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Biomedical subjects

M Zimmerman

Publications and source records attributed to M Zimmerman.

At least 73 records · Page 4Linked to original sources
PubMed1995

Interferon alfa-2b for chronic hepatitis C: effects of dose increment and duration of treatment on response rates. Results of the first multicentre Australian trial. Australia Hepatitis C Study Group.

Two hundred and thirty patients with histologically proven chronic hepatitis C were randomized to receive one of the following treatment protocols: (a) 3 million units of interferon alfa-2b thrice weekly for 6 months, (b) 5 million units thrice weekly for 6 months, or (c) 3 million units thrice weekly for 2 years. The short-term response to treatment was defined by normal alanine aminotransferase for at least 3 months and until the end of treatment, and was confirmed by loss of hepatitis C viraemia in 42 (91%) of 46 cases as determined by reverse transcription-polymerase chain reaction. Short-term response to interferon alfa-2b was independent of the incremental dose, being 64% for 5 million units and 58% for 3 million units. Long-term response to interferon alfa-2b was defined by continued normality of alanine aminotransferase levels for at least 6 months after treatment withdrawal. The long-term response rates among responders treated for 6 months and those treated for 2 years were 29% and 54%, respectively (p < 0.001). Among all 18 patients tested, serum HCV-RNA was negative at both 6 and 12 months of follow-up in all long-term responders, and none have subsequently relapsed. Improvement in hepatic necroinflammatory changes was confirmed by quantitative histology (Scheuer score) in responders at the end of interferon alfa-2b treatment. The changes were significantly greater among those who had been treated for 2 years compared with those treated for 6 months (p < 0.05 and p < 0.02, respectively, for portal and lobular inflammation scores). Several pretreatment characteristics could be correlated with a favourable response to interferon alfa-2b. Thus, absence of cirrhosis was associated with a short-term response of 75%, while only 42% of patients with cirrhosis had a short-term response (p < 0.001). The frequency of short-term response to interferon alfa-2b also differed according to mode of disease acquisition, being best for injecting drug use (71%), less favourable for blood transfusion (56%) and worst for sporadic cases (43%) (p < 0.01). This observed difference, however, was not independent of histology on multivariate analysis. In summary, a 5 million unit dose of interferon alfa-2b failed to improve the short-term or long-term response to interferon alfa-2b treatment, but prolongation of interferon alfa-2b treatment to 2 years resulted in substantially improved long-term response rate.

Adolescent↗
PubMed1995

Management of hemoptysis in a Third World city hospital: a retrospective study.

BACKGROUND: Massive hemoptysis (defined as blood loss greater than 600 ml/24h) is said to have a fatal outcome in up to 85% of patients when managed only medically. METHODS: A retrospective patient chart study was undertaken to analyse underlying pathology, management and outcome of hemoptysis patients in a hospital with no thoracic surgical, bronchoscopic or embolisation facilities. RESULTS: 63 patients were admitted for hemoptysis during a 2.5 year study period. Tuberculosis and sequelae of previous tuberculosis accounted for 65% of the cases. The patients with expectoration of more than 600 ml/24h had a shorter duration of hemoptysis (P = 0.033) and more often a history of tuberculosis (P = 0.023). The mortality rate was 6% (4/63 patients). Recurrent bleeding was not frequent (11%) and never severe enough for admission. CONCLUSIONS: Hemoptysis in a Third World city hospital is mainly caused by infectious disease. Under the above-mentioned circumstances, in view of a low mortality and recurrence rate, conservative treatment of hemoptysis in in-patients seems justified.

Adult↗
PubMed1995

Utilization of dental services in refugees in Sweden 1975-1985.

