The Northern Ireland dietary survey and related studies.
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Adolescent↗
Biomedical subjects
J J Strain
Publications and source records attributed to J J Strain.
Simultaneous measurement of free-living energy expenditure by the doubly labeled water method and heart-rate monitoring.
Total energy expenditure (TEE) was measured simultaneously in 14 free-living adults over 15 d by the doubly labeled water (DLW) method and for 2-4 separate days by heart-rate (HR) monitoring. Individual curves for HR vs oxygen consumption (VO2) were obtained and an HR (FLEX HR: 97 +/- 8 beats/min, range 84-113 beats/min) that discriminated between rest and activity was identified. Calibration curves were used to assign an energy value to daytime HR above FLEX HR. Below FLEX HR energy expenditure was taken as resting metabolism. Sleeping energy expenditure was assumed to be equal to basal metabolic rate. Average HR TEE (12.99 +/- 3.83 MJ/d) and average DLW TEE (12.89 +/- 3.80 MJ/d) were similar. HR TEE discrepancies ranged from -22.2% to +52.1%, with nine values lying within +/- 10% of DLW TEE estimates. The FLEX HR method provides a close estimation of the TEE of population groups. However, an increased number of sampling days may improve the precision of individual estimates of TEE.
Activities of Daily Living↗
Effect of dietary homocysteine on copper status in rats.
The effect on copper status of diets containing homocysteine, an intermediate in the transsulfuration pathway of methionine metabolism, was investigated in rats. Two groups of six male weanling Sprague-Dawley rats were provided with deionized water and pair-fed diets that were adequate (14.0 mg/kg) or deficient (1.3 mg/kg) in Cu to groups fed diets similarly adequate or deficient in Cu but containing DL-homocysteine (10 g/kg). Hemoglobin concentration, tissue Cu levels and the activities of the Cu-dependent enzymes--ceruloplasmin, superoxide dismutase and cytochrome c oxidase--were markedly lowered by Cu-deficient diets and by homocysteine. These dietary treatments also lowered the activity of glutathione peroxidase and produced concomitant increases in the activity of manganese-dependent superoxide dismutase and iron levels in the liver. However, dietary homocysteine decreased hepatic Mn and low Cu diets decreased cardiac iron content. Moreover, both dietary treatments significantly lowered kidney Fe levels. Homocysteine increased heart, liver and kidney weights (g/100 g body tissue) and greatly elevated the level of thiobarbituric acid reactive substances (TBARS) in heart tissue. These results indicate that dietary homocysteine can markedly lower Cu status in rats and result in tissue redistribution of Fe and increased cardiac levels of TBARS, a measure of lipid peroxidation.
Animals↗
Benzodiazepine use by chronic pain patients.
Of 114 patients presenting to the Pain Management Service at the Mount Sinai School of Medicine with chronic pain, 38% (N = 43) were taking one or more benzodiazepine drugs at the time of the initial assessment. The majority of patients were chronic users, with 14% (N = 6) having taken the medications for 1-2 years and 46% (N = 20) for 2 years or longer. Ninety-three percent (N = 40) of those given a benzodiazepine drug stated that it was initiated after the onset of pain. Although 86% (N = 37) were using the medication (all or in part) to improve sleep, they continued to report as many problems with sleep as the nonbenzodiazepine group did. Other drugs prescribed concurrently with the benzodiazepine drugs were narcotic drugs (58% of patients), antidepressant drugs (32%), nonsteroidal antiinflammatory agents (26%), and others (16%). Benzodiazepines have been reported to provide little therapeutic benefit to chronic pain patients, and may even exacerbate their symptoms. We have shown that benzodiazepine drugs are frequently prescribed for long-term use, for sleep, and in conjunction with narcotic drugs. Such use is contrary to generally accepted guidelines.
Adult↗
Issues in the identification of premenstrual syndromes.
Lack of information about the natural history of the premenstrual syndromes may make efforts regarding classification and treatment misguided. Thus, we report a naturalistic and noninstrusive approach to the problem of identification of the premenstrual syndromes, with particular focus on the issue of compliance with 2 months of daily prospective recordkeeping. Seventy-nine patients presenting for treatment of severe premenstrual symptoms were evaluated with a structured interview, psychological tests, and 2 months of daily prospective ratings of their symptoms. Weekly group follow-up meetings were held to foster compliance with recordkeeping. The typical woman seeking treatment for premenstrual symptoms in this study was middle-aged, highly educated, highly functioning, living in an urban setting, either married with children and family responsibilities or single and living alone, and supporting herself by a high-level job. She was anxious and depressed with multiple medical and gynecological problems. Despite a highly stressful life, she functioned at a very high level, but had consulted mental health professionals in the past. In general, she did not want medication. Consistent with other reports, only 20% of women seeking treatment for premenstrual symptoms had a premenstrual syndrome prospectively confirmed on the basis of 2 months of daily ratings. However, 81% of those with a prospectively confirmed premenstrual syndrome stated that after the 2-month evaluation period their symptoms no longer interfered with their functioning.
