebral injury: a factor analytic study of predriver and simulator testing.

OBJECTIVES: Off-road evaluations composed of psychometric testing and simulator driving are commonly used in rehabilitation settings to assess a person's fitness to resume driving after a cerebral injury. Although the results of these evaluation methods separately provide information about ability to drive, there is no clear understanding about what is measured in comprehensive off-road evaluations as a whole. This study explored the interrelationship of perceptual, cognitive, behavioral, and operational variables that form the basis for off-road evaluations in order to determine whether there are basic dimensions underlying performance in these evaluations and to derive a small set of variables that could help in refining methods for evaluating persons with cerebral injuries. METHODS: One-hundred six persons with cerebral damage due to brain injury or cerebrovascular accident were administered a predriver evaluation that consisted of selected neuropsychometric tests. Subjects were also evaluated in a driving simulator that measured their operational responses to filmed driving situations and assessed their behaviors. Principal component analysis was used to identify manifest and latent variables contributing to the results of the evaluations. RESULTS: The analysis produced a model with five independent (orthogonal) eigenvectors, or factors, for this population: Higher Order Visuospatial Abilities, Basic Visual Recognition and Responding, Anticipatory Braking, Defensive Steering, and Behavioral Manifestations of Complex Attention. These factors accounted for 66.14% of the total variance in the subjects' responses to comprehensive off-road evaluations. CONCLUSION: These factors were useful in understanding driving performance and the role of predriver and simulator testing in driver evaluations.

Adolescent↗
PubMed1997

Brain herniation into the middle ear and mastoid: concepts in diagnosis and surgical management.

OBJECTIVE: To review the occurrence characteristics of and clinical repair experience with brain herniation in to the middle ear and mastoid from 1970-1995. STUDY DESIGN: Retrospective chart/case review. SETTING: Private Otology/Neurotology referral practice. PATIENTS: Thirty-five patients with temporal bone brain herniation diagnosed and treated from 1970-1995. INTERVENTION: Diagnosis confirmed by CT and/or MRI. Treatment was surgical. MAIN OUTCOME MEASURES: Success of surgical repair of the problem in a large experience with follow-up of up to 180 months (mean, 48.7 months). RESULTS: Diagnosis is most effectively made by both (computed tomography (CT) and magnetic resonance imaging (MRI). In this series diagnosis was accurate in 89% with MRI. Primary repair was successful in all but three patients, two of whom required a second repair. One was unreconstructable. CONCLUSIONS: Temporal bone encephaloceles occur after ear surgery and in chronic otitis media. Prompt and effective surgical repair is successful and integral to complication avoidance.

Adult↗
PubMed1996

Demonstration of a bilateral projection from the rostral nucleus of the solitary tract to the medial parabrachial nucleus in rat.

This study examined the projection from the rostral nucleus of the solitary tract (rNST) to the medial parabrachial nucleus (mPBN) in male Wistar rats using DiI as a retrograde tracer and biotinylated dextran as an anterograde tracer. Following successful unilateral injection of DiI into the mPBN (n = 8), retrogradely labeled neurons were always found in the rNST both ipsilateral and contralateral to the pontine injection site. Significantly, approximately 25% of the total number of DiI-labeled neurons were located in the contralateral rNST. The labeled neurons were located throughout the rostral-caudal extent of the rNST with the most cells being located in the central portion of the nucleus, and the fewest located ventromedially and dorsolaterally. Supporting the findings of the retrograde labeling study, axons and terminals, anterogradely labeled by injecting biotinylated dextran unilaterally into the rNST (n = 4), were always found in both the ipsilateral and contralateral mPBN. Although the intensity of anterograde labeling was higher ipsilaterally, a mirror-image staining pattern consistently was present contralaterally. These results indicate that there is a substantial contralateral component of the projection from the rNST to the mPBN. This suggests that convergence of gustatory information from the two sides of the oral cavity may occur within the pons before processing in higher brain centers. These findings may have important implications as to where and how bilateral gustatory information is processed and integrated.

Animals↗
PubMed1996

Personality disorders predict onset of Axis I disorders and impaired functioning among homosexual men with and at risk of HIV infection.

