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Biomedical subjects

J Shapiro

Publications and source records attributed to J Shapiro.

At least 109 records · Page 6Linked to original sources
PubMed1995

Longitudinally predicting late adolescent and young adult drug use: childhood and adolescent precursors.

OBJECTIVE: To examine the childhood and adolescent personality determinants of young adult drug use. METHOD: Data were obtained on children when they were approximately 5.5 (time 1; T1), 14 (T2), 16 (T3), and 22 (T4) years of age. T2-T4 interviews of subjects and their mothers assessed child personality and behavior. At T1, 976 mothers were interviewed. The analysis was based on 734 subjects. RESULTS: Specific childhood and adolescent personality traits are related to stage of drug use in young adulthood. Regressions showed that (1) traits at T2 and T3 mediated the effect of traits at earlier ages on T4 drug use and (2) stage of drug use was stable from T3 to T4 despite controlling for personality. Significant interaction revealed two buffers weakening the effect of T3 drug use on T4 drug use. Many more T1-T3 personality traits, particularly low aggression, enhanced the effect of low T3 use on T4 use. CONCLUSIONS: Earlier findings that childhood personality is related to adolescent personality and then to drug use were extended to young adulthood. This mediational model indicates the stability of personality across development. Despite this stability, other results suggest ways to modify drug use.

Adolescent↗
PubMed1994

CSF inositol in schizophrenia and high-dose inositol treatment of schizophrenia.

Inositol is a key metabolite in the phosphatidylinositol cycle, which is a second messenger system for serotonin-2 receptors that have been implicated in the pathophysiology of schizophrenia. Cerebrospinal fluid inositol levels were measured in 20 schizophrenic patients and 19 age- and sex-matched controls and no difference was found. However, the patients were all neuroleptic-treated. A controlled double-blind crossover trial of 12 g daily of inositol for a month in 12 anergic schizophrenic patients, twice the dose given before in schizophrenia, did not show any beneficial effects. However, the number of patients studied was small and the length of time of inositol administration may not have been sufficient.

Adult↗
PubMed1994

How medical students think about ethical issues.

BACKGROUND: Although bioethics has become an established part of medical school curricula, relatively little is known about how students apply didactic material to clinical problem-solving situations. METHOD: Each of 92 second-year students (54 men and 38 women) at the University of California, Irvine, College of Medicine in 1991-92 wrote a paper identifying and attempting to resolve a clinical ethical dilemma of his or her choice. The papers were then coded for content, use of ethical theories and principles, degree of resolution, and level of personal orientation (i.e., evidence of personal involvement in the dilemmas). Data were analyzed by student sex and age, using chi-square tests of significance and correlational analysis. RESULTS: The students had no difficulty in identifying a range of ethical dilemma. Most students appeared to have understood and become familiar with the major ethical theories and principles currently in use, and to have employed them correctly. A majority of the students were able to successfully resolve their ethical dilemmas. Differences between the men and the women students were found regarding choice of topic, ethical principles used (p = .03), and level of personal orientation (p < .01). CONCLUSION: The women tended to be interested in issues involving broad social perspectives; to favor arguments emphasizing the rights of patients and families; and to incorporate personal responses, as well as abstract theories, in their assays. The men tended to be interested in issues involving personal control, authority, and responsibility; to advocate utilitarian, cost-containment thinking, and to rely exclusively on abstract, logical arguments. Further research should determine whether these differences can be identified in actual clinical decision making, and whether the differences have implications for the nature or quality of clinical decisions.

Attitude↗
PubMed1994

How will we use clinical guidelines? The experience of Medicare carriers.

While support for the development of clinical guidelines is widespread, there is little agreement about how they should be used. Because cost control is the force behind the medical effectiveness movement, the payers' preference, to link clinical guidelines to reimbursement, will likely prevail. We examine the utilization review programs of Medicare Part B carriers and the carriers' attempts to use clinical guidelines to determine medical necessity for the purpose of payment. We find that because the utilization review programs are driven by concerns about cost control, the carriers' actual review process relies on aggregate utilization and spending targets that have little to do with clinical guidelines. The carriers' medical review rhetoric--using the terms medically unnecessary and fraud and abuse as synonyms--also highlights their focus on cost control and the lack of concern about why services are used inappropriately.

Attitude of Health Personnel↗
PubMed1994

Educational/support group for Latino families of children with Down syndrome.

Experiences and observations based on an ongoing parent education-support group for Mexican-origin Latino parents of children with Down syndrome were described. Culturally mediated concepts were discussed in terms of their relevance to specific aspects of group functioning, including group structure, membership, and leadership. Problems of particular concern to this population that might adversely affect maintenance and growth of the group were also examined. Finally, the potential value of such support groups for this parent population were considered as were guidelines for enhancing the group experience.

