Biomedical subjects
J Cobb
Publications and source records attributed to J Cobb.
Left ventricular hypertrophy and mortality--results from the Framingham Study.
Data on the prognostic implications of left ventricular hypertrophy (LVH) in the Framingham Study based on routine ECG, echocardiogram (ECHO) and X-ray determination with 36 years of follow-up indicate that LVH has emerged as a powerful indicator of rapidly evolving lethal atherosclerotic disease, whether determined by ECG, ECHO or X-ray. Cardiovascular morbidity and mortality increase progressively with left ventricular muscle mass from lowest to highest values. The ECG and X-ray versions of LVH each independently contribute to the risk of cardiovascular events; each adds to the risk associated with the other, and those with both are at greater risk than those with either alone. Risk ratios associated with ECG-LVH are substantial and are greatest for cardiac failure and stroke, but coronary disease is the commonest and most lethal sequela. LVH is reversible, the anatomical variety more so than ECG-LVH, and reversal of this toward normal appears to confer greater benefit for the anatomical rather than the ECG manifestation of LVH. The risk of cardiovascular disease associated with LVH is not uniform, varying widely depending not only on whether there is concomitant ECG and anatomical evidence of hypertrophy but also on the associated hypertension, glucose intolerance, lipid profile and cigarette smoking habit. This suggests that there is much to be gained in correcting those associated risk factors which also promote the development of LVH.
Prevalence of dementia and probable senile dementia of the Alzheimer type in the Framingham Study.
We determined the prevalence of dementia and probable senile dementia of the Alzheimer type (SDAT) for biennial Exam 17 of the Framingham cohort (1982/1983). The prevalence of dementia was 30.5/1,000 for men and 48.2/1,000 for women and increased with advancing age. Cases of probable SDAT constituted 55.6% of all dementia cases. THe prevalence of SDAT was 11.7/1,000 for men and 30.1/1,000 for women and also increased with advancing age. Prevalence of dementia and probable SDAT were greater for women than men. The female:male ratio of prevalence for cohort members 75 years of age and older was 1.8 for all cases of dementia and 2.8 for cases of probable SDAT.
Screening for patients with alcohol problems: severity of patients identified by the CAGE.
Primary care physicians are well situated to identify patients with substance abuse problems and motivate them to seek appropriate assistance, but active programs are the exception. A study in a community setting was undertaken to assess the CAGE (the first letters of key words in a series of four questions about drinking: cut down; annoyed; guilty; and eye-opener), instrument in the routine screening for alcohol problems in both new and established patients. The screening process identified subjects for a pilot evaluation of a motivational interview designed to encourage problem-solving behavior. This article focuses on the screening results and the use of the CAGE instrument. During June and July of 1990, 687 patients of two primary care physicians belonging to a large group practice were asked to complete a health questionnaire that included the CAGE. Those who responded affirmatively to at least two of the four CAGE questions were requested to participate in follow-up assessment of problems associated with alcohol and health. The type and severity of alcohol problems experienced by patients who scored positive on the CAGE are described. Prevalence of a positive score on the CAGE was 8.6 percent with males, smokers, and blue collar and unemployed persons being more likely to score positive. The positive predictive value was .68. Primarily, persons with moderate alcohol problems were identified. Results show that the CAGE instrument is a useful screening device for identifying those with mild to moderate substance abuse problems, increasing the opportunity for intervention prior to serious medical complications. The instrument is easily administered, and has demonstrated relatively high levels of sensitivity and specificity. When combined with assessment and motivational interviews, the CAGE shows promise in the secondary prevention of substance abuse and related health problems.
Using chronic disease risk factors to adjust Medicare capitation payments.
This study evaluates the use of risk factors for chronic disease as health status adjusters for Medicare's capitation formula, the average adjusted per capita costs (AAPCC). Risk factor data for the surviving members of the Framingham Study cohort who were examined in 1982-83 were merged with 100 percent Medicare payment data for 1984 and 1985, matching on Social Security number and sex. Seven different AAPCC models were estimated to assess the independent contributions of risk factors and measures of prior utilization and disability in increasing the explanatory power of AAPCC. The findings suggest that inclusion of risk factors for chronic disease as health status adjusters can improve substantially the predictive accuracy of AAPCC.
Validation of two-dimensional models for estimation of portion size in nutrition research.
Explore the source record for details and available documents.
Volar wrist ganglia cured by carpal tunnel decompression.
Three patients are described, each of whom had both carpal tunnel syndrome and a volar wrist ganglion. Carpal tunnel decompression caused resolution of the ganglion. This suggests that both disorders may be caused by the same pressure phenomenon.
Wisconsin's Birth and Development Outcome Monitoring Program.
Explore the source record for details and available documents.
Studying the 'Grammar of Psychotherapy' Course using a student and control population. Some results, trends and disappointments.
