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Biomedical subjects

M G Newman

Publications and source records attributed to M G Newman.

At least 19 recordsLinked to original sources
PubMed2003

The social phobia diagnostic questionnaire: preliminary validation of a new self-report diagnostic measure of social phobia.

BACKGROUND: The development and validation of the Social Phobia Diagnostic Questionnaire (SPDQ), a new self-report diagnostic instrument for social phobia is described in three separate studies. STUDY 1: The participants were 125 undergraduates seeking help for an anxiety disorder of whom 60 had social phobia. Receiver operating characteristics (ROC) analysis was conducted comparing SPDQ diagnoses and clinician-based Anxiety Disorder Interview Schedule-IV (ADIS-IV) diagnoses of social phobia. Diagnoses made by the SPDQ showed an 85% specificity, an 82% sensitivity and kappa agreement with the ADIS-IV of 0.66. STUDY 2: The participants were 462 undergraduates who completed the SPDQ and a battery of additional questionnaires. The SPDQ had good internal consistency (alpha=0.95), good split-half reliability (r=0.90) and strong convergent and discriminant validity. STUDY 3: The participants were 145 undergraduates who completed the SPDQ at two time points separated by 2 weeks as well as several additional questionnaires. Scores on the SAD, FNE and SISST of SPDQ categorized undergraduates were also compared to scores on these measures from 35 clinical community participants to determine the clinical validity of the SPDQ. The SPDQ had strong 2-week test-retest reliability and good convergent and discriminant validity. Undergraduates diagnosed with social phobia by the SPDQ were not significantly different on the SAD, FNE and SISST from the socially phobic community sample, but both groups had significantly higher scores than undergraduates identified by the SPDQ as not meeting criteria for social phobia, demonstrating clinical validity of the SPDQ. CONCLUSIONS: These three studies provide preliminary evidence of the strong psychometric properties of the SPDQ as a measure to identify socially phobic participants.

Adolescent↗
PubMed2001

The effect of epidural analgesia on rates of episiotomy use and episiotomy extension in an inner-city hospital.

OBJECTIVE: To determine the relationship between epidural analgesia and episiotomy usage and episiotomy extension in parturients delivering vaginally. METHODS: A database of 20 888 women experiencing spontaneous vaginal delivery at Grady Memorial Hospital from 1990 to 1995 was examined to identify those receiving epidural analgesia. Patients who underwent epidural catheter placement and had adequate perineal anesthesia at delivery comprised the epidural group, and all others comprised the control group. Demographic characteristics and obstetric outcomes were compared. Univariate and multivariate analyses were used to test the association between epidural analgesia, rates of episiotomy and episiotomy extension. RESULTS: Of the 20888 women experiencing spontaneous vaginal deliveries 6785 (32.5%) received epidural analgesia. Women receiving epidural analgesia were more likely than those not receiving epidural analgesia to be African-American and nulliparous, and to have an occiput posterior presentation. Women receiving epidural analgesia were also more likely to receive an episiotomy (27.8% vs. 13.1%, odds ratio (OR) 2.56, 95% confidence interval (CI) 2.38-2.75) and were less likely to experience a second-degree perineal laceration (11.6% vs. 14.4%, OR 0.75, 95% CI 0.69-0.82) or a third- or fourth-degree extension (8.9% vs. 12.4%, OR 0.81, 95% CI 0.68-0.97). When the results were adjusted for nulliparity, posterior presentation, macrosomia, shoulder dystocia and prolonged second stage, epidural analgesia remained independently associated with receipt of episiotomy (OR 1.97, 95% CI 1.88-2.06) and reduced episiotomy extension (OR 0.74, 95% CI 0.54-0.94). CONCLUSION: Epidural analgesia increases the rates of episiotomy use, and decreases the rate of episiotomy extension, independently of clinical factors associated with episiotomy.

Adult↗
PubMed2001

Cigarette smoking and pre-eclampsia: their association and effects on clinical outcomes.

