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J J Strain

Publications and source records attributed to J J Strain.

At least 163 records · Page 9Linked to original sources
PubMed1991

Chronic illness and the physician-patient relationship: a response to the Hastings Center's "ethical challenges of chronic illness".

The following article is a response to the position paper of the Hastings Center, "Ethical Challenges of Chronic Illness", a product of their three year project on Ethics and Chronic Care. The authors of this paper, three prominent bioethicists, Daniel Callahan, Arthur Caplan, and Bruce Jennings, argue that there should be a different ethic for acute and chronic care. In pressing this distinction they provide philosophical grounds for limiting medical care for the elderly and chronically ill. We give a critical survey of their position and reject it as well as any attempt to characterize the physician-patient relationship as a commercial contract. We emphasize, as central features of good medical practice, a commitment to be the patient's agent and a determination to acquire and be guided by knowledge. These commitments may sometimes conflict with efforts to have the physician serve as an instrument of social and economic policies limiting medical care.

Attitude to Health↗
PubMed1991

Programmed cell death (apoptosis) in lymphoid and myeloid cell lines during zinc deficiency.

Three human cell lines of lymphoid (Molt-3 and Raji) or myeloid (HL-60) origin were maintained in vitro under zinc-sufficient or zinc-deficient conditions. Under these conditions, cell proliferation, viability and mode of death (apoptotic or necrotic) were assessed. All three cell types decreased their proliferative capacity and viability under conditions of zinc deficiency. Cell death in the HL-60 and Raji cultures occurred primarily via apoptosis, while most cells in zinc-deficient Molt-3 cultures died via necrosis. Apoptosis in zinc-deficient cultures of HL-60 and Raji cells was characterized by a slow decline in culture viability as cells with condensed and fragmented nuclear DNA appeared. These morphological changes were accompanied by an increase in cell buoyant density, which allowed separation of viable apoptotic cells from their non-apoptotic counterparts by means of percoll stepdensity gradients. Necrosis in zinc-deficient Molt-3 cultures was characterized by rapid loss of cell culture viability as these cells underwent direct lysis. Intact necrotic cells were easily identified by the flocculated state of their chromatin as well as the decreased basophilia of their cytoplasm. Analysis of DNA from apoptotic HL-60 and Raji cells revealed that internucleosomal DNA degradation, indicative of endogenous endonuclease activation, had occurred, whereas the nuclear DNA of necrotic Molt-3 cells remained relatively unfragmented. The different modes of cell death evoked may reflect the relative sensitivities of cells of these lineages to zinc levels in vivo.

Cell Division↗
PubMed1991

Cost offset from a psychiatric consultation-liaison intervention with elderly hip fracture patients.

OBJECTIVE: The authors hypothesized that psychiatric liaison screening of elderly patients with hip fractures would shorten the average length of hospital stay and increase the proportion of patients who returned home after discharge. METHOD: The study was performed at Mount Sinai Medical Center in New York and Northwestern Memorial Hospital in Chicago. The subjects were 452 patients 65 years or older who were consecutively admitted for surgical repair of fractured hips. During a baseline year the patients received traditional referral for psychiatric consultation. During the experimental year all the patients at Mount Sinai and the patients on one Northwestern Unit were screened for psychiatric consultation. RESULTS: The patients who received psychiatric liaison screening had a higher consultation rate than those who received traditional consultation. The rates of DSM-III disorders in the experimental year were 56% at Mount Sinai and 60% at Northwestern. The mean length of stay was reduced from 20.7 to 18.5 days at Mount Sinai and from 15.5 to 13.8 days at Northwestern, resulting in reductions in hospital costs ($647/day) of $166,926 and $97,361, respectively. Fees generated from Medicare service delivery could have paid for the $20,000 psychiatric intervention cost at each site. There was no difference, however, between the two years in the discharge placement of patients. CONCLUSIONS: Admission psychiatric liaison screening of elderly patients with hip fractures results in early detection of psychiatric morbidity, better psychiatric care, earlier discharge, and substantial cost savings to the hospital.

Aged↗
PubMed1991

Diagnosis and treatment of psychiatric disorders in medically ill inpatients.