Prior to 1940 the population of Sweden was one of the most homogeneous in Europe, with only 0.5% foreign born. Fifty years later, in 1990, the proportion of immigrants was around 15%. In order to describe and analyze consumption of dental care in different refugee groups in Sweden, data registered by the Department of Immigration and the National Social Insurance Board, on a random sample of 2489 refugees arriving in Sweden 1975-85, were merged. Information on nationality, date of arrival in Sweden, date of granting of permanent resident status and statistics on consumption of dental care were retrieved. During the period studied a total of 50,521 refugees arrived in Sweden. The average interval between arrival in Sweden and the first dental visit was 4.5 yr (95% < 1: 4.2-4.7). The total treatment time during the first course of treatment was 165.5 min (95% < 1: 148.7-182.3). Consumption of dental care did not decrease with an increased number of treatments. Only 38% of the refugees had visited a dentist at all in Sweden. With increasing number of years in Sweden the number of courses of dental treatment increased, but 41% of the refugees who had visited the dentist in Sweden had done so only once. This study shows a low utilization of dental services among refugees in Sweden in general. Refugees with dental visits in Sweden, in particular, had a high dental consumption.

Adolescent↗
PubMed1995

The Cognitive Bias Task and lateralized frontal lobe functions in males.

The Cognitive Bias Task (CBT) is a multiple-choice response selection paradigm characterized by inherent ambiguity. All items offer a range from extremely context-dependent to extremely context-invariant responses. Lateralized prefrontal lesions produce extreme, and opposite, response biases on CBT in right-handed males. Healthy control subjects perform in the middle range. Findings suggest a dynamic balance between two synergistic decision-making systems in the frontal lobes: context-dependent in the left hemisphere and context-invariant in the right. The robust lateralized effects, which are dependent on task ambiguity, are sensitive and specific to frontal dysfunction. CBT is discussed in comparison with the Wisconsin Card Sorting Test as a potential cognitive activation task for functional neuroimaging of the frontal lobes.

Adult↗
PubMed1995

Psychiatric screening in geriatric primary care: should it be for depression alone?

Depression in the elderly is highly prevalent, associated with functional disability and increased medical costs, and treatable; however, it is infrequently recognized and treated. The Agency for Health Care Policy and Research has advocated, therefore, increased case-finding efforts for depression in primary geriatric care. Anxiety, substance, and somatoform disorders in the elderly are similarly prevalent, associated with disability and cost, treatable, and also infrequently detected and treated. We believe that psychiatric case-finding in geriatric primary care should attend to these disorders, therefore, as well as to depression. In the present study, we examined whether the association between depressive and nondepressive forms of psychopathology was similar in geriatric and nongeriatric medical patients. We also examined the relationship between each type of pathology and health care utilization and global ratings of physical and mental health. In a VA hospital general medical outpatient clinic, 508 patients completed the SCREENER, which is a brief self-report questionnaire that screens for a range of psychiatric disorders, along with a self-report questionnaire regarding subjective health and medical care utilization. Of these patients, 98% were male, and the median age was 63 years. Patients aged 63 and over were compared to younger patients. In both geriatric and younger adult patients, we found substantial comorbidity between depressive and nondepressive forms of pathology. Moreover, in both age groups, there were significant associations between both depressive and nondepressive symptoms and fair-to-poor self-rated physical and mental health and increased medical care utilization. Approximately half of the cases of nondepressive disorders in the elderly were not comorbid with depression, and thus would not have been detected by screening for depression alone. Therefore, psychiatric case finding in primary care of geriatric males should be directed at anxiety, substance, and somatoform disorders, as well as at depression, for treatment resources to be triaged to maximally decrease morbidity and cost.

Age Factors↗
PubMed1995

Computerized measurements of the lower third molar related to chronologic age in young adults.

Chronologic age is an utmost important birth record in many industrialized Western countries. When the date of birth is unknown, there is a demand for establishing the chronologic age. Dental methods for age estimations are considered more reliable than most other methods by the majority of researchers and are among the most commonly used means to determine age. Traditionally, these methods have most often been based on subjectively estimated, radiographic stages of tooth development. In the present study metric measurements of the length of the forming root have been used and are compared with one standard method. The formed part of the root of the lower third molar as seen in a panoramic radiograph was digitized. Data were directly stored in a computer for subsequent statistical analysis. The technique of collecting data with the aid of a computer had some statistical advantages. The precision of age estimations was, however, slightly inferior to the standard method.

