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Biomedical subjects

R Garfinkel

Publications and source records attributed to R Garfinkel.

At least 19 recordsLinked to original sources
PubMed2005

Biomarkers in assessing residential insecticide exposures during pregnancy and effects on fetal growth.

The Columbia Center for Children's Environmental Health is using a combination of environmental and biologic measures to evaluate the effects of prenatal insecticide exposures among urban minorities in New York City. Of the 571 women enrolled, 85% report using some form of pest control during pregnancy and 46% report using exterminators, can sprays, and/or pest bombs. Chlorpyrifos, diazinon, and propoxur were detected in 99.7-100% of 48-h personal air samples collected from the mothers during pregnancy (n = 394) and in 39-70% of blood samples collected from the mothers (n = 326) and/or newborns (n = 341) at delivery. Maternal and newborn blood levels are similar and highly correlated (r = 0.4-08, P < 0.001). Levels of insecticides in blood samples and/or personal air samples decreased significantly following the 2000-2001 U.S. Environmental Protection Agency's regulatory actions to phase out residential use of chlorpyrifos and diazinon. Among infants born prior to 1/1/01, birth weight decreased by 67.3 g (95% confidence interval (CI) -116.6 to -17.8, P = 0.008) and birth length decreased by 0.43 centimeters (95% CI, -0.73 to -0.14, P = 0.004) for each unit increase in log-transformed cord plasma chlorpyrifos levels. Combined measures of (ln)cord plasma chlorpyrifos and diazinon (adjusted for relative potency) were also inversely associated with birth weight and length (P </= 0.007). Birth weight averaged 215.1 g less (95% CI -384.7 to -45.5) among those with the highest exposures compared to those without detectable levels. No association was seen between birth weight and length and cord plasma chlorpyrifos or diazinon among newborns born after 1/1/01 (P > 0.8). Results support recent regulatory action to phase out residential uses of these insecticides.

Adolescent↗
PubMed1999

Efficacy of interpersonal psychotherapy for depressed adolescents.

BACKGROUND: Psychotherapy is widely used for depressed adolescents, but evidence supporting its efficacy is sparse. METHODS: In a controlled, 12-week, clinical trial of Interpersonal Psychotherapy for Depressed Adolescents (IPT-A), 48 clinic-referred adolescents (aged 12-18 years) who met the criteria for DSM-III-R major depressive disorder were randomly assigned to either weekly IPT-A or clinical monitoring. Patients were seen biweekly by a "blind" independent evaluator to assess their symptoms, social functioning, and social problem-solving skills. Thirty-two of the 48 patients completed the protocol (21 IPT-A-assigned patients and 11 patients in the control group). RESULTS: Patients who received IPT-A reported a notably greater decrease in depressive symptoms and greater improvement in overall social functioning, functioning with friends, and specific problem-solving skills. In the intent-to-treat sample, 18 (75%) of 24 patients who received IPT-A compared with 11 patients (46%) in the control condition met recovery criterion (Hamilton Rating Scale for Depression score < or =6) at week 12. CONCLUSIONS: These preliminary findings support the feasibility, acceptability, and efficacy of 12 weeks of IPT-A in acutely depressed adolescents in reducing depressive symptoms and improving social functioning and interpersonal problem-solving skills. Because it is a small sample consisting largely of Latino, low socioeconomic status adolescents, further studies must be conducted with other adolescent populations to confirm the generalizability of the findings.

Adolescent↗
PubMed1998

Subtypes of ataques de nervios: the influence of coexisting psychiatric diagnosis.