Medical and surgical inpatients with coexisting psychiatric disorders pose several challenges to the consulting mental health professional in the general hospital. A major challenge is determining whether presenting signs and symptoms have a medical or psychiatric basis. Making such a determination requires a careful history, a mental status examination, and the utilization of bedside screening and diagnostic instruments. Recommended treatments include psychotherapy, psycho-education, and pharmacotherapy. However, psychotropic drugs must be used with caution because of potential interactions with drugs prescribed for medical conditions. Studies indicate that timely psychosocial interventions can improve the medical patient's mental health and have the potential to reduce length of hospital stay and utilization of health services.

Comorbidity↗
PubMed1990

Accuracy of weighed dietary records in studies of diet and health.

OBJECTIVE: To provide an independent evaluation of seven day weighed dietary records, which are currently accepted as the most accurate technique for assessing habitual dietary intake in studies investigating the links between diet and health. DESIGN: Subjects who had previously participated in the Northern Ireland diet and health study were reselected by stratified random sampling to represent the range of energy intakes in the study as assessed by the seven day weighed dietary record. SETTING: Northern Ireland. SUBJECTS: 31 Free living adults (16 men and 15 women). MAIN OUTCOME MEASURES: Energy intake as measured by the seven day weighed dietary record and total energy expenditure estimated concurrently by the doubly labelled water technique. RESULTS: Average recorded energy intakes were significantly lower than measured expenditure in the group overall (9.66 MJ/day v 12.15 MJ/day, 95% confidence interval 1.45 to 3.53 MJ/day). Among those in the upper third of energy intakes the mean (SE) ratio of intake to expenditure was close to 1.0, indicating accurate records (men 1.01 (0.11), women 0.96 (0.08]. In the middle and lower thirds the ratios for men were only 0.74 (0.05) and 0.70 (0.07) respectively and for women 0.89 (0.07) and 0.61 (0.07). CONCLUSIONS: These results show a serious bias in reporting habitual energy intake. If substantiated they may have wide implications for the interpretation of many nutritional studies.

Adolescent↗
PubMed1990

Patient noncompliance with self-administered chemotherapy.

The contribution of patient factors to nonadherence with self-administered cancer chemotherapy along with its prevalence was studied. Fifty-one patients with breast cancer enrolled in protocols that included the orally administered medications Cytoxan (cyclophosphamide) and/or prednisone were interviewed and assessed at five points in time over a 6-month period. Two summary measures of patient nonadherence derived by self-report were developed: (1) dosage, the overall percentage of drug missed during 26 weeks of treatment; and (2) behavioral, the percentage of behavioral events or prescribing occasions on which a criterion level of drug was missed. Twenty-two patients (43%) met criteria for noncompliance according to both behavioral and dosage definitions. Univariate analyses showed more nonadherence in the clinic and private community settings than in the academic setting. Stepwise multiple logistic regression analyses assessed the contribution of patient demographic, psychologic, and physical symptom factors on patient noncompliance. In the regression analyses patient noncompliance was associated with (1) treatment location, more nonadherence in the private community-based treatment sector than in the academic setting; and (2) income, more nonadherence among those having lower incomes. In assessing total dose requirements in clinical research trials, rates of patient nonadherence need to be considered, and treatment location controlled.

Administration, Oral↗
PubMed1990

Interventions in consultation/liaison psychiatry. Part I: Patterns of recommendations.

In a previous study, a checklist and a schema for operationalized interventions have been described. In this study, these operationalized interventions have been used in clinical practice in 820 cases. In 287 cases (35%), recommendations focusing on the medical treatment, other than diagnostic action (41%) and medication (68%), were provided. This emphasis on the intensity of medical treatment is an unreported finding. The further distribution of recommendations over the different intervention domains was: obtaining additional psychosocial information, 30%; psychosocial management on the ward, 61%, specifically its organization; discharge planning, 41%; and aftercare management, 24%. Recommendations infrequently used included: monitoring of cognition and behavior, referrals to occupational therapy and alcohol- and drug-related facilities, and a detailed specification of postdischarge care. Since consultee concordance with the consultant's recommendations is important to treatment outcome, this method of a systematic recording of operationalized recommendations is a first step toward enhancing the evaluation of treatment recommended and provided by consultation/liaison (C/L) psychiatrists. Moreover, these operationalized recommendations help advance the specification of protocols for psychiatric intervention studies.

Combined Modality Therapy↗
PubMed1990

Interventions in consultation/liaison psychiatry. Part II: Concordance.