Adolescent↗
PubMed1995

Esophageal adenocarcinoma associated with Barrett's esophagus: long-term management with laser ablation.

We report the use of neodymium:yttrium-aluminum-garnet (Nd:YAG) laser ablation to treat high-grade dysplasia and intramucosal esophageal adenocarcinoma associated with Barrett's esophagus in a patient who refused surgery. Throughout laser therapy, the patient received omeprazole 40 mg/day. After 1 1/2 yr, five laser treatments totaling 22,055 J given over a period of 13 months achieved squamous reepithelialization and absence of malignant transformation in the first area in which carcinoma was diagnosed. Squamous reepithelialization was maintained 1 yr later, confirming recent reports that photoablation plus omeprazole can achieve regression of Barrett's esophagus. During the last year of follow-up, a second contiguous area discovered to contain carcinoma was treated three times by photoablation, with a total of 13,164 J; biopsy showed only low-grade dysplasia in this area after two laser treatments totaling 8,108 J. No complications were seen during or after any of the laser sessions, and the patient remained asymptomatic 2 1/2 yr after the first photoablation and 3 yr after presentation.

Adenocarcinoma↗
PubMed1994

Diagnosing personality disorders. A review of issues and research methods.

Many questions face researchers conducting personality disorder research. Which measure should be used? When should patients be evaluated--at initial presentation when they are still symptomatic, or after symptom resolution? Can a patient accurately describe his or her personality, or must an informant be contacted? What do you do when personality traits change during an individual's lifetime? I discuss these and other issues of personality disorder assessment in the DSM-III/DSM-III-R era, and examine the empiric literature bearing on these questions. First, I review studies of diagnostic reliability and stability, because studies of the above questions can only be interpreted in the context of the limitations imposed by modest reliability.

Humans↗
PubMed1994

Measuring physician attitudes toward cost, uncertainty, malpractice, and utilization review.

OBJECTIVE: To develop a reliable measure of physician attitudes postulated to influence resource utilization. DESIGN: Statements related to attitudes that may influence resource use were culled from the literature and informal discussions with physicians. SETTING: Academic medical center. PARTICIPANTS: All faculty and housestaff in internal medicine, pediatrics, family medicine, and surgery at an academic medical center were surveyed. The response rate was 59% (n = 428). RESULTS: Exploratory factor analysis of all internal medicine surveys revealed four prominent domains. These closely corresponded with our a-priori hypothesized domains and were interpreted as cost-consciousness, discomfort with uncertainty, fear of malpractice, and annoyance with utilization review. A replication of the analysis using 25 survey items and conducted on the remainder of the data (surgeons, pediatricians, and family practitioners) revealed a similar four-factor solution. Scales were constructed for each of the four domains. Cronbach's alpha ranged from 0.66 to 0.88. Discomfort from uncertainty and fear of malpractice were moderately correlated (r = 0.42); other scale-scale correlations were modest. Of the four attitude measures, only cost-consciousness was associated with lower self-estimates of resource use. Both annoyance with utilization review and fear of malpractice increased as the proportion of time spent in patient care increased. CONCLUSIONS: Although various physician attitudes and beliefs have been hypothesized to influence health services resource use, reliable and valid measures for most of these have not been developed. The authors developed a 19-item survey instrument designed to measure these attitudes reliably. The four scales developed in this study may help identify physician attitudes that are important determinants of physician decision making and help foster a better understanding of physicians' reactions and acculturation to different practice environments.

Academic Medical Centers↗
PubMed1994

Screening for depression in medical patients. Is the focus too narrow?

