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Biomedical subjects

J J Rivera

Publications and source records attributed to J J Rivera.

15 recordsLinked to original sources
PubMed2001

Caudal epidural injections with sarapin or steroids in chronic low back pain.

Epidural steroid injections are the most commonly used procedures to manage chronic low back pain in interventional pain management settings. Approaches available to access the epidural space in the lumbosacral spine include the interlaminar, transforaminal, and caudal. The overall effectiveness of epidural steroid injections has been highly variable. This study included 65 patients who underwent diagnostic facet joint nerve blocks utilizing comparative local anesthetic blocks and were shown to be negative for facet joint pain and other problems such as sacroiliac joint pain before enrollment into the study. They were randomly selected from 105 patients negative for facet joint pain allocated into three groups, with Group I consisting of 15 patients comprising a convenience control sample treated conservatively; Group II, consisting of 22 patients treated with caudal epidural with local anesthetic and Sarapin(R); and Group III, consisting of 33 patients treated with caudal epidural with a mixture of local anesthetic, and betamethasone. The study period lasted for 3 years. Results showed that there was significant improvement in patients receiving caudal epidural injections, with a decrease in pain associated with improved physical, functional and mental status; and decreased narcotic intake combined with return to work. The study showed that at 1 month 96% of the patients evaluated showed significant improvement, which declined to 56% at 3 months and 16% at 6 months, with administration of 1 to 3 injections. Cumulative relief with 1 to 12 injections was noted in 96% of the patients at 1 month, 95% at 3 months, 85% at 6 months, and 67% at 1 year. The study also showed cost effectiveness of this treatment, with a cost of $ 2550 for 1-year improvement of quality of life . In conclusion, caudal epidural injections with steroids or Sarapin are an effective modality of treatment in managing chronic, persistent low back pain that fails to respond to conservative modalities of treatments and is also negative for facet joint pain. The treatment is not only effective clinically but also is cost effective.

Journal Article↗
PubMed2001

Influence of psychological factors on the ability to diagnose chronic low back pain of facet joint origin.

This study was designed to determine the prevalence of lumbar facet joint pain in patients suffering with or without somatization disorder. The study was performed using comparative local anesthetic blocks. One hundred consecutive patients with chronic low back pain, with or without somatization, were evaluated. The results showed that, among patients suffering with chronic low back pain, 44% of the patients without somatization and 38% of the patients with somatization were positive for facet joint pain. The diagnosis of facet joint pain was not influenced by the presence or absence of somatization disorder. The evaluation also was extended to depression, generalized anxiety disorder and combinations with or without somatization thereof which showed no significant differences in the prevalence of facet joint pain. The results of this study demonstrated that the facet joint was a source of pain in chronic low back pain patients in 44% of the patients without somatization and 38% of the patients with somatization. This study also showed that there was no correlation between the presence or absence of facet joint pain and the presence or absence of somatization disorder or any other psychological condition or combination thereof.

Journal Article↗
PubMed2001

Effectiveness of percutaneous adhesiolysis with hypertonic saline neurolysis in refractory spinal stenosis.

The increasing proportion of elderly patients, coupled with increasing longevity, causes the problem of lumbosacral pain secondary to spinal stenosis of the lumbar spine to be an important issue. Symptoms of spinal stenosis are caused by entrapment and compression of intraspinal vascular and nervous structures; which may lead to inactivity, loss of productivity, and potential loss of independence, particularly in the elderly. Surgical decompression is considered as the natural treatment. However, the results of surgical treatments have been mixed. Results of conservative treatment are also not encouraging. While the effectiveness of caudal epidural blocks for lumbar canal stenosis was positive, the effectiveness of interlaminar epidural steroid injections showed no beneficial effects on symptomatology of spinal stenosis. Percutaneous epidural adhesiolysis with hypertonic saline neurolysis has been studied in patients with refractory low back pain secondary to post lumbar laminectomy syndrome, as well as spinal stenosis. The specific role of adhesiolysis and hypertonic saline neurolysis in the management of refractory low back and lower extremity pain secondary to spinal stenosis has not been studied. This retrospective evaluation included 18 patients derived from a total sample of 239 patients undergoing adhesiolysis and hypertonic saline neurolysis over a period of 3 years. The results showed significant improvement with reduction of pain; with improvement of physical health, mental health, and functional status. Improvement in psychological status was also noted, with decrease in narcotic intake. Epidural adhesiolysis with hypertonic saline neurolysis is a safe and probably effective modality of treatment in managing symptomatic moderate to severe lumbar spinal canal stenosis.

Journal Article↗
PubMed2001

Effectiveness of lumbar facet joint nerve blocks in chronic low back pain: a randomized clinical trial.