OBJECTIVE: To determine the effects of smoking on pre-eclampsia in an inner-city, predominantly African-American prenatal population. METHODS: We performed a retrospective cohort study of all primigravidas who delivered singletons in our institution between 1980 and 1989. The study population consisted of 1862 smokers and 16,508 non-smokers. Univariate analysis and multiple logistic regression were used to identify relationships between smoking and adverse outcomes. RESULTS: The pre-eclampsia rate was significantly lower among smokers (11.3% vs. 13.0%, OR 0.85, 95% CI 0.73-0.99). Smokers with pre-eclampsia had higher rates of infants with low birth weight (OR 1.44, 95% CI 1.26-1.65) and very low birth weight (OR 1.85, 95% Cl 1.55-2.20) and higher rates of placental abruption (OR 3.49, 95% CI 1.65-7.28) compared to non-smoking pre-eclamptics. This relationship persisted after correction for age, race, chronic hypertension and pre-eclampsia as confounding variables. CONCLUSIONS: Cigarette smoking was associated with a lower rate of pre-eclampsia among primigravidas independently of other maternal factors. Perinatal outcomes were significantly worsened among pre-eclamptics who smoked.

Adolescent↗
PubMed2000

The relationship of childhood sexual abuse and depression with somatic symptoms and medical utilization.

BACKGROUND: Previous research suggests that childhood sexual abuse is associated with high rates of retrospectively reported medical utilization and medical problems as an adult. The goal of this study was to determine if abused females have higher rates of medical utilization using self-report and objective measures, compared with non-abused females. A further goal was to determine whether findings of prior research would be replicated when childhood physical abuse level was controlled. This study also examined the moderating impact of depressed mood on current health measures in this population. METHODS: Six hundred and eight women recruited from a health maintenance organization completed self-report measures of health symptoms for the previous month and doctor visits for the previous year. Objective doctor records over a 2 year period were examined for a subset of 136 of these women. RESULTS: Results showed significantly more self-reported health symptoms and more self-reported doctor visits in abused participants compared with those who reported no childhood history of sexual abuse. Objective doctor visits demonstrated the same pattern with abused participants exhibiting more visits related to out-patient surgery and out-patient internal medicine. In addition, persons who were both sexually abused and depressed tended to visit the emergency room more frequently and to have more in-patient internal medicine and ophthalmology visits than sexually abused participants who reported low depressed mood and non-abused controls. CONCLUSIONS: These results replicate prior studies and suggest that current depression may moderate the relationship between sexual abuse and medical problems in adulthood.

Adolescent↗
PubMed2000

Interleukin-1 genetic association with periodontitis in clinical practice.

BACKGROUND: Periodontitis is a bacterial disease modified by multiple risk factors. The pro-inflammatory cytokine interleukin- (IL-1) is a key regulator of the host responses to microbial infection and a major modulator of extracellular matrix catabolism and bone resorption. It has been reported that variations in the IL-1 gene cluster on chromosome 2 are associated with increased susceptibility to severe adult periodontitis. METHODS: The present study evaluated the association between a composite IL-1 genotype, including allele 2 at each of two loci (IL-1A +4845 plus IL- B +3954), and a broad spectrum of periodontally healthy to diseased patients in a population that is typically encountered in a dental practice setting. Ninety patients, non-smokers or former smokers with less than 10 pack-year (pk/yr) history, were recruited from a private dental practice. The major outcome variable was bone loss determined by computerized linear measurements of radiographs. Genotypes were analyzed from finger-stick blood samples using previously reported methods. RESULTS: Multivariate logistic regression models demonstrated that patient age, former smoking history, and the IL-1 genotype were significantly associated with severity of adult periodontitis. For non-smokers or former light smokers (<5 pk/yr), IL-1 genotype positives were at increased odds ratio of having moderate to severe periodontal disease of 3.75 (95% CI: 1.04-13.50) to 5.27 (95% CI: 1.23-22.70), depending on ethnicity, compared to IL-1 genotype negatives. Former moderate smokers (>5 pk/yr and <10 pk/yr) who were IL-1 genotype negative were at increased odds ratio of having moderate to severe periodontal disease of 7.43 (95% CI: 1.20-46.20) compared to non-smokers or former light smokers who were IL-1 genotype negative. In addition, past smoking history was also a significant effect modifier as demonstrated by the statistically significant interaction between past smoking history status and IL-1 genotype status. CONCLUSIONS: This study demonstrates that the composite IL-1 genotype is significantly associated with the severity of adult periodontitis. It also confirmed that both IL-1 genotyping and smoking history provide objective risk factors for periodontal disease in a private practice environment.

