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Biomedical subjects

R Howard

Publications and source records attributed to R Howard.

At least 73 records · Page 4Linked to original sources
PubMed1999

The FEAR: a rapid screening instrument for generalized anxiety in elderly primary care attenders.

OBJECTIVE: To develop a shorter version of the Anxiety Disorder Scale (ADS) for use as a rapid screening instrument in primary care. DESIGN: Two-stage screening design. Primary care attenders aged 65 and over were screened for generalized anxiety in the surgery with the 11-item generalized anxiety subscale of the ADS (ADS GA), a selected subsample then proceeding to a clinical validation interview. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Scores on the ADS GA, non-hierarchical ICD-10 caseness for generalized anxiety established by brief clinical interview by an old age psychiatrist. RESULTS: The prevalence rate of generalized anxiety was 16% using the established cutpoint and showed an age-related decline. A cutpoint of 2-3/11 appeared to give optimal performance in this small sample (sensitivity 85%, specificity 77%, positive predictive value 52%), suggesting that 36% of elderly general practice attenders might be diagnosed as having generalized anxiety. A reduced four-item version gave a predicted sensitivity of 77%, a specificity of 83% and a positive predictive value of 63% (cutpoint 1-2/4). CONCLUSIONS: A four-item version of the ADS GA, the FEAR (frequency of anxiety; enduring nature of anxiety; alcohol or sedative use; restlessness or fidgeting), has potential as a rapid screening instrument for use in primary care.

Aged↗
PubMed1999

Anxiety and its treatment in the elderly.

A search for references relating to the treatment of anxiety disorders in the elderly was made using the BIDS computerized database back to 1981, the Medline computerized database back to 1983, and the PsycLIT computerized database back to 1974, together with a search of relevant citations. The profusion of clinical recommendations was found to contrast with the lack of adequate supporting controlled clinical trials. There was evidence of a trend away from the benzodiazepine class of anxiolytics and an upsurge in interest in agents active at the serotonin receptor, although with the possible exception of buspirone, there is so far little research evidence for advocating use of the new agents in the elderly. Psychological therapies may be useful for many types of anxiety in the elderly, but their efficacy is also as yet unproven. Rational prescribing recommendations for anxiety in this age group will require controlled clinical trials incorporating a multiaxial approach to anxiety assessment, quality-of-life measures, psychological and placebo controls, and adequate follow-up intervals.

Aged↗
PubMed1999

HLA haplotypes and microsatellite polymorphisms in and around the major histocompatibility complex region in a Native American population with a high prevalence of scleroderma (systemic sclerosis).

Choctaw Native Americans in southeastern Oklahoma have the highest prevalence of scleroderma or systemic sclerosis yet found (469/100,000). An Amerindian HLA DR2 haplotype (DRB1*1602) was significantly associated with scleroderma in this population in a previous study. It is not known, however, if other disease genes are linked to this HLA haplotype. The regions flanking the HLA loci were studied with polymorphic microsatellite markers. An extended HLA DR2 (DRB1*1602, DQA1*0501, DQB1*0301, DPB1*1301) haplotype that includes the class I and III regions was identified which was significantly associated with scleroderma in the Oklahoma Choctaw. No other significant associations with microsatellite marker alleles immediately flanking the HLA region were found.

Autoimmune Diseases↗
PubMed1999

Relationship between fire fighting suppression tasks and physical fitness.

This investigation evaluated the relationship between physical fitness and performance of fire suppression tasks. The following mean +/- SD values were associated with 91 fire fighters: age 31.69 +/- 7.39 years, height 177.29 +/- 6.38 cm, weight 83.97 +/- 10.86 kg, % fat 13.78 +/- 4.31, fat free weight (FFW) 71.52 +/- 7.66 kg, pull-ups 9.03 +/- 4.79, push-ups 41.02 +/- 14.08, 1.5 mile run 737.60 +/- 108.11 s, sit and reach 32.00 +/- 8.5 cm, sit-ups 39.88 +/- 7.75, and total grip strength 116.75 +/- 17.67 kg. The physical performance assessment (PPA) consisted of the following: stair climb, hoist, forcible entry, hose advance, and victim rescue. Significant correlations (p < 0.01) were found between the PPA and the following: total grip strength (r = -0.54), FFW (r = -0.47), height (r = -0.40), pull-ups (r = -0.38), push-ups (r = -0.38), 1.5 mile run (r = 0.38), sit-ups (r = -0.32), weight (r = -0.30) and % fat (r = 0.30). Multiple regression analysis indicated that the best multiple predictor of PPA was the 1.5 mile run, FFW, and pull-ups, r = 0.73, p < 0.001. This investigation shows the importance of physical fitness as related to performance of fire suppression job tasks.

Adult↗
PubMed1999

Neuropsychological impairment in stroke, carotid stenosis, and peripheral vascular disease, A comparison with healthy community residents.