The current study assesses the relationship between presenting symptomatology of the self-labeled Hispanic popular diagnosis of ataques de nervios and the specific co-morbid psychiatric diagnoses. Hispanic subjects seeking treatment at an anxiety disorders clinic (n = 156) were assessed with a specially designed self-report instrument for both traditional ataque de nervios and panic symptoms, and with structured or semistructured psychiatric interviews for Axis-I disorders. This report focuses on 102 subjects with ataque de nervios who also met criteria for panic disorder, other anxiety disorders, or an affective disorder. Distinct ataque symptom patterns correlated with co-existing panic disorder, affective disorders, or other anxiety disorders. Individuals with both ataque and panic disorder reported the most asphyxia, fear of dying, and increased fear during their ataques. People with ataques who also met criteria for affective disorder reported the most anger, screaming, becoming aggressive, and breaking things during ataques. Ataque positive subjects with other anxiety disorders were less salient for both panic-like and emotional-anger symptoms. The findings suggest that (a) ataque de nervios is a popular label referring to several distinct patterns of loss of emotional control, (b) the type of loss of emotional control is influenced by the associated psychiatric disorder, and (c) ataque symptom patterns may be a useful clinical marker for detecting psychiatric disorders. Further study is needed to examine the relationship between ataque de nervios and psychiatric disorders, as well as the relationship to cultural, demographic, environmental, and personality factors.

Adult↗
PubMed1998

Separation/divorce and child and adolescent completed suicide.

OBJECTIVE: To investigate factors that may modify the effect of separation/divorce on youth suicide. METHOD: A case-control, psychological autopsy study of 120 of 170 consecutive suicides younger than age 20 and 147 community age-, sex-, and ethnic group-matched controls living in the greater New York area was conducted. Fifty-eight suicide victims and 49 community controls came from nonintact families of origin, indicating the permanent separation/divorce of the biological parents. Potential modifiers of separation/divorce include youth's age at separation, custodial parent's remarriage, nonresidential parent's frequency of contact, parent-child relationships, and parental psychopathology. RESULTS: The relatively small impact of separation/divorce was further diminished after accounting for parental psychopathology. An interaction of separation/divorce and the father-child relationship emerged. CONCLUSION: The dramatic increase in youth suicide during the past three decades seems unlikely to be attributable to the increase in divorce rates.

Adolescent↗
PubMed1998

Parent-victim agreement in adolescent suicide research.

OBJECTIVE: The necessary absence of the victim's report in psychological autopsy studies is likely to introduce a systematic reporting bias. The authors investigated the nature and extent of this bias by examining agreement between accounts of symptomatology given by adolescents who made a serious suicide attempt and their parents. METHOD: Fifty-two attempters younger than age 20 were matched individually on age, sex, and ethnicity to a sample of suicide completers in two previous investigations. A semistructured interview was used to assess symptoms for DSM-III disorders. Diagnoses were assigned using two distinct computer algorithms, based respectively on youth and parent informant reports. Kappa values were estimated for each diagnostic category and related symptoms. RESULTS: Highest rates of parent-youth agreement were found for substance abuse and disruptive disorders. Rates of conduct disorder (nonaggressive) and major depression were reported less frequently by parents relative to their children. At the symptom level, parents less frequently reported Gets drunk and Frequency of drinking. CONCLUSIONS: Psychological autopsy studies of adolescent suicide are likely to underestimate the prevalence of psychiatric disorders in general and major depression and alcohol abuse in particular. These risk factors may be more predictive than previously thought.

Adolescent↗
PubMed1998

Atypical features and treatment response in the National Institute of Mental Health Treatment of Depression Collaborative Research Program.