This randomized clinical trial was designed to determine the effectiveness of therapeutic lumbar facet joint nerve blocks. Two hundred patients were evaluated with controlled diagnostic blocks for the presence of facet joint mediated pain. Eighty four patients, or 42% were determined to have lumbar facet joint mediated pain. These patients were randomly allocated into two groups: Group I receiving therapeutic injections with local anesthetic and Sarapin, and Group II receiving therapeutic injections with a mixture of local anesthetic, Sarapin, and methyl prednisolone. A total of 73 patients were treated with medial branch blocks under fluoroscopy. Results showed that patients underwent multiple procedures over a period of 2(1/2) years. The mean number of procedures or interventions was 2.5 +/- 0.09 from 1 to 3 months, whereas it was 4 +/- 0.13 for 4 to 6 months, 6.1 +/- 0.21 for 7 to 12 months, and 8.4 +/- 0.31 for 13 to 32 months. Cumulative significant relief with one to three injections was 100% up to 1 to 3 months, 82% for 4 to 6 months, 21% for 7 to 12 months, and 10% after 12 months, with a mean relief of 6.5 +/- 0.76 months. There was significant improvement noted in overall health status with improvement not only in pain relief, but also with physical, functional, and psychological status, as well as return-to-work status. In conclusion, the results of this study demonstrate that medial branch blocks with local anesthetic and Sarapin, with or without steroids, are a cost effective modality of treatment, resulting in improvement in pain status, physical status, psychological status, functional status and return to work.

Journal Article↗
PubMed2000

Music perception and octave generalization in rhesus monkeys.

Two rhesus monkeys were tested for octave generalization in 8 experiments by transposing 6- and 7-note musical passages by an octave and requiring same or different judgments. The monkeys showed no octave generalization to random-synthetic melodies, atonal melodies, or individual notes. They did show complete octave generalization to childhood songs (e.g., "Happy Birthday") and tonal melodies (from a tonality algorithm). Octave generalization was equally strong for 2-octave transpositions but not for 0.5- or 1.5-octave transpositions of childhood songs. These results combine to show that tonal melodies form musical gestalts for monkeys, as they do for humans, and retain their identity when transposed with whole octaves so that chroma (key) is preserved. This conclusion implicates similar transduction, storage, processing, and relational memory of musical passages in monkeys and humans and has implications for nature-nurture origins of music perception.

Analysis of Variance↗
PubMed1998

Outcomes of homeless mentally ill chemical abusers in community residences and a therapeutic community.

OBJECTIVES: The feasibility and effectiveness of treating homeless mentally ill chemical abusers in community residences compared with a therapeutic community were evaluated. METHODS: A total of 694 homeless mentally ill chemical abusers were randomly referred to two community residences or a therapeutic community. All programs were enhanced to treat persons with dual diagnoses. Subjects' attrition, substance use, and psychopathology were measured at two, six, and 12 months. RESULTS: Forty-two percent of the 694 referred subjects were admitted to their assigned program and showed up for treatment, and 13 percent completed 12 months or more. Clients retained at both types of program showed reductions in substance use and psychopathology, but reductions were greater at the therapeutic community. Compared with subjects in the community residences, those in the therapeutic community were more likely to be drug free, as measured by urine analysis and self-reports, and showed greater improvement in psychiatric symptoms, as measured by the Center for Epidemiological Studies--Depression Scale and the Brief Psychiatric Rating Scale. Their functioning also improved, as measured by the Global Assessment of Functioning scale. CONCLUSIONS: Homeless mentally ill chemical abusers who are retained in community-based residential programs, especially in therapeutic communities, can be successfully treated.

Adult↗
PubMed1998

HIV infection risks among homeless, mentally ill, chemical misusing men.

This study attempts to identify the specific role that each of three conditions afflicting homeless, mentally ill, chemically misusing (HMICM) men plays in exposing these men to the risk of HIV infection. Three hundred and fifteen HMICM men (33 of whom were HIV+) were interviewed on intravenous drug use (IVDU) and sex practices. Two scales of risky IVDU practices and sex conducts were constructed and analyzed in relation to HIV status. The severity of homelessness, mental illness, and chemical misuse, then, were analyzed as possible predictors of risky IVDU and sex practices. Strong correlations were found between IVDU practices and HIV seropositivity, and between risky sex conduct and HIV seropositivity. Serious depression was the strongest predictor of risky IVDU practices. Prolonged homelessness was the condition most associated with risky sexual conduct. This study concludes that HMICM men are at high risk for HIV infection, stemming, predominately, from two conditions: depression, leading to risky IVDU practices, and homelessness, leading to risky sex conduct with two separate types of risky behavior.

Adult↗
PubMed1997

Memory of auditory lists by rhesus monkeys (Macaca mulatta).