Adult↗
PubMed2000

Recommendations for a cost-offset model of psychotherapy allocation using generalized anxiety disorder as an example.

As inexpensive interventions gain empirical support, there is an increasing risk that such data may be used by health maintenance organizations to unfairly restrict the number and type of therapy sessions reimbursed for all clients, even those less likely to benefit from economical treatments. As a result, it is important to identify clients who may not respond to specific therapies and to empirically support ways to treat them. Successful treatment of nonresponders is also valuable because predictors of treatment failure tend to predict cost related to medical and disability expenses. Using generalized anxiety disorder as an example, this article suggests a flexible and comprehensive approach to cost-benefit analysis in psychotherapy that includes clients who may not improve in response to current data-based interventions. In addition, suggestions are made for the identification of alternative treatment approaches, and a potential treatment allocation model is recommended.

Anxiety Disorders↗
PubMed1999

Future directions in the treatment of anxiety disorders: an examination of theory, basic science, public policy, psychotherapy research, clinical training, and practice.

This article represents a transcribed roundtable discussion on anxiety disorders that took place at the 1998 Society for Psychotherapy Research in Snowbird, Utah. Eminent experts in the field of anxiety disorders took part in a discussion that focused on issues related to theory, basic science, public policy, therapy research, clinical training, and practice. Important topics addressed by the panel included the role of theory in research and clinical practice, the importance of psychopharmacological interventions, efficacy versus effectiveness research, the impact of public policy on research advancement, and the interface between basic science, research, and clinical practice.

Anxiety Disorders↗
PubMed1999

A palmtop computer program for the treatment of generalized anxiety disorder.

This is the first report of a palmtop computer program developed to increase the efficiency and cost-effectiveness of cognitive behavioral therapy for generalized anxiety disorder (GAD). The computer program offers advantages to researchers, therapists, and clients. These advantages include continuous, unobtrusive collection of process data on treatment adherence as well as on the impact of cognitive behavioral therapy techniques in the client's natural setting. In addition, the computer extends treatment beyond the therapy hour and motivates clients to comply with homework assignments by prompting practice of cognitive behavioral strategies. The successful application of the palmtop computer program reported in this integrated series suggests a new line of research directed toward increasing the cost-effectiveness of what is currently the gold-standard treatment for GAD.

Adult↗
PubMed1998

Improved clinical decision-making using the evidence-based approach.

This article summarizes the evidence-based approach, a comprehensive and rigorous method for evaluating information, improving decision-making and implementing clinical treatment. The participants in The American Academy of Periodontology World Workshop assessed the evidentiary status of periodontal and implant treatment using the evidence-based approach. The major goal of the Workshop was to improve treatment decisions by increasing the strength of the inference that practitioners can derive from the base of knowledge contained within the literature.

Decision Making↗
PubMed1997

Comparison of palmtop-computer-assisted brief cognitive-behavioral treatment to cognitive-behavioral treatment for panic disorder.

In the present study, the authors sought to determine whether the efficiency and cost-effectiveness of cognitive-behavioral treatment (CBT) for panic disorder could be improved by adjunctive computer-assisted therapy. Eighteen participants who met Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised; American Psychiatric Association, 1987) criteria for panic disorder were randomly assigned to a 12-session CBT (CBT 12) condition (D. H. Barlow & M. G. Craske, 1989) or to a 4-session computer-assisted CBT (CBT4-CA) condition. Palmtop computers, with a program developed to incorporate basic principles of CBT, were used by CBT4-CA clients whenever they felt anxious or wanted to practice the therapy techniques and were used by all participants as a momentary assessment tool. CBT4-CA clients carried the computer at all times and continued to use it for 8 weeks after termination of therapy. Analyses of clinically significant changes showed superiority of CBT12 at posttest on some measures; however, there were no differences at follow-up.