BACKGROUND: A longitudinal study was conducted to investigate whether personality disorders (PDs) increase risk for the development of future Axis I disorders and serious functional impairment among human immunodeficiency virus (HIV)-seropositive and HIV-seronegative homosexual men. METHOD: Baseline assessments of PDs, Axis I disorders and symptoms, and Global Assessments of Functioning were conducted with a community sample of 107 (66 HIV-positive and 41 HIV-negative) homosexual men participating in a longitudinal study with semiannual interviews over 3 years. RESULTS: Logistic regression analysis indicated that PDs predicted onset of subsequent Axis I disorders after controlling for both HIV status and lifetime Axis I history (adjusted odds ratio, 4.31; P=.01; 95% confidence interval, 1.39 to 13.32). Of the 21 participants with PDs, 16 (76%) were subsequently diagnosed with Axis I disorders on at least one occasion. By contrast, only 36 (42%) of the 86 participants without PDs were subsequently diagnosed with Axis I disorders. Further, 33% of the participants with PDs, in comparison with only 8% of those without PDs, were assigned Global Assessments of Functioning scores of 50 or lower, indicating serious impairment during the postbaseline study period (adjusted odds ratio, 5.70; P<.005; 95% confidence interval, 1.66 to 19.53). CONCLUSION: Personality disorders may contribute to increased risk for onset of Axis I disorders and serious impairment among homosexual men regardless of HIV serologic status.

Adult↗
PubMed1996

The difficult patient: prevalence, psychopathology, and functional impairment.

OBJECTIVE: To determine the proportion of primary care patients who are experienced by their physicians as "difficult," and to assess the association of difficulty with physical and mental disorders, functional impairment, health care utilization, and satisfaction with medical care. DESIGN: Survey. SETTING: Four primary care clinics. PATIENTS: Six-hundred twenty-seven adult patients. MEASUREMENTS: Physician perception of difficulty (Difficult Doctor-Patient Relationship Questionnaire), mental disorders and symptoms (Primary Care Evaluation of Mental Disorders, [PRIME-MDI]), functional status (Medical Outcomes Study Short-Form Health Survey [SF-20]), utilization of and satisfaction with medical care by patient self-report. RESULTS: Physicians rated 96 (15%) of their 627 patients as difficult (site range 11-20%). Difficult patients were much more likely than not-difficult patients to have a mental disorder (67% vs 35% [corrected], p < .0001). Six psychiatric disorders had particularly strong associations with difficulty: multisomatoform disorder (odds ratio [OR] = 12.3. 95% confidence interval [CI] = 5.9-26.8), panic disorder (OR = 6.9, 95% CI = 2.6-18.1), dysthymia (OR = 4.2, 95% CI = 2.0-8.7), generalized anxiety (OR = 3.4, 95% CI = 1.7-7.1), major depressive disorder (OR = 3.0, 95% CI = 1.8-5.3), and probable alcohol abuse or dependence (OR = 2.6, 95% CI = 1.01-6.7). Compared with not-difficult patients, difficult patients had more functional impairment, higher health care utilization, and lower satisfaction with care, whereas demographic characteristics and physical illnesses were not associated with difficulty. The presence of mental disorders accounted for a substantial proportion of the excess functional impairment and dissatisfaction in difficult patients. CONCLUSIONS: Difficult patients are prevalent in primary care settings and have more psychiatric disorders, functional impairment, health care utilization, and dissatisfaction with care. Future studies are needed to determine whether improved diagnosis and management of mental disorders in difficult patients could diminish their excess disability, health care costs, and dissatisfaction with medical care, as well as the physicians experience of difficulty.

Adult↗
PubMed1996

Renal compensation for cecal loss in Gambel's quail (Callipepla gambelii).

Some studies have implicated the avian digestive cecae as important sites of water and solute reclamation working in concert with the lower intestine and the kidneys as part of an integrated osmoregulatory system. In Gambel's quail (Callipepla gambelii), we studied compensatory adjustments in renal function on days 6-7 and 16-17 following ligation of cecae. Plasma osmolality (Posm) varied significantly between groups with sham-operated birds (Cs), with an average (Posm) of 348 mOsm/kg H2O and quail with ligated cecae (Cx) having a (Posm) of 355 mOsm/kg H2O. We detected no change in the rate of glomerular filtration (GFR) between experimental and control groups either shortly after cecectomy or after 16-17 d following surgery. Regression analysis of GFR and urine flow rate (V) showed that Cx birds had a significantly lower V at a given GFR than did controls, evidence that Cx quail absorbed more fluid in their renal tubules. Increased fluid reabsorption was apparently driven by an enhanced reabsorption of sodium. Indeed, sodium excretion was lower in Cx quail as compared to sham-operated birds. On days 6-7, Cx quail drank more water than Cs birds, but by days 16-17 drinking rates were similar. At the end of the experiments, Cx quail showed a proliferation of microvilli along the apical membrane of the rectum, an adjustment consistent with the idea that the rectum alters its absorption capacity to adjust for the loss of cecal function.