Adolescent↗
Excess dietary methionine decreases indices of copper status in the rat.
Two groups (n = 5) of male weanling Wistar rats were housed individually and fed copper (Cu)-deficient (0.5 mg Cu/kg) diets either with or without methionine supplementation (18 g/kg) for 49 days. Plasma caeruloplasmin (EC 1.16.3.1) and erythrocyte superoxide dismutase (EC 1.15.1.1, CuSOD) activities were measured in blood. Tissue Cu levels and the activities of cytochrome c oxidase (EC 1.9.3.1, CCO) and CuSOD were measured in the heart and liver. Hepatic activities of the sulfhydryl-sensitive enzymes, creatine kinase (EC 2.7.3.2), fumarase (EC 4.2.1.2) glutathione S-transferase (EC 2.5.1.18) and lipoamide dehydrogenase (EC 1.6.4.3) were also measured. Apart from cardiac CCO activity all of the measured indices of Cu status were found to be significantly (p less than 0.05) decreased in the methionine supplemented rats. Although fumarase activity was significantly (p less than 0.05) decreased in the methionine-supplemented animals compared with controls, the activities of the other sulfhydryl-sensitive enzymes were not significantly decreased. These results suggest that some of the toxic effects of excess dietary methionine may be mediated through interference with copper metabolism rather than through the previously postulated inhibition of sulfhydryl-sensitive enzymes by metabolites of methionine.
Animals↗
Religious belief, depression, and ambulation status in elderly women with broken hips.
The authors studied the relationship between religious belief and psychiatric and medical status in 30 elderly women recovering from the surgical repair of broken hips. Religious belief was associated with lower levels of depressive symptoms and better ambulation status.
Age Factors↗
Change in diagnosis at termination of psychiatric consultation.
Changes in 358 initial diagnoses made by psychiatric consultants in a medical inpatient setting were examined. Initial diagnoses from five groups--major depression, adjustment disorder with depressed mood, dementia, delirium, and the somatoform disorders--were compared with diagnoses made at termination of consultation. Differences in stability of diagnosis between the groups failed to reach significance (pz = .078). However, a trend was found for diagnoses of major depression to be the least stable; 21.7 percent of initial diagnoses were changed by termination. The results emphasize the provisional nature of initial psychiatric diagnoses in the medical setting and suggest the need for repeated assessment of the patient before beginning potentially hazardous treatment, especially for major depression.
Diagnosis, Differential↗
Follow-up of psychiatric comorbidity in the general hospital.
Although appropriate follow-up is an important task in the consultation setting, little attention has been directed to its frequency, or the risk profile for minimal or maximal follow-up. Eight hundred twenty-three patients from 1983 to 1986 were examined at the Mount Sinai Hospital using a computerized psychiatric consultation database that recorded demographic information, reason for referral, DSM-III 5 Axes diagnosis, recommendations and number of follow-up interviews. Forty-two percent of the consultations had three or less (minimum) follow-up visits. The minimum follow-up group were significantly less often referred for depression or diagnosed as depression (p = .01), had fewer psychosocial stressors (Axis III) (p = .03), and recommendations for psychosocial treatment by the psychiatric consultant (p = .0001), but had significantly more personality disorders (Axis II) (p = .04). Sixty-two percent of the consultation patients were correctly classified into the follow-up groups by the variables: 1) marital status; 2) living situation; 3) problem assessed as chronic illness or pain; 4) absence of an Axis I diagnosis or diagnostic uncertainty; and 5) number of recommendations by the consultant.
Chronic Disease↗
The evolution of quality of life evaluations in cancer therapy.
Patients' feelings, psychological and functional status, and quality of life have often been regarded as unmeasurable subjective entities that cannot be scientifically studied. But now, with better measurement tools, the cancer patient's Quality of Life can be understood in more operational terms than the "soft" subjective statements that have too often characterized the field to date. This paper addresses the issue of Quality of Life from several perspectives: 1. Historical antecedents of the concept; 2. precipitating factors; 3. evolution of the concept; 4. historical development of the measures; and 5. applications of Quality of Life assessments, including implications for research, teaching, and clinical care.
