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Biomedical subjects

J Dickens

Publications and source records attributed to J Dickens.

9 recordsLinked to original sources
PubMed2006

Risk factors for incident Alzheimer's disease in African Americans and Yoruba.

INTRODUCTION: The incidence rate of Alzheimer's disease (AD) was found to be 2 times lower in Yoruba than in African Americans. This study was aimed at identifying the factors associated with increased risk of incident AD in the two communities. METHODOLOGY: A two-stage design with initial screening using the CSI'D followed by neuropsychological test battery, relations' interview and physician assessment in a sub-sample.NINCDS-ADRDA criteria were met for AD. The risk factor variables assessed included demographic, lifestyle, medical and family history items. RESULTS: In the Yoruba, AD was associated with age (OR = 1.07) and female gender (OR = 2.93). In African Americans, age (OR = 1.09) and rural living (OR = 2.08) were the significant risk factors, while alcohol was protective (OR = 0.49). DISCUSSION: Age was a significant risk factor for AD at both sites. The higher risk of incident AD in the Yoruba female, and in African Americans who resided in rural areas in childhood were similar with the prevalence cases. Alcohol emerged a protective factor in African Americans. More studies are required, including biological measurements, to adequately explain the differences in rates.

Black or African American↗
PubMed2006

Cholesterol, APOE genotype, and Alzheimer disease: an epidemiologic study of Nigerian Yoruba.

OBJECTIVE: To examine the relationship between cholesterol and other lipids, APOE genotype, and risk of Alzheimer disease (AD) in a population-based study of elderly Yoruba living in Ibadan, Nigeria. METHODS: Blood samples and clinical data were collected from Yoruba study participants aged 70 years and older (N = 1,075) as part of the Indianapolis-Ibadan Dementia Project, a longitudinal epidemiologic study of AD. Cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglyceride levels were measured in fasting blood samples. DNA was extracted and APOE was genotyped. Diagnoses of AD were made by consensus using National Institute of Neurologic Disorders/Stroke-Alzheimer's Disease and Related Disorders Association criteria. RESULTS: Logistic regression models showed interaction after adjusting for age and gender between APOE-epsilon4 genotype and biomarkers in the risk of AD cholesterol*genotype (p = 0.022), LDL*genotype (p= 0.018), and triglyceride*genotype (p = 0.036). Increasing levels of cholesterol and LDL were associated with increased risk of AD in individuals without the APOE-epsilon4 allele, but not in those with APOE-epsilon4. There was no significant association between levels of triglycerides and AD risk in those without APOE-epsilon4. CONCLUSIONS: There was a significant interaction between cholesterol, APOE-epsilon4, and the risk of Alzheimer disease (AD) in the Yoruba, a population that has lower cholesterol levels and lower incidence rates of AD compared to African Americans. APOE status needs to be considered when assessing the relationship between lipid levels and AD risk in population studies.

Aged↗
PubMed2001

Prevalence of cognitive impairment: data from the Indianapolis Study of Health and Aging.

BACKGROUND: The epidemiology and natural history of cognitive impairment that is not dementia is important to the understanding of normal aging and dementia. OBJECTIVE: To determine the prevalence and outcome of cognitive impairment that is not dementia in an elderly African American population. METHOD: A two-phase, longitudinal study of aging and dementia. A total of 2212 community-dwelling African American residents of Indianapolis, IN, aged 65 and older were screened, and a subset (n = 351) received full clinical assessment and diagnosis. Subsets of the clinically assessed were seen again for clinical assessment and rediagnosis at 18 and 48 months. Weighted logistic regression was used to generate age-specific prevalence estimates. RESULTS: The overall rate of cognitive impairment among community-dwelling elderly was 23.4%. Age-specific rates indicate increasing prevalence with increasing age: 19.2% for ages 65 to 74 years, 27.6% for ages 75 to 84 years, and 38.0% for ages 85+ years. The most frequent cause of cognitive impairment was medically unexplained memory loss with a community prevalence of 12.5%, followed by medical illness-associated cognitive impairment (4.0% prevalence), stroke (3.6% prevalence), and alcohol abuse (1.5% prevalence). At 18-month follow-up, 26% (17/66) of the subjects had become demented. CONCLUSIONS: Cognitive impairment short of dementia affects nearly one in four community-dwelling elders and is a major risk factor for later development of dementia.

Age Distribution↗
PubMed2000

Modular separation-based fiber-optic sensors for remote in situ monitoring.

