How to evaluate suspected immunodeficiency.
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Child↗
Biomedical subjects
M S Kaplan
Publications and source records attributed to M S Kaplan.
Firearm suicide among older women in the U.S.
Contrary to the common view that older women (65+) in the United States use suicide methods that have relatively low potential for death, firearms have become the most common suicide method in this group. The present study examines the association between demographic and geographic factors and the use of firearms vs other suicide methods. Data were derived from the National Center for Health Statistics (NCHS) Mortality Detail Files (1989-1991). Results from a logistic regression analysis indicate that among white women 65 and over who died by suicide in 1989-1991, the risk of using firearms varied significantly across demographic and geographic subcategories of the population. The following characteristics among women were significantly more likely to be associated with the use of firearms as a suicide method: ages 65-74, married, of lower educational attainment, in nonmetropolitan areas, and in the South. Research is needed to assess the effects of limiting firearms on the growing proportion of firearm-related suicides among older women.
Age Factors↗
Distress and coping among women with HIV infection: preliminary findings from a multiethnic sample.
In a multiethnic sample of 53 women with HIV/AIDS, nearly 40% reported clinically significant levels of depression symptomatology and anxiety. Compared to a nonpatient norm, distress levels were higher among the Latina, African-American, and white women who made up the HIV sample. Prayer and rediscovery of self were their most frequent coping responses, suggesting that clinicians working with HIV/AIDS populations not overlook the importance of spiritual faith and practices in adapting to HIV infection.
Adaptation, Psychological↗
Social patterns of smoking behavior: trends and practice implications.
In this article the authors contend that the social work profession has paid scant attention to the problem of tobacco use. The article reviews the literature on the health effects of tobacco, the impact of smoking on vulnerable populations, and the marketing practices of the tobacco industry. The underlying premise is that personal behavior is heavily influenced by the political and social environment and that from childhood on individuals are enticed to smoke. The article makes recommendations for political action, including coalition building, community organizing, and political advocacy.
Adolescent↗
Sociodemographic predictors of firearm suicide among older white males.
Compared to women, younger males, and other racial/ethnic groups in the United States, white males 65 and over have the highest suicide rates. Using the Mortality Detail Files (1989-1991), this study examined the sociodemographic factors associated with late life firearm (vs other methods) suicide among white males. White males aged 65-84 residing in nonmetropolitan areas who were married, divorced, or widowed and with less than a high school education were significantly more likely to have killed themselves with a firearm than with other methods. Policy initiatives and community interventions should incorporate knowledge of those demographic subgroups most at risk for firearm suicide.
Aged↗
Scatter and attenuation correction for 111In based on energy spectrum fitting.
A combined scatter and attenuation correction that does not require a transmission scan is proposed for 111In imaging. Estimates of the unscattered intensity at both 171 and 245 keV are obtained by fitting the observed energy spectrum at each pixel or region of interest using the measured scatter-free spectrum and a simple model for scatter. The scatter model for the 171 keV peak accounts for scatter contributed by both the 171 and 245 keV emissions. After correcting for scatter, the attenuation is estimated from the observed ratio of photopeak intensities using the known difference in attenuation at the two emission energies and a model based on a point source in water. Accurate scatter correction is a prerequisite for the success of this method because scatter from the higher energy emission will otherwise contaminate the lower photopeak. This differential attenuation method (DAM) of estimating attenuation is demonstrated and calibrated using a series of point source measurements with a wedge-shaped attenuator. The observed absolute and differential attenuation are in good agreement with the narrow-beam linear attenuation coefficients for water. Estimates of precision suggest a depth resolution of 1.0-2.5 cm for realistic count densities over the clinically relevant depth range (0-25 cm). The accuracy of DAM in a more realistic attenuation environment is assessed using a hot sphere inside the anthropomorphic data spectrum torso phantom viewed from several angles (with differing attenuation). Finally, the potential of DAM for SPECT attenuation correction was investigated by computer simulation using the SIMSET Monte Carlo software. Preliminary results based on measured planar data and simulated SPECT data indicate that DAM can improve the quality and quantitative accuracy of 111In images. In one SPECT simulation study, the average error in tumor to soft-tissue ratios was reduced from 32% for uncorrected data to 8% for data corrected with DAM. However, the technique is susceptible to significant noise amplification and can cause substantial streak artifacts in low-count SPECT studies if sufficient smoothing of the depth estimates is not performed.