There is growing consensus that depression is a major public health problem causing significant psychosocial morbidity and mortality which should be addressed by case-finding effects in primary care settings. A large amount of literature has examined the ability of self-report questionnaires to detect depression in medical patients and the results have been encouraging. However, studies of general population and psychiatric patient samples indicate that depression is frequently comorbid with other psychiatric disorders, and that psychiatric disorders other than depression are also associated with significant morbidity and mortality. Consequently, we believe that psychiatric screening in primary care should be broad based. We administered a newly developed, multidimensional questionnaire (the SCREENER), that simultaneously screens for a range of DSM-III-R psychiatric disorders, to 508 medical outpatients attending a VA general medical clinic. Compared with nondepressed cases, the depressed patients significantly more often reported all of the nondepressive symptoms. Nine of the ten nondepressive disorders screened for by the SCREENER were significantly more frequent in the depressed group. Most patients who screened positive for depression also screened positive for at least one nondepressive disorder. Compared with patients who only screened positive for depression, those who screened positive for both depression and a nondepressive disorder rated their physical and emotional health more poorly and made more visits to the doctor. Compared with patients who did not screen positive for any disorder, those who only screened positive for a nondepressive disorder rated their physical and emotional health more poorly, and more frequently had a history of mental health treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Screening for psychiatric disorders in medical patients: a feasibility and patient acceptance study.

This study examines whether medical patients were bothered or upset by being asked to complete a questionnaire about emotional and substance use problems, and whether a newly developed, brief questionnaire that screens for several psychiatric disorders (the SCREENER) was easy for patients to complete. A consecutive series of outpatients attending the General Medical Clinic at the Philadelphia Veterans Affair Medical Center (VAMC) was approached to ask their participation in a research study requiring the completion of a brief questionnaire about their emotions, moods, thoughts, and behaviors, and a second questionnaire that asked their opinion about the first measure. Only 3.1% of the patients indicated that the questions were difficult to answer, whereas 84.6% found the questions easy or very easy to answer. Between 80% to 90% of the patients were not embarrassed, upset, annoyed, or uncomfortable by answering the questions. Individuals with a history of psychiatric treatment and poorer current mental health were the most likely to have a negative reaction to the questionnaire. Thus, the medical patients in this study reacted favorably to the completion of a broad-based questionnaire about emotional problems. The questions were judged easy to answer and rarely aroused significant negative affect.

Aged↗
PubMed1994

Killing of Giardia lamblia by cryptdins and cationic neutrophil peptides.

Antimicrobial polypeptides such as the defensins kill a wide range of organisms, including bacteria, fungi, viruses, and tumor cells. Because of the recent finding that intestinal defensins, also known as cryptdins, are synthesized by the Paneth cells of the small intestinal crypts and released into the lumen, we asked whether defensins and other small cationic antimicrobial peptides could kill the trophozoites of Giardia lamblia, which colonize the small intestine. Four mouse cryptdins, two neutrophil defensins (HNP-1 [human] and NP-2 [rabbit]), and the unique tryptophan-rich bovine neutrophil polypeptide indolicidin each had some antigiardial activity against trophozoites in vitro. Cryptdins 2 and 3, indolicidin, and NP-2 each reduced viability by more than 3 log units in 2 h, and killing by all peptides was dose and time dependent. Exposure of trophozoites to peptides frequently resulted in cell aggregation and dramatic changes in morphology. The mechanism of binding and lysis appeared to involve charge interactions, since 150 mM NaCl as well as millimolar levels of Ca2+ and Mg2+ inhibited killing by most of the peptides. Our studies show that G. lamblia is sensitive to defensins and indolicidin and suggest that these small polypeptides could play a role in nonimmune host defenses.

Amino Acid Sequence↗
PubMed1994

Health education and community empowerment: conceptualizing and measuring perceptions of individual, organizational, and community control.

The prevailing emphasis in health education is on understanding and changing life-style choices and individual health behaviors related to health status. Although such approaches are appropriate for some health problems, they often ignore the association between increased morbidity and mortality and social, structural, and physical factors in the environment, such as inadequate housing, poor sanitation, unemployment, exposure to toxic chemicals, occupational stress, minority status, powerlessness or alienation, and the lack of supportive interpersonal relationships. A conceptual model of the stress process incorporates the relationships among these environmental factors, powerlessness (or conversely empowerment), social support, and health status. The concept of empowerment has been examined in diverse academic disciplines and professional fields. However, there is still a lack of clarity on the conceptualization of empowerment at different levels of practice, including its measurement, relationship to health, and application to health education. The purpose of this article is to address these issues as they relate to the concept of community empowerment. It provides a definition of community empowerment that includes individual, organizational, and community levels of analysis; describes how empowerment fits within a broader conceptual model of stress and its relationship to health status; and examines a series of scales that measure perceptions of individual, organizational, community, and multiple levels of control. The article concludes with broad guidelines for and barriers to a community empowerment approach for health education practice.

