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Biomedical subjects

M Swartz

Publications and source records attributed to M Swartz.

At least 37 records · Page 2Linked to original sources
PubMed1998

Risk reconsidered: targets of violence in the social networks of people with serious psychiatric disorders.

Risk Reconsidered: Targets of violence in the Social Networks of People with Serious Mental illness. This exploratory analysis addresses the questions: 1) Who among the members of the social network of a person diagnosed with a major psychiatric disorder is likely to become a target of violence? 2) What kind of relationships do targets have with respondents in terms of the quality and quantity of interactions?, and 3) What are the risk factors that contribute to being a target of violence for people who are in the social networks of persons with serious mental disorders? The samples of 169 people with serious mental disorders were followed for 30 months. A logistic regression model of the risk for being a target of violence among the members of the cohort's social network reveals that both target and respondent characteristics are salient, and that mothers who live with adult children who have schizophrenia and co-occurring substance abuse bear a substantially elevated risk of becoming a target of violence, compared to other social network members. Other factors that elevate the risk for being a target of violence are being an immediate family members of the respondent, more time in residence with the respondent, and whether the respondent is financially dependent on the family. Respondents with the most mental health center visits had lower odds of committing an act or threat of violence against a social network member.

Adult↗
PubMed1998

Treatment boundaries in the case management relationship: a clinical case and discussion.

Case managers provide services in a variety of settings and situations that challenge traditional ideas about professional roles and practices. The concepts of treatment boundaries, drawn from the psychotherapy literature, are helpful in conceptualizing appropriate professional norms in case management. This article reviews concepts of treatment boundaries and provides a clinical case for illustration and discussion.

Adult↗
PubMed1998

Vitamin E (alpha-tocopherol) in the treatment of tardive dyskinesia: a statistical meta-analysis.

Tardive dyskinesia is an involuntary movement disorder developing following treatment with neuroleptics. As many as 50% of chronic psychotic patients develop this disabling condition. No treatment has been found effective for tardive dyskinesia. This study was undertaken to meta-analyze the effects of vitamin E (alpha-tocopherol) reported in the last decade. All studies published since 1987, focusing on vitamin E and tardive dyskinesia are reviewed. Double-blind studies are analyzed using measures of effect and variance as described by secondary analysis of magnitude of effects in pooled data. A total of 223 patients received vitamin E treatment (400-1600 IU/day) for tardive dyskinesia, in 12 studies. A significant subgroup (28.3%) showed a modest improvement. Vitamin E was well tolerated, and only rarely did side effects occur-of no clinical significance. Vitamin E is a safe, well-tolerated compound that may provide some beneficial effects in patients suffering from neuroleptic-induced tardive dyskinesia.

Adult↗
PubMed1997

Hyperplasia of lymphatic vessels in VEGF-C transgenic mice.

No growth factors specific for the lymphatic vascular system have yet been described. Vascular endothelial growth factor (VEGF) regulates vascular permeability and angiogenesis, but does not promote lymphangiogenesis. Overexpression of VEGF-C, a ligand of the VEGF receptors VEGFR-3 and VEGFR-2, in the skin of transgenic mice resulted in lymphatic, but not vascular, endothelial proliferation and vessel enlargement. Thus, VEGF-C induces selective hyperplasia of the lymphatic vasculature, which is involved in the draining of interstitial fluid and in immune function, inflammation, and tumor metastasis. VEGF-C may play a role in disorders involving the lymphatic system and may be of potential use in therapeutic lymphangiogenesis.

Animals↗
PubMed1997

Prevalence, correlates, and course of minor depression and major depression in the National Comorbidity Survey.

Data from the National Comorbidity Survey are used to study the lifetime prevalences, correlates, course and impairments associated with minor depression (mD), major depression 5-6 symptoms (MD 5-6), and major depression with seven or more symptoms (MD 7-9) in an effort to determine whether mD is on a continuum with MD. There is a monotonic increase in average number of episodes, average length of longest episode, impairment, comorbidity, and parental history of psychiatric disorders as we go from mD to Md 5-6 to MD 7-9. In most of these cases, though, the differences between mD and MD 5-6 are no longer than the differences between MD 5-6 and MD 7-9, arguing for continuity between mD and MD. Coupled with the finding from earlier studies that subclinical depression is a significant risk factor for major depression, these results argue that minor depression is a variant of depressive disorder that should be considered seriously both as a target for preventive intervention and for treatment. The paper closes with suggestions regarding the analysis of mD subtypes in future longitudinal studies.

Adolescent↗
PubMed1997

Valve replacement in the small aortic annulus: prospective randomized trial of St. Jude with Medtronic Hall.