BACKGROUND AND PURPOSE: An increasing body of literature suggests a role for clinically "silent" cerebrovascular disease in the pathogenesis of cognitive impairment. Such pathology commonly occurs in the absence of stroke. The main aim of the study was to examine neuropsychological impairment associated with cerebrovascular and peripheral vascular disease (PVD) and to compare cognitive deficits with a nonvascular control group. The main hypothesis was that older people with both transient ischemic attack (TIA) and PVD would demonstrate greater cognitive impairment than controls. METHODS: A battery of neuropsychological tests was administered to 4 groups of community residents older than 65 years. The groups comprised 25 patients with carotid stenosis and TIA, 25 nonamputees with PVD, 25 patients with stroke, and 25 matched (with the stroke group) controls. RESULTS: Stroke patients showed greater impairment than controls in all tests. PVD patients did not perform significantly worse (P<0.05 after Bonferroni correction) than control subjects on any of the neuropsychological tests. However, 25% of PVD patients had scores lying within the bottom 5% of control group scores for attention, calculation, and 1 test of frontal lobe function. TIA patients were more impaired in general intellectual impairment and frontal lobe function than controls. Frontal lobe impairment, suicidal thinking, and age were all independent predictors of global cognitive impairment in the TIA group. Frontal lobe impairment was the only predictor of global cognitive impairment in the PVD group. CONCLUSIONS: TIA and PVD patients showed similar patterns of neuropsychological impairment, but TIA may result in more prolonged cognitive impairment, particularly in frontal lobe function. This group may be at increased risk of vascular dementia as well as impulsivity and suicide.

Aged↗
PubMed1999

Primitive reflexes in cerebrovascular disease: a community study of older people with stroke and carotid stenosis.

OBJECTIVES: To determine the prevalence of primitive reflexes (frontal release signs) in elderly community residents with cerebrovascular disease and to examine their relationship with neuropsychological and mood-related variables. METHODS: Three groups of 25 people over 65 with anterior circulation stroke, transient ischaemic attack (TIA) and a control group were assessed using measures of generalized cognitive impairment, frontal lobe dysfunction, frontal release signs and mood-related variables. Predictors of cerebrovascular disease were examined further in stroke and TIA groups. RESULTS: Both stroke and TIA groups showed a higher mean score on the Frontal Release Signs Scale and a higher prevalence of most reflexes than the control group. Verbal fluency and DSM-IV depressive disorder were independent predictors of frontal release signs. CONCLUSION: TIAs may predispose to subtle neurological impairment, which may be mediated by frontal lobe damage. Their role in the pathogenesis of depression in later life requires further exploration.

Affect↗
PubMed1998

Investigation of facial recognition memory and happy and sad facial expression perception: an fMRI study.

We investigated facial recognition memory (for previously unfamiliar faces) and facial expression perception with functional magnetic resonance imaging (fMRI). Eight healthy, right-handed volunteers participated. For the facial recognition task, subjects made a decision as to the familiarity of each of 50 faces (25 previously viewed; 25 novel). We detected signal increase in the right middle temporal gyrus and left prefrontal cortex during presentation of familiar faces, and in several brain regions, including bilateral posterior cingulate gyri, bilateral insulae and right middle occipital cortex during presentation of unfamiliar faces. Standard facial expressions of emotion were used as stimuli in two further tasks of facial expression perception. In the first task, subjects were presented with alternating happy and neutral faces; in the second task, subjects were presented with alternating sad and neutral faces. During presentation of happy facial expressions, we detected a signal increase predominantly in the left anterior cingulate gyrus, bilateral posterior cingulate gyri, medial frontal cortex and right supramarginal gyrus, brain regions previously implicated in visuospatial and emotion processing tasks. No brain regions showed increased signal intensity during presentation of sad facial expressions. These results provide evidence for a distinction between the neural correlates of facial recognition memory and perception of facial expression but, whilst highlighting the role of limbic structures in perception of happy facial expressions, do not allow the mapping of a distinct neural substrate for perception of sad facial expressions.

Adult↗
PubMed1998

The relationship between anxiety disorders and age.

OBJECTIVES: To review the major community-based epidemiological studies that have reported data on anxiety disorders in individuals aged 65 and over and to examine age-related changes in their prevalence and incidence. DATA SOURCES AND STUDY SELECTION: All English language entries relating to anxiety in the BIDS, EMBASE, Medline and PsychLit computerized databases, together with a search of relevant citations. DATA SYNTHESIS: The prevalence of phobic disorders in the population aged 65 or over lies between 0.7% and 12% over a 1-6-month period. As the rates for social phobia, 1%, and simple phobia, 4%, are fairly consistent, much of this variation is due to agoraphobia, whose prevalence lies between 1.4% and 7.9%. The prevalence of obsessive-compulsive disorder is 0.1-0.8%, panic disorder 0.1% and generalized anxiety 4%. Women do have a higher prevalence of anxiety disorders than men but this difference diminishes with increasing age, as does the apparent prevalence of all anxiety disorders apart from generalized anxiety, measured without hierarchical rules, which appears to be maintained or increase. The relative importance of various explanations for this apparent reduction is discussed, including the three that are of greatest public health and clinical importance: cohort effects, anxiety-related mortality and comorbidity between anxiety and cognitive impairment. A tri-dimensional approach (psychic, somatic and behavioural) to anxiety measurement is advocated in order to facilitate future studies of age-related changes which may lead to a reappraisal of the status of generalized anxiety as a 'residual category'.