Biophysical Phenomena↗
Firearm suicide among older men.
Data from the Compressed Mortality File for the years 1979 to 1991 were analyzed to determine epidemiologic trends in the rates of suicide by firearms among three age groups of white and black men age 65 and older (65 to 74 years, 75 to 84 years, and 85 years and older). In 1991, among men age 65 and older, firearms accounted for 80 percent of all suicides. Firearm suicide rates increased significantly over time among white men in all three age groups, especially those age 75 and older, and among black men between the ages of 75 and 84. Clinicians should regularly conduct a firearm-availability history with elderly men who are depressed or suicidal.
Age Factors↗
Managing elder suicide: a profile of American and Canadian Crisis Prevention Centers.
Suicides among older adults in the United States and Canada in the last decade have accounted for an increasing share of all suicides. In both countries the use of firearms among older adults has steadily increased. Despite these trends, little is known about the extent to which crisis centers are prepared to prevent elder suicide. A survey of AAS-listed crisis prevention centers examined the training, knowledge, and current practices relevant to elder suicide among personnel in 321 crisis prevention centers in both countries. Results revealed insufficient training, a lack of familiarity with recent suicide trends, and limited outreach to older adults.
Adult↗
Energy-based scatter corrections for scintillation camera images of iodine-131.
UNLABELLED: The use of high-dose 131I antibody therapy requires accurate measurement of normal tissue uptake to optimize the therapeutic dose. One of the factors limiting the accuracy of such measurements is scatter and collimator septal penetration. This study evaluated two classes of energy-based scatter corrections for quantitative 131I imaging: window-based and spectrum-fitting. METHODS: The window-based approaches estimate scatter from data in two or three energy windows placed on either side of the 364-keV photopeak using empirical weighting factors. A set of images from spheres in an elliptical phantom were used to evaluate each of the window-based corrections. The spectrum-fitting technique estimates detected scatter at each pixel by fitting the observed energy spectrum with a function that models the photopeak and scatter, and which incorporates the response function of the camera. This technique was evaluated using a set of Rollo phantom images. RESULTS: All of the window-based methods performed significantly better than a single photopeak window (338-389 keV), but the weighting factors were found to depend on the object being imaged. For images contaminated with scatter, the spectrum-fitting method significantly improved quantitation over photopeak windowing. Little difference, however, between any of the methods was observed for images containing small amounts of scatter. CONCLUSION: Most clinical 131I imaging protocols will benefit from qualitative and quantitative improvements provided by the spectrum-fitting scatter correction. The technique offers the practical advantage that it does not require phantom-based calibrations. Finally, our results suggest that septal penetration and scatter in the collimator and other detector-head components are important sources of error in quantitative 131I images.
Gamma Cameras↗
The growing use of firearms by suicidal older women, 1979-1992: a research note.
Suicide among older women (65+) has received very little attention despite increasing numbers of suicides in this population. An examination of national mortality data from the National Center for Health Statistics for the years 1979 through 1992 shows an increasing trend in rates of suicide among older women and a declining trend among women under 65. Over the 14-year period, firearms replaced poisoning as the most prevalent method of suicide by women 65 and over. The results seem consistent with the assertion that the availability, familiarity, and cultural acceptability of firearms may play a role in the choice of suicide method among older women. Although violent death and the use of firearms are generally associated with males in our society, the trends reported here indicate that greater attention to firearm suicides among older women is warranted.
Age Factors↗
Reducing the risk of falls among the elderly.
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Accidental Falls↗
The Adolescent Sexual Interest Card Sort: test-retest reliability and concurrent validity in relation to phallometric assessment.
Test-retest reliability and concurrent validity studies on the Adolescent Sexual Interest Card Sort (ASIC) were conducted in two samples of 38 juvenile sexual offenders, each. Of the 64 items of the ASIC, 60 were found to be significantly correlated across test administrations. Cronbach's coefficient alpha was employed to determine the internal consistency of ASIC items. Coefficients ranged from .62 to .96 across categories, with an overall alpha of .97. Client ratings of sexual interests via the Card Sort were correlated with phallometric response to similar categories of stimuli. Significant correlations were found for only 4 of the 14 categories examined, suggesting little correspondence between client report of sexual interest on the ASIC and phallometric assessment of the same. Findings are consistent with the adult sex offender literature suggesting that self-report measures are particularly vulnerable to dissimulation and often at variance with more objective measurement. Clinical and research issues pertinent to the measurement of sexual arousal and interest in juvenile sexual offenders are discussed.