OBJECTIVE: The ideal prosthesis for aortic valve replacement in patients with small annuli remains controversial and has yet to be identified. The purpose of this report is to compare the St. Jude (SJ) Medical and Medtronic Hall (MH) valves for aortic valve replacement in the small aortic root. METHODS: From 1986 to 1994 we prospectively randomized 456 patients to receive either the SJ or the MH valve. From this population, 80 patients (SJ, 42 patients; MH 38 patients) had a 19 or 21 mm aortic prosthesis inserted without annulus enlarging procedure. RESULTS: Follow-up was complete in all 80 patients for 270 patient years (mean 40.5 months). Analysis showed that the SJ and MH groups were similar with respect to age, gender, body surface area, valve area, NYHA class, ventricular function, prosthesis size, frequency of revascularization, bypass and global ischemic time. There were two operative deaths (1 SJ, 1 MH). Clinical performance and Dobutamine stress transesophageal doppler echocardiography could not demonstrate a significant advantage of one prosthesis over the other in this population. The change in aortic valve gradient, and left ventricular mass index measured preoperatively and within 12 months postoperatively were not different in both cohorts. CONCLUSION: The study could not detect a difference in the performance of the SJ and MH heart valves for aortic valve replacement in patients with small aortic annuli.

Adult↗
PubMed1997

Violence and severe mental disorder in clinical and community populations: the effects of psychotic symptoms, comorbidity, and lack of treatment.

This paper examines links between violent behavior, type and severity of psychopathology, substance abuse comorbidity, and community mental health treatment, using matched data from two surveys: the National Institute of Mental Health Epidemiologic Catchment Area project and the Triangle Mental Health Survey (a North Carolina study of adults with severe and persistent mental illness). Multivariate logistic regression analysis was used to model the risk of violent acts attributable to three domains of independent variables: sociodemographic characteristics, clinical diagnoses and symptomatology, and mental health services utilization. Findings include: (1) Symptom severity was significantly greater in the clinically-selected sample than in the community survey of respondents with comparable diagnoses who self-reported using mental health services; (2) Violence risk was related to psychoticism/agitation in a curvilinear form; (3) In a multivariable model, violence was significantly associated with substance abuse comorbidity, particular psychotic symptoms (perceived threat and loss of internal cognitive controls), and absence of recent contact with a community mental health provider; (4) The relationship between lack of treatment and higher odds of violence was less pronounced among respondents with substance abuse comorbidity; (5) When clinical and services-use variables were taken into account, sociodemographic predictors were not significantly related to violence.

Adult↗
PubMed1996

Lung volume reduction surgery in ventilator-dependent COPD patients.

BACKGROUND: Lung volume reduction surgery has been advocated recently as adjunctive surgical therapy to improve lung and chest wall mechanics in selected patients with diffuse emphysema. Although clear-cut guidelines to select candidates have not been fully established, patients decompensated with significant pulmonary artery hypertension and hypercapnic respiratory failure are currently not considered suitable subjects. Accordingly, ventilator-dependent COPD patients are not considered candidates for this procedure. However, because ventilator-dependent COPD patients have an exceptionally poor prognosis, we elected to offer them this promising, but unproved surgical intervention. Herein, we describe the outcome of these three patients. PATIENTS: The 3 patients had recurrent exacerbations of COPD precipitating respiratory failure, and following aggressive medical therapy remained mechanically ventilated for 11 to 16 weeks (1 patient had a brief period of successful weaning before returning to mechanical ventilation). Prior to surgery, the patients had severe hypercapnia and cor pulmonale. Compared with preoperative values, surgery resulted in improvements in PaO2/FIO2, 304 +/- 80 (SD) vs 229 +/- 48 mm Hg, reductions in PaCO2, 44 +/- 3 vs 60 +/- 9 mm Hg, increases in FVC, 1.63 + 0.52 vs 1.09 +/- 0.05 L, and maximum inspiratory pressure, 57 +/- 22 vs 29 +/- 12 cm H2O. Postoperative complications included persistent air leaks and one tension pneumothorax. Patients weaned from mechanical ventilation after 10 to 21 days all were discharged home and they continue to demonstrate improved gas exchange and functional status. CONCLUSIONS: Lung volume reduction surgery in select, ventilator-dependent COPD patients can result in improved gas exchange and respiratory mechanics that enable successful weaning and overall improved functional status.

Female↗
PubMed1996

Comorbidity of DSM-III-R major depressive disorder in the general population: results from the US National Comorbidity Survey.