Adaptation, Psychological↗
PubMed1994

Prevalence of fluorosis and other enamel defects related to caries among adults in communities with optimal and low water fluoride concentrations.

The aim of this Swedish study, performed in 1982, was to determine the prevalence of fluorotic and nonfluorotic enamel defects among adults in areas with optimal and low fluoride concentrations in water. The fluorosis prevalence was also related to caries prevalence in these areas. The study was based on clinical examinations of subjects born between 1939-1951 who had been drinking water with a fluoride content representative of their area of residence all their lives. This water was the only appreciable source of fluoride during tooth formation. Two hundred and sixty individuals living in the optimal fluoride area were included in the study and 236 individuals from the low fluoride area. The results showed first, a low prevalence of mild dental fluorosis in the area with optimal fluoride content in its drinking water; secondly, a low prevalence of non-fluorotic enamel defects, which was, however, higher in the low fluoride area than in the optimal fluoride area; thirdly, that caries prevalence was lower among those with fluorotic enamel defects in the optimal fluoride area; and lastly, caries prevalence was not influenced by non-fluorotic enamel defects.

Adult↗
PubMed1993

A method to detect intercenter differences in the application of contemporary diagnostic criteria.

The use of specified diagnostic criteria is part of routine psychiatric practice and research. However, there is evidence that the same criteria may be interpreted and applied differently at different research centers. The next question is whether it is possible to detect these systematic intercenter differences in diagnostic practices. An inexpensive, nonlaborious, standardized method is needed that can easily be used at any site. In the present report, we demonstrate how self-report questionnaires can provide a method of detecting systematic differences in the application of contemporary diagnostic criteria. Sixty consecutively admitted inpatients with nonpsychotic major depressive disorder were interviewed with standardized schedules and diagnosed according to two interpretations of the Research Diagnostic Criteria (RDC) and DSM-III endogenous/melancholia criteria. The patients also completed the Inventory to Diagnose Depression, a self-report scale designed to diagnose major depression and subtype patients according to RDC and DSM-III endogenous/melancholia criteria. The interview to self-report ratio for diagnosing endogenous depression and melancholia was associated with diagnosticians' interpretation of the criteria. A broader application of the criteria resulted in a higher ratio. A paper-and-pencil questionnaire could be useful in detecting systematic interinvestigator differences in the broadness or narrowness with which criteria are applied. The advantage of a self-report scale is that it is free from systematic biases and tendencies of clinician raters. Of course, ratings on questionnaires are not free of bias; however, it is less likely that differences between samples will reflect a systematic variation in response set.

Adult↗
PubMed1993

Simplified preventive dentistry program for Chilean refugees: effectiveness of one versus two instructional sessions.

A simplified dental health program for newly arrived refugees was evaluated. The efficacy of presenting the program in one instructional session or two was compared. 193 Chilean refugees, granted residency in Stockholm in Spring 1981 or in Spring 1982, participated. The subjects were divided into two groups. One group received a dental health program only at the first visit, in conjunction with the baseline examination, and the other group was recalled for a further session 3 months after the baseline examination. Both groups were recalled for evaluation 6 months after the initial visit. At follow-up the groups comprised 94 and 65 subjects respectively. The mean relative reductions in gingivitis (relating GBI reduction to baseline GBI) were 33.2% (95% < I: 29.1 to 37.3%) in the single-visit group and 40.5% (95% < I: 35.9 to 45.8%) in the two-visit group. The reduction in periodontal pocket depth was mainly a reduction of shallow pockets. The maximum effect was attained after one instructional session.

Adult↗