The psychiatric consultant is dependent upon the consultee for the implementation of many of his or her recommendations. Therefore, research as to the fate of recommendations suggested to the consultee is of eminent importance. The concordance (performing a suggested recommendation) paradigm, as developed by Popkin et al. is further elaborated for biologic and psychologic, as well as social, recommendations that were described in an earlier study. The results of the assessment of consultee concordance for 317 psychiatric consultation patients are described. Specific attention is directed to the development of criteria, the method of assessment, the mechanisms underlying nonconcordance, and the description of methods to enhance concordance. This study indicates that assessment of and control for concordance needs to be an integrated part of all consultation/liaison psychiatry (C/L) intervention studies in order to document the actual implementation of recommendations, accurately assess the findings of C/L outcome research, and avoid error measurement.

Aftercare↗
PubMed1990

Differentiating major depression from adjustment disorder with depressed mood in the medical setting.

Although the psychiatric consultant in the general hospital setting is frequently called on to distinguish major depression from adjustment disorder, no studies to date have examined whether the two diagnoses are in fact distinguishable. Analysis of computerized data base records from 944 cases seen by psychiatric consultants from 1981-1987 revealed 59 cases of major depression and 130 cases of adjustment disorder with depressed mood. Patients with major depression were more likely to be older (p less than 0.001), widowed (p less than 0.001), and living alone (p less than 0.005). Patients with adjustment disorder with depressed mood received higher ratings on Axis IV (p less than 0.01), and lower severity of illness ratings (p less than 0.001) were seen later in the hospital stay (p less than 0.05), and they were more likely to be rated by the consultant as improved by the time the case was terminated (p less than 0.001). The results suggest that the two disorders may be distinguished in the consultation population and that adjustment disorder with depressed mood may have descriptive validity in the medical inpatient setting.

Adaptation, Psychological↗
PubMed1990

Sexual abuse and premenstrual syndrome: comparison between a lower and higher socioeconomic group.

Of 174 women presenting symptoms of premenstrual syndrome (PMS), 40% had a history as victims of sexual abuse. Thirty-three percent were of a high-SES (socioeconomic status) group and 52% of a low-SES group. The authors found a connection between sexual abuse and psychiatric hospitalization for women seeking treatment for PMS. Beck Depression Inventory scores were high, supporting current research indicating a prevalence of affective disorders in women seeking treatment for PMS. However, the authors found few differences between the high- and low-SES groups. Specific questioning regarding a history of adverse sexual experiences is critical in evaluating all patients.

Adolescent↗
PubMed1990

The asbestos worker who smokes: adding insult to injury.

Evaluates whether asbestos workers who smoke cigarettes, thereby increasing their cancer risk synergistically, differ from asbestos workers who choose not to smoke. Demographic, personality, psychologic, and cognitive differences were examined. Engaging in this highly detrimental health behavior was related exclusively to cognitive factors. Although current smokers were cognitively aware of their added health risk, in comparison to past and "never" smokers, they minimized the salience of awareness by fatalistically attributing their health to chance factors such as luck and by minimizing the dangers of smoking, the benefits of smoking cessation, and their own increased vulnerability to life-threatening illnesses. Results are explained in light of the apparent denial of risk. The need for physician intervention is strongly advocated.

Asbestosis↗
PubMed1990

Iron sufficiency in the population of Northern Ireland: estimates from blood measurements.

Estimates of iron status in a random sample (218 men, 283 women) of the Northern Ireland population (aged 18-64 years) were obtained from blood measurements. Multiple criteria were used to determine Fe deficiency and body Fe stores were calculated as an index of Fe sufficiency. Three distinct groups with respect to Fe stores were identified on the basis of sex and menstrual status. Estimates of body Fe stores, mean (and SD), were 13.4 (SD 5.97), 5.3 (SD 6.09) and 8.5 (SD 6.72) mM for men, woman aged 18-44 years and women aged 45-64 years respectively. The prevalence of Fe-deficiency anaemia was low, ranging from 0.5% in men to 6.6% and 4.6% in the younger and older women respectively. The prevalence of Fe deficiency was low in men (1.4%) and older women (5.7%) rising to 11.0% in the younger group of women. The disproportionately elevated serum ferritin relative to transferrin saturation supported the suggestion that chronic inflammation might have influenced Fe status measurements in men and older women.

Adolescent↗