Because depression with atypical features is poorly responsive to imipramine, treatment trials including a tricyclic antidepressant arm should assess depressive subtype. Sotsky and Simmens had previously reanalyzed data from the National Institute of Mental Health Treatment of Depression Collaborative Research Program (TDCRP) providing independent confirmation that imipramine is ineffective for patients with atypical features. The TDCRP was a 16-week study in which 239 outpatients with major depression were randomly assigned to cognitive behavior therapy (CBT), interpersonal psychotherapy (IPT), imipraminecase management (IMI-CM), or pill placebo-case management (Pbo-CM). We used Sotsky and Simmens' algorithm to investigate the effect of diagnostic subtype on all four treatments. Hierarchical multiple regression analyses demonstrated IMI-CM benefit relative to Pbo-CM in patients without but not in those with atypical features. These analyses did not demonstrate differential psychotherapy efficacy between depressive subtypes. In conclusion, subsequent analyses of the TDCRP study demonstrated the need to identify the subgroup of depressed patients who have atypical features. Failure to identify this subtype underestimates imipramine's benefit in the appropriately treated subgroup. Comparisons of other treatments with imipramine may be misleading if they do not account for diagnostic subtype.

Algorithms↗
PubMed1994

Ataque de nervios and panic disorder.

OBJECTIVE: Ataque de nervios ("attack of nerves") is an illness category used frequently by Hispanic individuals to describe one or more particular symptom complexes. A review of the literature on ataque suggested some overlap with panic disorder. This study investigated the overlap with panic disorder as well as other DSM-III-R axis I disorders. METHOD: Hispanic subjects seeking treatment at an anxiety disorders clinic (N = 156) were assessed with a specially designed questionnaire for self-report of ataque de nervios and panic symptoms and with structured or semistructured psychiatric interviews for axis I disorders. RESULTS: Seventy percent of the subjects reported at least one ataque de nervios; 80% of these were female, whereas 57% of the group without these attacks were female. There were no differences in DSM-III-R diagnoses between the groups with and without ataque de nervios. Ataque was frequently associated with one or more anxiety and affective disorders, including panic disorder, generalized anxiety disorder, recurrent major depression, and anxiety not otherwise specified. Of the 45 subjects with both ataque de nervios and primary panic disorder, 80% appeared to have labeled panic disorder as ataque. Ataque de nervios was associated with panic symptoms even in subjects without panic disorder, but the self-reporting of ataque conveyed additional clinical information about the subjects with panic disorder. Ataque de nervios was similar in frequency and symptoms among subjects of Dominican and Puerto Rican origin. CONCLUSIONS: Ataque de nervios overlaps with panic disorder but is a more inclusive construct. Further study of its interrelation with axis I disorders is needed.

Adult↗
PubMed1994

Neuropsychiatric and neuropsychological findings in conduct disorder and attention-deficit hyperactivity disorder.

Neuropsychiatric and neuropsychological evaluations were performed in a pilot study of adolescents with DSM-III-R disruptive behavior disorders, including conduct disorder (CD) and attention-deficit hyperactivity disorder (ADHD). The following comparisons were made: 1) CD comorbid with ADHD vs. CD only; 2) all subjects with ADHD vs. all non-ADHD; and 3) all subjects with CD vs. all non-CD. The CD + ADHD group had increased left-sided soft signs compared with the CD group. CD + ADHD subjects significantly underperformed CD subjects on several executive functioning measures, with no differences on Verbal IQ subtests. Results are discrepant with previous findings of deficient verbal functioning in delinquent populations. However, findings may not be generalizable because of sampling limitations.

Adolescent↗
PubMed1994

Functional impairment in social phobia.

BACKGROUND: This study examined the nature of impairment of functioning in persons with social phobia and assessed the validity of two new rating scales for describing impairment in social phobia. METHOD: In 32 patients with social phobia and 14 normal control subjects, impairment was assessed using the Disability Profile and the Liebowitz Self-Rated Disability Scale, new instruments designed to provide clinician- and patient-rated descriptive measures of current and lifetime functional impairment related to emotional problems. Validity of the new scales was assessed by measuring internal consistency, comparing scores for patients and controls, and comparing scores with those on standard measures of disability, social phobia symptoms, and social support. RESULTS: More than half of all social phobic patients reported at least moderate impairment at some time in their lives, due to social anxiety and avoidance, in areas of education, employment, family relationships, marriage/romantic relationships, friendships/social network, and other interests. Social phobic patients were rated more impaired than normal controls on nearly all items on both measures. Both scales were internally consistent, with Cronbach's alpha coefficients for lifetime and current disability subscales in the range of .87 to .92. Significant positive correlations of scores on the new scales with scores on coadministered standard scales of social phobia symptoms and disability demonstrated concurrent validity. Disability was not significantly correlated with measures of social support. CONCLUSION: Social phobia is associated with impairment in most areas of functioning, and the new scales appear useful in assessing functional impairment related to social phobia.