In a study of the effects of the teaching of the 'Grammar of Psychotherapy' Course, 26 subjects were matched with 27 controls. The students were found to have significantly better interviews than the controls as rated by their patients and by independent blind assessment of their audiotapes six months later. There are some trends which were of interest, although not statistically significant.
Increasing patient participation using an extended consultation: an inner city study.
An inner city practice in Birmingham has developed a new style of extended consultation to increase patient participation in primary care, based on previous initiatives in the practice, in particular allowing patients access to medical records, adopting an open reception style, and including consultations with a nurse practitioner. In a three stage consultation lasting approximately 30 minutes patients were offered a session with a receptionist for assisted access to medical records, a session of 15-20 minutes with a doctor or nurse and a self help session with a receptionist. This extended consultation was welcomed by patients, who showed a marked degree of participation, and it also increased the satisfaction and cooperation of project staff. This type of consultation provides a model for increasing patient participation in general practice.
After safe sex, safe surgery?
Explore the source record for details and available documents.
Generalised anxiety: a controlled treatment study.
Explore the source record for details and available documents.
A reproducible model of metastatic brain and ocular tumor by hematogenous inoculation of the VX2 tumor in rabbits.
A metastatic brain-tumor model has been developed in rabbits by infusing the VX2 carcinoma into the internal carotid artery to simulate hematogenous dissemination of tumor. In a series of 25 New Zealand White rabbits, multiple metastases arose in the hemisphere of 24 (96%) and in the eye of 22 (92%); in all instances ocular metastases were ipsilateral to the site of infusion. Ocular metastases were visible in the anterior chamber in 80% of animals 3 to 12 days after the infusion of VX2 tumor cell suspension. All rabbits deteriorated neurologically or died by Day 15 after the inoculation. Multiple metastases were demonstrated by magnetic resonance imaging as early as 5 to 7 days after infusion of the tumor cells and were confirmed at autopsy. This technique models hematogenous metastases to the brain and eye and is useful in evaluating the response of metastases to chemotherapy and radiation therapy directed to the brain and eye.
Inner city care--bridging two worlds.
Explore the source record for details and available documents.
Behavioural psychotherapy for neurological illness.
Explore the source record for details and available documents.
The Illness Behavior Questionnaire as an aid to clinical assessment.
The Illness Behavior Questionnaire (IBQ) is a 62-item self-report instrument that provides information relevant to the delineation of a patient's attitudes, ideas, affects, and attributions in relation to illness. The scores generated are described, and nine clinical vignettes are presented, together with IBQ score profiles and interpretations to illustrate the manner in which the latter may complement other clinical data. The ways in which individuals react to their own health status is becoming of greater importance as the taking of responsibility for one's own health is increasingly emphasized. The IBQ provides information that should be relevant to the management of patients, regardless of the specific nature of their illness.
Behaviour therapy in phobic and obsessional disorders.
Behaviour therapy consisting of specific exposure in vivo is reviewed in terms of its clinical usefulness for the treatment of agoraphobia, obsessive compulsive neurosis and related conditions. A combined behavioural and psychological formulation of individual target problems is advocated. These can be rated in terms of discomfort, disability, and physiological indices of anxiety. Although discomfort and disability have been found to correlate, their relationship with anxiety measures is questioned. Variables affecting the outcome of exposure are reviewed, including: duration--best results with prolonged, frequent sessions over a short period; arousal--experience of high anxiety not essential; adjunctive cognitive therapy--considered to add nothing to effectiveness during exposure treatment. The author goes on to argue that simple response prevention is effective in reducing ritualising activities in obsessive compulsive neurosis, without effecting concomitant anxiety. Whereas anxiety responds independently to exposure therapy, and hence that the anxiety reduction model of obsessive compulsive neurosis is inadequate. The putative anti-obsessional properties of clomipramine are questioned, and the utility of imipramine in agoraphobia is disputed.
Clomipramine and exposure for obsessive-compulsive rituals: i.
Forty chronic obsessive-compulsive ritualizers were randomly assigned to treatment with oral clomipramine or placebo for 8 months. During weeks 4 to 7 these two groups were each randomly split into treatment by relaxation or by exposure in vivo, and during weeks 7 to 10 all patients had exposure in vivo. Double blind assessments were made at weeks 4, 7, 10, 18, 36, 62 and 114. Results are reported to one year. Clomipramine produced significant improvement in rituals, mood and social adjustment, but only in those patients who initially had depressed mood. The clomipramine effect was maximum from weeks 10 to 18 and diminished thereafter. On stopping clomipramine patients often relapsed and improved again on restarting the drug. Relaxation produced little change. Exposure produced significant lasting improvement in rituals, but less change in mood; improvement generalized to social adjustment at follow-up. Clomipramine plus exposure had a slight additive but not interactional effect. Clomipramine enhanced compliance both with exposure and with relaxation. Clomipramine is useful for compulsive ritualizers with depressed mood, but may need continuation for over a year and combination with exposure in vivo. Exposure in vivo remains the treatment of choice for rituals without depressed mood.