General population data are presented on the prevalence and correlates of comorbidity between DSM-III-R major depressive disorder (MDD) and other DSM-III-R disorders. The data come from the US National Comorbidity Survey, a large general population survey of persons aged 15-54 years in the non-institutionalised civilian population. Diagnoses are based on a modified version of the Composite International Diagnostic Interview (CIDI). The analysis shows that most cases of lifetime MDD are secondary. In the sense that they occur in people with a prior history of another DSM-III-R disorder. Anxiety disorders are the most common primary disorders. The time-lagged effects of most primary disorders on the risk of subsequent MDD continue for many years without change in magnitude. Secondary MDD is, in general, more persistent and severe than pure or primary MDD. This has special public health significance because lifetime prevalence of secondary MDD has increased in recent cohorts, while the prevalence of pure and primary depression has remained unchanged.

Adolescent↗
PubMed1994

Sex and depression in the National Comorbidity Survey. II: Cohort effects.

Data from a nationally representative sample of the general population are used to study cohort differences in the prevalence of DSM-III-R Major Depressive Episode (MDE). We document increasing lifetime prevalence of MDE among both men and women in more recent cohorts, but no major change in the sex ratio over the 40-year period retrospectively covered in the survey. We find a cohort difference in 12-month MDE, with older women much more likely than older men to have recurrent episodes. This sex difference in recurrence plays an important part in the elevated 12-month prevalence of depression among women compared to men in the 45-54 age range.

Adolescent↗
PubMed1993

Cellulitis caused by Legionella pneumophila.

A patient with lymphoma presented with pneumonia. While receiving antibiotics, he developed a rapidly spreading cellulitis. The soft tissues were debrided in the operating room, and pathological examination showed fat necrosis and a fibrinopurulent exudate in the fibroadipose tissue; direct immunofluorescence of the debrided tissue revealed the presence of Legionella pneumophila. Culture of the specimen obtained during the operation yielded L. pneumophila. To our knowledge, this represents the first case report of cellulitis due to L. pneumophila.

Aged↗
PubMed1993

Premedication with non-selective and M1-selective muscarinic antagonists before ECT.

Atropine treatment before electroconvulsive therapy (ECT) is used for two main reasons: a) to prevent transient post-ictal bradyarrhythmias due to excessive vagal tone; b) to minimize secretions within the respiratory tract. In the present study we have compared the effects of premedication using atropine, a non-selective muscarinic antagonist, with biperiden, an M1-selective muscarinic antagonist. Cardiac rate and other cardiac parameters and respiratory tract secretions after ECT were compared in order to determine whether atropine effects following ECT involve central or peripheral antagonistic effects. Our results show that in preventing excessive sialorrhea following ECT, atropine works antagonistically through peripheral glandular M2 receptors whereas biperiden antagonizing M1 receptors fails to prevent sialorrhea. Our results are not conclusive concerning cardiac protective effects of atropine following ECT. None of the patients, whether premedicated by atropine or biperiden, displayed bradyarrhythmias following ECT. No significant differences were found in any of the measured cardiac parameters following ECT between atropine and biperiden premedications. Thus, the question whether atropine exerts its protective cardiac effects following ECT through central (probably M1) or peripheral M2 receptors remains open.

Adult↗
PubMed1992

Specificity and sensitivity of the assay for elastin-derived peptides in chronic obstructive pulmonary disease.

One prediction of the protease-antiprotease hypothesis of chronic obstructive pulmonary disease (COPD) pathogenesis is the appearance of elastin-derived degradation products in the plasmas of affected patients that are due to the breakdown of alveolar interstitial elastin by an excess of elastolytic activity in the lung. We previously demonstrated a significant elevation of plasma elastin-derived peptides (EDP) in subjects with COPD in comparison with asymptomatic smokers with normal spirometry or normal nonsmokers. To better determine the selectivity of the assay for EDP as a marker of COPD, we measured plasma EDP levels in different patient populations. These included subjects with COPD, subjects with diseases that may involve accelerated elastolysis (pneumonia, atherosclerotic vascular disease, and inflammatory arthritis), subjects with diseases hypothesized to involve pulmonary inflammation without elastolysis (asthma and acute tracheobronchitis), asymptomatic smokers with normal spirometry, and healthy, nonsmoking subjects. Mean plasma EDP levels in subjects with COPD were elevated above those in all other subjects (p less than 0.01). The prospective analyses of specificity and sensitivity of plasma EDP levels as markers of COPD gave values of 91 and 65%, respectively. Utilizing receiver operating characteristic curve analysis to assess the diagnostic and screening performance of plasma EDP as a test for COPD (perfect test equals an area under the curve of 1.0), the area under the curve was 0.87, which compares favorably with many widely used clinical tests. These data demonstrate that the assay for plasma EDP is a quantitative, easily measured, and highly specific marker for subjects with COPD.

Adult↗