Activities of Daily Living↗
PubMed1984

Interhemispherical comparisons in the processing of contour and random texture sinewave stereograms.

Contour and random texture stereograms were developed, using continuously variable, vertically oriented, sinewave horizontal disparities and variable texture densities. The contours were both computer printed and generated, and presented on a dual-beam oscilloscope; the textures were generated on a UNIVAC-to-Calcomp plotter, photographed, and then presented as slides, via rear-view polarized screens, in both static and dynamic modes. By means of fixation control, in normal subjects, the images in the right and left visual fields (thus: left and right visual cortices) were studied either separately or together. Parameters such as apparent depth, rate of depth-phi-motion, target density (matching and mismatching), depth ripple rate, Panum's horizontal fusion-disparity limits, and imposed monocular vertical prismatic imbalance, were studied for the separate hemispheres. In all but a few instances, the results show comparable, thus symmetrical, performances for right and left visual cortices. In those few instances where we could say that clear inter-cortical differences were found, they were found with both contour and texture targets. Furthermore, the density range of the targets (from 0.5 down to 0.005) was chosen so as to cover the phenomenal and physical range from true textures, at the high density end, to single disparate dots, at the low disparity end. But no sharp flex points were found, for any of several parameters, when moving from textured to dot targets. Although generally, observer and hemispherical variance were greater with the higher densities, the curves (with density) were ogival or S-shaped in form and never discontinuous. These results are discussed in the context of two previous findings in the literature. We cannot support the claim that there is somehow a difference in the way in which the visual cortex processes localized dot or contour targets from the way in which it processes pattern or texture targets. Secondly, the literature tends increasingly to support the contention that right occipital injuries hinder the processing of texture stereograms but not that of dot or contour stereograms. Since we could find only a scattered enhancement of right hemispherical prowess in normal vision, with both sorts of stereograms, this suggests that, - should these effects be reliably found in such patients, - they would have a different and non-congenital basis.

Brain↗
PubMed1976

Replicating psychiatric ratings through multiple regression analysis: The Midtown Manhattan Restudy.

This paper examines three related questions: First, can psychiatrists' judgments be successfully predicted by multiple regression techniques? Second, assuming that they can, are such ratings a valid measure of mental health for the same sample at a later point in time? Third, what is the relation between mental health ratings made in 1954 and such subsequently reported behavioral outcomes as nervous breakdown, mental hospitalization, or seeking professional help for emotional problems? The evidence presented warrants two conclusion. (1) The computer-derived mental health ratings are an adequate substitute for the original ratings. The regression equation accounts for 69 percent of the variance in those ratings; and the computer-derived ratings behave in the same way as the psychiatrists' ratings in relation to other variables. (2) However, neither the psychiatrists' ratings nor the computer-derived ratings are very accurate in predicting subsequent self-reported behavior indicative of mental impairment.

Adult↗
PubMedDate not supplied

Impact of fetal scalp blood pH on the incidence of cesarean section performed for fetal distress.

To determine the impact of fetal scalp blood pH sampling (FSBpH) on the incidence of cesarean section performed for fetal distress, a retrospective clinical study was designed to compare rates of surgical intervention before and after the introduction of FSBpH in 1977. The use of the FSBpH sampling has been shown to decrease the rate of cesarean section as a means of dealing with fetal distress from 78.0% to 57.5% without a significant change in the Apgar score.

Apgar Score↗