Animals↗
PubMed1996

Gender, quality of life, and mental disorders in primary care: results from the PRIME-MD 1000 study.

BACKGROUND: Recently there has been increased interest in the special mental health needs of women. We used data from the PRIME-MD 1000 study to assess gender differences in the frequency of mental disorders in primary care settings, and to explore the potential impact of these differences on health-related quality of life (HRQL). SUBJECTS AND METHODS: One thousand primary care patients (559 women) were interviewed during the PRIME-MD study, which was conducted at four primary care clinics affiliated with university hospitals throughout the eastern United States. Patients completed a one-page questionnaire in the waiting room prior to being seen by the physician; patients and physicians then completed together a clinician evaluation guide that used DSM-III-R algorithms to diagnose mood, anxiety, somatoform, eating, and alcohol related disorders. Health-related quality of life was assessed with the Medical Outcomes Study SF-20 General Health Survey. RESULTS: Women were more likely than men to have at least one mental disorder (43% versus 33%, P < 0.05). Higher rates were particularly prominent for mood disorders (31% of women versus 19% of men, odds ratio [OR] = 1.9, 95% confidence interval [CI] 1.4 to 2.6), anxiety disorders (22% versus 13%, OR = 1.9, CI = 1.3 to 2.8), and somatoform disorders (18% versus 9%, OR = 2.2, CI = 1.5 to 3.4). Psychiatric comorbidity was also more common in women (26% of women had two or more mental disorders versus 15% of men, P < 0.05). Unadjusted HRQL scores, ranging from 0 to 100, with 100 = best health, were all significantly lower in women than in men (eg, physical function = 67 in women versus 76 in men, P < 0.0001; mental health = 69 in women versus 76 in men, P < 0.0001). Many HRQL differences persisted after controlling for age, education, ethnicity, marital status, and number of physical disorders; however, differences in HRQL were eliminated in 5 of 6 domains after controlling for number of mental disorders. When compared with female patients of male physicians, female patients of female physicians demonstrated similar satisfaction with care, health care utilization, HRQL, and recognition rate of mental disorders. CONCLUSIONS: In the 1,000 patients of the PRIME-MD study, mood, anxiety, and somatoform disorders and psychiatric comorbidity were all significantly more common in women than men. The HRQL scores were poorer in women than men, although most of this difference was accounted for by the difference in prevalence of mental disorders. These data suggest that one of the most important aspects of a primary care physician's care of female patients is to screen for and treat common mental disorders.

Adult↗
PubMed1996

Efficacy in sheep and pharmacokinetics in cattle that led to the selection of eprinomectin as a topical endectocide for cattle.

Eprinomectin (MK-397 or 4"-epi-acetylamino-4"-deoxy-avermectin B1) is a novel avermectin selected for development as a topical endectocide for all cattle, including lactating cows. The initial efficacy assessments were made in sheep to identify subclasses of the avermectin/milbemycins that possessed inherent activity against a spectrum of nematode parasites. This included examination of several hundred analogs each given orally to a single sheep experimentally infected with a range of parasitic nematodes. Representatives of several subclasses, most notably the 4"-epi-amino avermectin B1 subclass, were identified as possessing potent, broad-spectrum activity against the endoparasites, whereas subclasses such as those with a variety of synthetic substitutions at C-4a or oximes at C-5 were among the least potent. Eprinomectin, a member of the 4"-epi-amino subclass, possessed potent activity against the range of nematodes when tested at 0.025 mg kg-1 per os. Milk and plasma concentration profiles were also made for these and other selected avermectin/milbemycins following topical administration to lactating dairy cattle. The molecular structure of each compound had a significant effect on the milk to plasma ratio, but the ratio of each was constant over time, implying an equilibrium between the 2 compartments. Compounds that were saturated at the C-22,23 bond had milk to plasma ratios > or = 1.0, whereas those unsaturated at this bond were generally < or = 1.0. The milk to plasma ratio of eprinomectin was < or = 0.2. Therefore, not only is eprinomectin the most potent broad-spectrum avermectin/milbemycin identified to date, but it also possesses one of the lowest milk partitioning coefficients in this class of antiparasitics.

Administration, Topical↗