Monkey auditory memory was tested with increasing list lengths of 4, 6, 8, and 10 sounds. Five-hundred and twenty environmental sounds of 3-s duration were used. In Experiment 1, the monkeys initiated each list by touching the center speaker. They touched 1 of 2 side speakers to indicate whether a single test sound (presented from both side speakers simultaneously) was or was not in the list. The serial-position functions showed prominent primacy effects (good first-item memory) and recency effects (good last-item memory). Experiment 2 repeated the procedure without the list-initiation response and with a variable intertrial interval. The results of both experiments were similar and are discussed in relation to theories and hypotheses of serial-position effects.

Animals↗
PubMed1997

Pre- and post-admission attrition of homeless, mentally ill chemical abusers referred to residential treatment programs.

AIMS: To assess the magnitude and psychopathologic predictors of attrition among homeless, mentally ill chemical abusers (MICAs) referred to residential treatment programs in New York City. DESIGN: Homeless, MICAs were randomly referred to a therapeutic community (TC) or community residence (CR) and monitored with regard to pre- and post-admission attrition. SETTINGS: Community based treatment facilities modified to treat both substance abuse and major mental illness. PARTICIPANTS: Homeless individuals with a major mental illness (DSM-III-R) and a history of abusing alcohol or other drugs. MEASUREMENTS: Attrition rates and selected scales of psychopathology. FINDINGS: From an initial pool of 694 treatment candidates, 147 (22%) were rejected for admission at their assigned facility; 247 (36%) failed to show up for treatment; and 212 (31%) dropped out of treatment at some point during the first 12 months. Contrary to expectation, those with severe levels of psychotic ideation, depressive symptoms and hostility were admitted to treatment more frequently and stayed in treatment longer at the TC, a high demand approach, than the CR, a low demand approach. CONCLUSION: Clinicians should consider the TC as a viable treatment option for MICAs.

Adult↗
PubMed1990

Naming, rehearsal, and interstimulus interval effects in memory processing.

Recognition memory was tested for lists of 6 briefly (0.08 s) presented pictures at different interstimulus intervals (ISI) of 0.08, 1, and 4 s. Experiment 1 showed a 16% performance increase (ISI effect) for increasing ISI for travel slide but not kaleidoscope pictures. Experiment 2 showed that learning names for the kaleidoscope pictures then resulted in a substantial (20%) ISI effect, not attributable solely to the added exposure to the pictures. Experiment 3 required names, color evaluations, or blank stares during list-memory presentations. Interviews established that the most effective memory strategy was chaining the names together, followed by repeating the most current name, and in turn followed by reliance upon only the sensory experience. All groups in Experiments 2 and 3, independent of ISI effects, showed U-shaped serial position functions. Rehearsal is shown to be nonessential and cannot be the general cause of the primary effect of the serial position function.

Adolescent↗
PubMed1981

Doppler ultrasound versus testicular scanning in the evaluation of the acute scrotum.

A comparative prospective study of the Doppler ultrasonogram, the testicular scan and the surgical findings in patients with an acute scrotum is presented. The testicular scan was found to be the most reliable diagnostic method since it correlated with the surgical findings in 100 per cent of the cases. The Doppler ultrasonogram proved to be useful since it gave a positive correlation in 79 per cent of the cases studied.

Adolescent↗
PubMedDate not supplied

Depressive symptoms and mentally ill chemical abusers' perception of the treatment environment in residential settings.

In assessing the socioenvironmental characteristics of psychiatric treatment programs, researchers typically assume that their measurements are unaffected by client characteristics. However, our analysis among mentally ill chemical abusers in a therapeutic community and community residences found significant associations between subscales of the Community Oriented Program Evaluation Scale (COPES) and depressive symptoms, as measured by the CES-D, after 2, 6, and 12 months of treatment. Investigators of treatment environments should consider depressive symptoms as a possible threat to the validity of their findings.

Adult↗
PubMedDate not supplied

Characteristics and treatment of homeless, mentally ill, chemical-abusing men.

Comparing two types of treatment modalities in treating homeless, mentally ill, chemical-abusing (HMICAs) men and studying their characteristics, 723 HMICAs were interviewed on their childhood and family background and their psychiatric and substance abuse disorders, and then randomly assigned into either therapeutic community (TC) or community residence (CR) programs. The TC and CRs were found to differ from one another in their intake and admission procedures, their preadmission and postadmission dropout rates, and the effects of treatment on psychological status. The TC admitted their clients into treatment faster, tended to take more impaired clients, and had a lower preadmission dropout rate than the CRs did. The CRs had a lower postadmission dropout rate and were able to retain clients longer than the TC did. Comparing clients who stayed in treatment one year or longer, the TC appears to be more effective than the CRs in reducing depressive, psychotic, and functional symptoms. HMICAs' childhood and family background reveal severe parental deprivations and high prevalence of alcohol and other drug abuse, mental illness, and criminal behavior among the clients' parents. HMICAs' characteristics suggest that these men are completely outside mainstream society. They are severely impaired psychiatrically, chronically addicted, and often involved with the criminal system, thus occupying multiple deviant roles.

Adult↗