Age Factors↗
PubMed1998

Vascular dementia: dead or alive?

The term 'Vascular Dementia' remains popular as a diagnostic entity, since it encompasses a variety of vascular pathologies. This is in stark contrast to many clinical classificatory systems that weight their definitions strongly towards stroke alone. A diagnosis of vascular dementia is complicated by compounding factors that reduce both the validity and specificity of diagnostic systems. This review highlights some of the problems faced in epidemiological, clinical, neuropathological and radiological studies attempting to define a clear-cut syndrome of dementia associated with cerebrovascular disease. The role of non-stroke ischaemia is also discussed. It is concluded that the term vascular dementia may have outlived its usefulness as a valid concept; alternative approaches are suggested.

Cerebrovascular Disorders↗
PubMed1998

Cognitive impairment in late life schizophrenia: a suitable case for treatment?

The benign side-effect profiles of the atypical antipsychotic drugs have earned them an important niche in old age psychiatry. Evidence for a specific improvement in cognitive function associated with the use of these drugs is inconsistent and the definitive studies are still awaited. If these drugs can improve cognitive function in elderly patients with schizophrenia and schizophrenia-like psychosis, then in terms of patient-years of effective treatment of cognition, this action may be more significant than the treatment of Alzheimer's disease with cholinergic therapies.

Age of Onset↗
PubMed1998

An unusual case of pica.

Pica is the persistent, culturally and developmentally inappropriate ingestion of non-nutritive substances (DSM-IV). AB is a 75-year-old lady with a 40-year history of schizophrenia and a 20-year history of pica who, at emergency laparotomy, had 175.32 Pounds of loose change in her stomach. Although pica has been reported to coexist with schizophrenia, she had had no positive symptoms of schizophrenia for at least 20 years. She has CT evidence of fronto-tempotal atrophy most marked on the left in the temporal lobe and on the right in the frontal lobe. Pica has been found to be related to cognitive deficits and hyperoral behaviour to temporal lesions. Neuropsychological testing reveals deficits closely related to these changes.

Aged↗
PubMed1998

Adult skin disease in the pediatric patient.

The incidence of many skin diseases peak in adulthood, and these disorders may be difficult to recognize when they do present in childhood. Their clinical features may be distinct in pediatric patients, and they may be managed differently in children as compared to adults. Therefore, it is important that dermatologists are able to identify "adult" skin disease in the pediatric patient, and know how to appropriately manage these problems in young patients. The epidemiology, clinical features, differential diagnosis, and management of the following "adult" skin diseases in children are reviewed: psoriasis, lichen planus, rosacea, Sweet's syndrome, and mucosis fungoides. Distinctive features of lichen sclerosus and immunobullous diseases in childhood will also be briefly discussed.

Child↗
PubMed1998

Dementia and ethnicity.

Ethnic differences in rates of dementia nationally, within multiethnic communities, and internationally have important repercussions. The question "Do ethnic differences exist in rates of dementia?" is a crucial one that has implications for service delivery and also offers opportunities for future research on possible etiological factors. Epidemiological surveys suggest that ethnic and geographical differences do occur in rates of dementia, but cross-cultural surveys are fraught with problems. The need for further methodologically sound, cross-cultural comparative studies is paramount to confirm or disclaim the ethnic differences observed to date.

Africa↗
PubMed1998

Short-term outcome after mesh or shouldice herniorrhaphy: a randomized, prospective study.

BACKGROUND: Retrospective analyses have shown that long-term recurrence rates after Lichtenstein mesh and Shouldice herniorrhaphies are low. Therefore differences in short-term outcome may be important determinants of one's choice of repair. Although proponents of the mesh repair claim that their methods is less morbid, to our knowledge no prospective comparative studies of short-term morbidity have been reported. METHODS: One hundred five adult patients were randomized to undergo either a mesh or Shouldice inguinal hernia repair. Postoperative pain, narcotic use, and time to resumption of usual activities and employment were recorded. Patients were blinded to the type of repair received until all data were collected. RESULTS: There was no difference between the herniorrhaphy methods with respect to postoperative pain, duration of narcotic use, and time to resumption of usual activity and employment. Recovery was rapid for both groups of patients. By 3 days after operation, 50% of patients rated their pain as very mild or less and no longer required narcotic analgesics. Patients in both groups returned to usual activity and work by a median of 9 days after operation. CONCLUSION: Both of these well-established methods can be used to repair inguinal hernias with local anesthetics in an outpatient setting with minimal morbidity. Despite the "tension-free" design of the mesh repair, short-term outcomes of mesh and Shouldice repairs of inguinal hernias do not differ.

Ambulatory Surgical Procedures↗