Adolescent↗
Multiwindow scatter correction techniques in single-photon imaging.
We studied the performance of linear scatter correction methods for single-photon imaging with Tc-99m and Tl-201, using a numerical model of the Rollo phantom and measurements with a gamma camera modified to record position and energy information in list mode form. We compared the performance of these methods to per-image optimized linear methods and to locally adaptive linear methods, and developed estimates of the limits on accuracy of scatter correction imposed by the presence of Poisson noise. For both Tc-99m and Tl-201 imaging at a fixed depth, particularly at low count rates, the performance of dual-window methods, or of adaptive methods, is near the best possible for linear methods. Smoothing of the scatter estimate results in minor improvement for Tl-201. Substantial gaps between the performance of any of these linear methods and the limits imposed by Poisson noise remain and are due primarily to bias, with the gap for Tl-201 being larger than that for Tc-99m.
Algorithms↗
Trends in firearm suicide among older American males: 1979-1988.
Elderly men are more likely to commit suicide than any other age group in the United States. Moreover, their rate of suicide steadily increased between 1979 and 1988. National Center for Health Statistics (NCHS) Compressed Mortality data were used to perform an age-specific analysis of linear trends. Males 65 and over were the most likely to use firearms followed by those 55-64. In 1988, nearly 8 out of 10 suicides by males 65 and over were committed with a firearm. Firearm-related suicide rates were much lower for blacks than whites 65 and over; however, suicides among blacks were more likely to involve firearms than among whites in this age group. The authors call for a broad public policy effort directed at reducing the availability of firearms.
Adolescent↗
Psychiatric impairment and childhood victimization experiences in female child molesters.
OBJECTIVE: To assess psychiatric impairment and childhood victimization experiences in female child molesters. METHOD: Eleven incarcerated female child molesters were compared to 11 women imprisoned for nonsexual offenses as to their psychiatric diagnoses based on interviews with the Structured Clinical Interview for DSM-III-R, Outpatient Version (SCID-OP), the SCID II for Personality Disorders, and the Harvard-Upjohn Post-Traumatic Stress Disorder (PTSD) Interview. A family and sexual history with a description of childhood victimization experiences was also obtained by using the Wyatt Sexual History Questionnaire. RESULTS: The majority of the subjects in each group exhibited major depression, alcohol/substance abuse, and PTSD, but the sexual offenders demonstrated more psychiatric impairment on the Global Assessment of Functioning Scale on the SCID-OP. The sexual offenders demonstrated a higher incidence of childhood physical and sexual abuse within the family than the comparison group, and these victimization experiences were more severe and more frequently associated with PTSD. The sexual offenders and the comparison women described negative relationships with parents and caretakers, and with spouses or boyfriends. However, the sexual offenders perceived their parents as more abusive, while the comparison women regarded their parents as more neglecting. CONCLUSIONS: Incarcerated female child molesters exhibited greater psychiatric impairment and more intrafamilial physical and sexual abuse than a comparison group of women imprisoned for nonsexual offenses.
Adolescent↗
The importance of appropriate challenges in diagnosing food sensitivity.
Two patients with clinically significant immunoglobulin E (IgE) mediated reactions to cow's milk which occur only under special circumstances are described. Although double-blind, placebo-controlled food challenges or open food challenges are generally very helpful, certain patients who react only under special circumstances might be missed when these office tests are used. The two reported incidences occurred in older children who seemed to outgrow their cow-milk allergy but still had clinically significant allergic reactions under certain circumstances.
Adolescent↗
Complications in children with a severe allergy to cow milk.
A case-comparison study compared the allergic and health complications of children who had severe IgE-mediated allergy to cow milk in infancy (study group) with those of other atopic children (control group). Severity of clinical atopy, IgE sensitization to other allergens, and recurrent episodes of anaphylaxis, as well as growth and development were compared in 16 health plan member children aged 2 to 18 years with histories of IgE-mediated anaphylaxis and 16 age- and gender-matched allergy patients. Data were analyzed using the sign test or the signed-rank test of the difference scores of the matched study-control pairs. The results showed the study group differed from the control group throughout childhood by having more specific allergen sensitizations, atopic dermatitis, episodes of sudden severe anaphylaxis, and hospitalizations. Other health complications may exist. Medical care of these children should address these problems.
Adolescent↗