Attitude to Health↗
Evaluation and treatment of mental disorders in patients with AIDS.
Mental symptoms are common in patients with AIDS. Optimal management involves the identification and treatment of underlying mental disorders rather than symptomatic treatment alone. Organic mental disorders are very frequent in AIDS, particularly with seriously ill patients who are medical inpatients. There is a high priori probability that such common symptoms as agitation, irritability, and insomnia will be caused by an organic mental disorder. Psychopharmacology in the patient with AIDS requires considerable caution. Lower doses and careful surveillance for subtle neuropsychiatric side effects are necessary. Routine medical contact with a compassionate physician may be of inestimable value to the patient in coping with the fear and dread that surround the illness.
AIDS Dementia Complex↗
Dietary saturated or polyunsaturated fat and copper deficiency in the rat.
Dietary fat-type and copper (Cu) deficiency have been independently identified as potentially important factors in the etiology of ischemic heart disease (IHD); a disease that has been linked to inflammation and oxygen free radical (OFR) mediated damage. Group (n = 6) of male, weanling, Wistar rats were provided ad libitum with deionized water and control or low Cu diets containing (200 g/kg) either saturated or polyunsaturated fatty acids (SFA or PUFA, respectively) for 56 d. Measurement of several indices of Cu status indicated that both groups fed the low Cu diets were Cu-deficient. SFA consumption resulted in significantly increased hepatic Cu (p less than 0.001) and iron (Fe) (p less than 0.001) concentrations and xanthine oxidase activity (p less than 0.05) and significantly decreased hepatic glucose-6-phosphate dehydrogenase activity (p less than 0.001). Although Cu deficiency resulted in significantly decreased hepatic copper-zinc superoxide dismutase (CuZnSOD) activity (p less than 0.01), no significant effect on the activities of the other hepatic antioxidant enzymes, manganese superoxide dismutase, catalase, and glutathione peroxidase, or glutathione reductase, were observed. Cu deficiency also resulted in significantly decreased hepatic Cu levels (p less than 0.001) and cytochrome c oxidase activity (p less than 0.01). No significant difference in hepatic thiobarbituric acid reactive substances (TBARS), a measure of lipid peroxidation, was found between groups consuming SFA or PUFA, but both Cu-deficient groups exhibited significantly increased hepatic TBARS (p less than 0.001), compared to controls. This was probably owing to the significantly decreased hepatic CuZnSOD activity observed in the Cu-deficient, compared to control animals.
Animals↗
Critical issues in the review of diagnostic criteria for "adjustment disorders" and "psychological factors affecting physical condition".
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Adjustment Disorders↗
Psychiatric consultation on an otolaryngology liaison service.
Otolaryngology patients (especially those with tracheostomies) present a significant challenge to psychiatrists from both a diagnostic and therapeutic standpoint. To date, no study has been made of psychiatric disorders among this important group of patients. At the Mount Sinai Medical Center, a liaison psychiatrist has been involved with a specialized otolaryngology cluster unit since 1979. Using a 384-item computerized database protocol developed at Mount Sinai, data on 139 otolaryngology patients were recorded and compared with 1662 "Other" inpatient psychiatric consultations on the medical and surgical services during 1980-1987. The otolaryngology patients as a group were more likely to be male (p = 0.011), married (p = 0.001) and employed (p less than 0.001). Cancer was the most common medical disorder, and the average level of stress as reported on DSM-III's Axis IV (5.1, severe) was significantly greater (p less than 0.0001) than that for the "Other." The most common psychiatric response was adjustment disorder (36%). The length of stay of those ENT patients seen in psychiatric consultation was 26.4 days, in contrast to 11.1 days for all ENT patients. However, the length of stay of those patients on ENT receiving a psychiatric consultation was not different from the "Other" psychiatric consultation cohort (26.3 days). Despite the higher level of stress, the incidence of significant psychiatric morbidity was lower for the ENT cohort. The primary effect of the liaison psychiatrist was to lower the threshold for case identification that enhanced the referral rate on the ENT unit.
Adaptation, Psychological↗
Consultation--liaison psychiatry. Possibilities for the 1990s.