Adult↗
PubMed1997

The interleukin-1 genotype as a severity factor in adult periodontal disease.

Although specific bacteria, dental plaque, and age are associated with periodontal disease, there are currently no reliable predictors of periodontitis severity. Studies in twins have suggested a genetic contribution to the pathogenesis of periodontitis, but previous attempts to identify genetic markers have been unsuccessful. The pro-inflammatory cytokines interleukin-1 (IL-1) and tumor necrosis factor alpha (TNF alpha) are key regulators of the host responses to microbial infection. IL-1 is also a major modulator of extracellular matrix catabolism and bone resorption. We report a specific genotype of the polymorphic IL-1 gene cluster that was associated with severity of periodontitis in non-smokers, and distinguished individuals with severe periodontitis from those with mild disease (odds ratio 18.9 for ages 40-60 years). Functionally, the specific periodontitis-associated IL-1 genotype comprises a variant in the IL-1B gene that is associated with high levels of IL-1 production. In smokers severe disease was not correlated with genotype. In this study, 86.0% of the severe periodontitis patients were accounted for by either smoking or the IL-1 genotype. This study demonstrates that specific genetic markers, that have been associated with increased IL-1 production, are a strong indicator of susceptibility to severe periodontitis in adults.

Adult↗
PubMed1997

Evidence-based periodontal treatment. Highlights from the 1996 World Workshop in Periodontics.

State-of-the-art periodontal therapy involves a wide range of diagnostic and treatment options. The 1996 World Workshop in Periodontics used an evidence-based approach to assess the efficacy of many of these options. This article describes the evidence-based approach and summarizes the findings of the workshop in the areas of diagnosis and nonsurgical and surgical periodontal therapy as well as dental implants.

Alveolar Bone Loss↗
PubMed1997

Design and implementation of clinical trials of antimicrobial drugs and devices used in periodontal disease treatment.

The design and implementation of clinical trials (CTs) carried out to evaluate antimicrobial and anti-infective drugs and devices are one of the most difficult challenges in contemporary periodontal research and product development. The overwhelming amount of evidence which has established a microbial etiology for periodontitis is the basis for developing and testing antimicrobial treatments. Well-designed antimicrobial CTs start with a carefully crafted hypothesis and a protocol which explicitly integrates the requirements of the patient, the clinician, the sponsor, and regulatory authorities. Surrogate variables for effectiveness must be clinically relevant, scientifically sound, and statistically valid. Currently, clinical attachment level measurements and alveolar bone assessments are accepted as proof of effectiveness. Indication and claim support of the antimicrobial product guide the design and implementation of the CT. Adverse microbiologic consequences, such as lack of antimicrobial susceptibility, wrong spectrum, incorrect dosage, non-compliance, and drug interference, must be monitored. Successful CTs balance a large group of variables used to screen, randomize, and assign subjects to experimental and control groups to ensure that prognostic and risk factors are properly accounted for.

Anti-Bacterial Agents↗
PubMed1997

Genetic risk for severe periodontal disease.

The discovery of a genetic marker that is highly associated with increased risk for severe periodontitis is a major breakthrough in the clinical management of all dental patients. The marker is not diagnostic; rather, it is a prognostic test, and it is used to identify patients who are much more susceptible to plaque. Individuals who have the marker have a 6 to 19 times higher chance of getting severe periodontitis than those who do not have the marker. It is estimated that 30% of the US population will test positive. This new information supplements existing microbiology and immunology research. A limitation with the established view of the etiology of periodontal disease makes it difficult to explain to patients why they are more or less at risk based solely on their level of oral hygiene. It has also been difficult to predict the clinical outcomes of various treatments for individual patients because each person responds differently to their own plaque. The genetic discovery helps to explain why some people with a little plaque have a lot of disease, and why other people with a lot of plaque have only minor problems. By incorporating the constant factor, genetics, into your philosophy of practice, the patient's periodontal needs and desires can be better understood and managed.

Algorithms↗