A modular separation-based fiber-optic sensor (SBFOS) with an integrated electronically controlled injection device is described for potential use in remote environmental monitoring. An SBFOS is a chemical monitor that integrates the separation selectivity and versatility afforded by capillary electrophoresis with the remote and high sensitivity capabilities of fiber-optic-based laser-induced fluorescence sensing. The detection module of the SBFOS accommodates all essential sensing components for dual-optical fiber, on-capillary fluorescence detection. An injection module, similar to injection platforms on micro-analysis chips, is also integrated to the SBFOS. The injection module allows for electronically controlled injection of the sample onto the separation capillary. The design and operational characteristics of the modular SBFOS are discussed in this paper. A micellar electrokinetic capillary chromatography mode of separation is employed to evaluate the potential of the sensor for in situ monitoring of neutral toxins (aflatoxins). The analytical figures of merit for the modular SBFOS include analysis times of between 5 and 10 min, separation efficiencies of approximately 10(4) theoretical plates, detection limits for aflatoxins in the mid-to-low nanomolar range, and controllable operation that results in sensor performance that is largely immune to sample matrix effects.

Chromatography↗
PubMed1997

The relationship between the supply of cardiac catheterization laboratories, cardiologists and the use of invasive cardiac procedures in northern New England.

OBJECTIVES: Utilization rates of coronary angiography and cardiac revascularization have been found to vary between areas. This study addresses the relationship between resource supply and procedure rates. METHODS: We compared the association of per capita catheterization laboratories, per capita cardiologists and multi-provider markets (where more than one hospital offers coronary angiography services) with the utilization rates for angiography and cardiac revascularization in northern New England, USA. Administrative data were used to capture invasive cardiac procedures. Small area analyses were used to create coronary angiography service areas. Linear regression methods were used to measure associations between the resource supply and utilization rates. RESULTS: Variation in the use of invasive cardiac procedures was strongly associated with the population-based availability of catheterization facilities and multi-provider markets and unrelated to cardiologist supply or need (as reflected in the hospitalization rates for myocardial infarction). In the multivariate model, an increase of 1 catheterization laboratory per 100,000 population was associated with an increase in the angiography rate of 1.62 per 1000 population; those service areas with multi-provider markets were associated with an additional increase in the angiography rate of 1.27 per 1000 population (R2 = 0.84, P = 0.0006). There was a moderately strong relationship between the catheterization laboratories per capita and the revascularization rates (R2 = 0.43, P = 0.029). Angiography rates were highly associated with cardiac revascularization rates: an increase in the angiography rate of 1 per 1000 population was associated with a 0.46 per 1000 increase in the cardiac revascularization rate (R2 = 0.85, P = 0.0001). CONCLUSIONS: Our work suggests that current efforts to address variation in cardiac procedures through activities such as appropriateness criteria, guidelines and utilization review are misdirected and should be redirected towards capacity, in this case the supply of catheterization facilities.

Cardiac Catheterization↗
PubMed1993

Diagnostic dilemmas in psychiatric consultation/liaison: the problem of depression.

We use the case of a 62-year-old retired widow, referred for psychiatric evaluation by the internal medicine house staff, to illustrate the complexities of diagnosing depressive syndromes in medically ill patients. The patient's presenting symptoms included diarrhea, severe weight loss, and abdominal pain. She appeared cachectic, but diagnostic findings did not account sufficiently for the degree of weight loss observed. When symptoms failed to resolve, the psychiatric consultation was requested. Chronic cognitive symptoms, including feelings of guilt, anhedonia, and hopelessness, were noted. These symptoms had been present since the death of the patient's sister 2 years earlier. This case shows the importance of processing clinical data carefully to include both medical and psychiatric symptoms. It also reveals the need for an ongoing evaluation to gather significant information so the diagnosis can be solidified, allowing more specificity in planning treatment.

Bereavement↗
PubMed1993

An exercise therapy program for balance disorders.

Patients with chronic balance or disequilibrium disorders can be difficult to evaluate and treat, due to the complex integration of sensory systems which control balance function. There is a trend away from placing these patients on long-term sedative medication. In fact, long-term sedative medications may actually reduce or prevent central compensation. For patients with chronic balance disorders who have already been appropriately treated with medicine and/or surgery, we now strongly recommend an active exercise therapy program, which promotes central compensation and improves general fitness.

Exercise Therapy↗
PubMed1990

A structurally novel inhibitor of cGMP phosphodiesterase with vasodilator activity.

A novel, potent, competitive inhibitor of smooth muscle cGMP phosphodiesterase is described (Compound I, [4-[2-n-butyl-5-chloro-1-(2- chlorobenzyl)imidazolyl]methyl] acetate). The compound is highly selective for inhibiting cGMP phosphodiesterase compared with cAMP phosphodiesterase. Compound I inhibits the contraction of smooth muscle in response to a variety of agonists in the same concentration range to that which inhibits the enzyme. Compound I produced a dose-related reduction in the pressor responses to angiotensin II infusion while not inhibiting the responses to bolus doses of angiotensin II. Two structural analogues of Compound I which did not inhibit cGMP phosphodiesterase failed to inhibit smooth muscle contraction in vitro and did not affect angiotensin II pressor responses in vivo. We propose a mechanism to account for the effects of a cGMP phosphodiesterase inhibitor on smooth muscle contraction in vitro and in vivo.

3',5'-Cyclic-AMP Phosphodiesterases↗