Adult↗
PubMed1994

The process of faculty-mentored student research in family medicine: motives and lessons.

BACKGROUND AND OBJECTIVES: Research suggests that the strongest predictor of postgraduate research activity is medical student research involvement. Yet many medical students still regard family medicine as a "nonresearch" specialty. The purposes of this study were to discover what motivated a group of first-year medical students (and their faculty mentors) to participate in a summer research assistantship and how both groups evaluated the challenges and satisfactions of the experience. METHODS: The study used a grounded theory qualitative methodology that emphasizes an in-depth, inductive approach to evaluation research. Over a 2-year period, 11 first-year medical students who participated in a summer research assistantship and their 10 faculty mentors completed written questionnaires and were interviewed by our research team. Various categories of analysis were constructed and refined over the course of the study to explain the raw data collected through interviews, written questionnaires, and field notes. RESULTS: Findings included identification of a core theme or meaning that motivated participation in the project for students and faculty. This theme was expressed in terms of professional, personal, relational, and societal goals. The study also identified three interrelated mechanisms (socialization, relationship, and technical skill transmission) used in varying degrees by students and faculty to achieve these goals. CONCLUSION: In addition to technical mastery and knowledge, students were actively seeking professional relationships with faculty mentors, greater understanding of other peoples and cultures, and increased self-understanding and self-esteem. Junior and senior faculty reflected differing and multilevel motivations for participating in a research assistantship program.

Adult↗
PubMed1993

Inositol treatment raises CSF inositol levels.

Inositol is a key precursor for synthesis of phosphatidylinositol in a major second messenger signalling system. It is biologically active in syndromes such as respiratory distress syndrome but has been thought to be excluded from CNS by the blood-brain barrier. Oral inositol treatment of 8 patients is shown to significantly increase CSF inositol by almost 70%, suggesting possible CNS therapeutic applications of this compound and possible CNS side-effects of systemic therapy.

Adult↗
PubMed1993

The role of cricopharyngeus muscle in pharyngoesophageal disorders.

The cricopharyngeus muscle is generally thought to be responsible for the high pressure zone of the pharyngoesophageal (upper esophageal) sphincter. In this review we critically examined the evidence for the role of the cricopharyngeus muscle in the manometric pharyngoesophageal sphincter. The available studies show disparities between the anatomic location of the cricopharyngeus muscle and the manometric high pressure zone of the pharyngoesophageal sphincter. The cricopharyngeus muscle seems to correspond to the distal 1/3 of the sphincteric high pressure zone and the peak high pressure zone appears to be located proximal to the cricopharyngeus muscle. The discrepancy between the upper high pressure zone and the anatomic cricopharyngeus is important in understanding the role of the cricopharyngeus muscle in the pathophysiology and treatment of clinical disorders of the pharyngoesophageal sphincter.

Esophageal Diseases↗
PubMed1993

Treatment of chronic severe alopecia areata with topical diphenylcyclopropenone and 5% minoxidil: a clinical and immunopathologic evaluation.

BACKGROUND: Topical diphenylcyclopropenone (DPCP) and minoxidil have been used in the treatment of alopecia areata with variable results. OBJECTIVE: This study was designed to evaluate the efficacy of DPCP alone or in combination with topical 5% minoxidil for the treatment of chronic severe alopecia areata. The effect of therapy on cutaneous T-cell and Langerhans cell subpopulations and intercellular adhesion molecule-1 (ICAM-1) expression was also examined. METHODS: Fifteen patients with chronic (more than 2 years), severe (more than 50% scalp involvement) alopecia areata participated in a 24-week trial. Half of the scalp was treated with DPCP once weekly and with either 5% minoxidil solution or a vehicle solution twice daily in a randomized double-blind design. Skin biopsy specimens from each half of the scalp were obtained before therapy and after 12 and 24 weeks of therapy for histologic and immunophenotypic analysis. RESULTS: Thirteen patients completed the study. Five of 13 patients (38%) showed marked regrowth of coarse terminal hair after 24 weeks of treatment with DPCP. The addition of topical 5% minoxidil did not produce any significant clinical benefit in this 24-week trial. Immunophenotypic analysis showed no differences between responders and nonresponders at baseline. During treatment, Leu-4, Leu-2, Leu-3, and keratinocyte ICAM-1 expression were significantly reduced in biopsy specimens of responders versus nonresponders. CONCLUSION: DPCP treatment showed a 38% success rate in producing cosmetically acceptable regrowth in patients with chronic severe alopecia areata.

Administration, Cutaneous↗