In order for consultation-liaison (C/L) psychiatry to enhance its acceptance and funding, carefully designed outcome studies that will demonstrate its clinical effectiveness to other disciplines in medicine, departments of psychiatry, hospital administration, third-party payors, and patients are required. The development of alternative methods of funding C/L services is described: (1) high-risk screening, renal transplant, geriatric units (Medicare); (2) salary stipends from collaborating disciplines, e.g., medicine, ENT, neoplastics; (3) consultation fees; (4) ambulatory C/L clinics (Medicaid); and (5) grants from collaborative research. With a change in structure when it can be employed (from consultation to the screen methodology), the development of scientifically derived outcome data of C/L psychiatry interventions, adequate documentation of the evaluation and treatment by C/L psychiatry, and the new tools biological psychiatry and psychopharmacology will provide, the 1990s could and should be an exciting time for this subspecialty of psychiatry.
Forecasting↗
Somatoform disorders in the general hospital inpatient setting.
The somatoform disorders present dilemmas on acute inpatient medical/surgical services because they may closely mimic authentic physical illness and result in misapplied medical treatment. However, there have been few diagnostic studies of this important group in the medical/surgical inpatient setting. Inpatient psychiatric consultations at Mount Sinai Medical Center during 1980-1987 were recorded using a 384-item computerized data base protocol. DSM-III somatoform disorders were identified in 33 of 1801 initial consultations (1.8%) and in 35 of 1363 at time of termination (2.6%); demographic and diagnostic characteristics of somatoforms and others were compared. The question of a psychogenic component to the illness and problem with pain management were the most common stated reasons for consultation. Somatoform patients were more likely than others to be female (p less than 0.05), Hispanic (p less than 0.05), and to have Axis II comorbidity (p less than 0.001). Axis III comorbidity was present in 94%. Thirty-one percent of patients diagnosed as somatoform on final follow-up assessment had not been diagnosable as somatoform on initial assessment. The findings emphasize the necessity of ongoing assessment in improving diagnostic certainty, as well as the prevalence and importance of medical comorbidity among patients with somatoform disorders in this setting.
Hospitals, General↗
DSM-IV issues for consultation psychiatry.
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Adjustment Disorders↗
Effects of copper deficiency on hepatic and cardiac antioxidant enzyme activities in lactose- and sucrose-fed rats.
1. A number of dietary sugars are known to mediate the effects of copper deficiency. The effects of lactose (compared with sucrose) and a dietary Cu deficiency on hepatic and cardiac antioxidant enzyme activities and tissue mineral element status were investigated in the rat. 2. Groups (n 6) of male weanling Wistar rats were provided ad lib. with deionized water and diets containing sucrose (580 g/kg) or sucrose and lactose (387 g/kg and 193 g/kg respectively) with either control (12.0 mg/kg) or deficient (1.5 mg/kg) quantities of Cu for 77 d. 3. Animals consuming the low-Cu diets exhibited significantly decreased tissue Cu levels (P less than 0.01), hepatic and cardiac cytochrome c oxidase (EC 1.9.3.1, CCO) activities (P less than 0.01 and P less than 0.001 respectively) and hepatic Cu-zinc superoxide dismutase (EC 1.15.1.1, CuZnSOD) activity (P less than 0.05). The low-Cu diets also significantly decreased cardiac manganese superoxide dismutase (EC 1.15.1.1, MnSOD), catalase (EC 1.11.1.6) and glutathione peroxidase (EC 1.11.1.9, GSH-Px) activities (P less than 0.01, P less than 0.05 and P less than 0.001 respectively). 4. Hepatic Mn was significantly increased in both lactose-fed (P less than 0.001) and Cu-deficient (P less than 0.01) animals. These increases were unrelated to hepatic MnSOD activity. Cardiac Zn was significantly (P less than 0.01) increased in Cu-deficient animals. 5. Lactose feeding resulted in significantly increased cardiac CCO activity (P less than 0.001) but significantly decreased hepatic CuZnSOD (P less than 0.05), catalase (P less than 0.01) and GSH-Px (P less than 0.001) activities. 6. The activities of lactose dehydrogenase (EC 1.1.1.27, LDH) and glucose-6-phosphate dehydrogenase (EC 1.1.1.49, G6PDH) were found to be significantly (P less than 0.05 and P less than 0.01 respectively) increased in Cu-deficient animals and G6PDH activity was significantly (P less than 0.01) decreased as a result of lactose consumption. 7. The observed changes in antioxidant enzyme activities associated with both Cu deficieny and lactose consumption may have important implications for the development of free radical mediated cell damage. However, no significant differences in either hepatic or cardiac levels of thiobarbituric acid reactive substances, a measure of lipid peroxidation, were found.
Animals↗