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Biomedical subjects

S Crawford

Publications and source records attributed to S Crawford.

At least 37 records · Page 2Linked to original sources
PubMed2001

Longitudinal study of hormone levels and depression among women transitioning through menopause.

OBJECTIVE: To address the association between depression and absolute levels of estradiol, and change in estradiol, among women during the menopausal transition. METHODS: This was a prospective, observational study conducted in Massachusetts, USA. Analyses reported here are based on the first three interviews following baseline (T1-T3). The participants were 309 women aged initially 43-53 years, who contributed a total of 728 observations (mean number of observations per subject 2.36). The main outcome measure was depression as measured by the Center for Epidemiologic Studies-Depression (CES-D) scale. RESULTS: CES-D score was not significantly associated with menopause status categories, nor was it associated with annual change in estradiol level (E2) (p = 0.19). The unadjusted association between log E2 and CES-D was negative (odds ratio 0.69) and statistically significant (p = 0.03). Upon adjustment for symptoms, however, the association remained negative but was no longer statistically significant (p = 0.26). Hot flushes/night sweats were positively associated with CES-D (p = 0.04), and trouble sleeping was strongly positively related to CES-D (p < 0.001). CONCLUSIONS: Results provide strong support for the domino or symptom hypothesis, which posits that depressed mood is caused by vasomotor symptoms associated with changing estrogen levels. Estradiol did not have a direct effect, independent of symptoms. This study adds to the body of literature suggesting that any association found between menopause and depression is most likely to be explained by other factors, such as symptoms and sleep problems. Findings also highlight the importance of studying the complex relationship between hormone levels, sleep problems and vasomotor symptoms during the menopausal transition.

Adult↗
PubMed2001

Improving the health of Oklahomans: status and goals of adult immunization.

This article will discuss the prevalence and impact of the infectious diseases affecting adult Oklahomans for which vaccines are available. Evidence for vaccine utilization and the present status and future aspirations for population-wide immunization rates in Oklahoma will also be reviewed. The information and data herein are taken mainly from recommendations established by the US Preventive Services Task Force (USPSTF); the Centers for Disease Control (CDC) publication Epidemiology and Prevention of Vaccine-Preventable Disease; the findings of the Advisory Committee on Immunization Practices (ACIP) as published in the CDC's Morbidity and Mortality Weekly Report; the Oklahoma State Department of Health (OSDH) State of the State's Health Report; and the Behavioral Risk Factor Surveillance System (BRFSS), a telephone survey conducted by the CDC.

Adult↗
PubMed2000

Analysis of switching insurance plan type. Comparison of two statistical methods.

PURPOSE: To compare results of 2 statistical methods for identifying factors in claims data that are associated with switching insurance plans between managed care (MC) and indemnity (IN).METHODS: Using claims data from 2 insurance providers in a northeastern city, we analyzed patients aged 18+ with diabetes, asthma, or congestive heart failure (CHF) who were covered any time in 1993-1997 (N = 88,917). Stratifying by initial plan type, we examined predictors of switching from the initial plan type using logistic regression and survival analysis. Covariates included age, time in study (for logistic models), gender, diabetes (yes/no), CHF (yes/no), and asthma (yes/no). Survival analysis accounted for time to switch and allowed time-varying covariates.RESULTS: In logistic regression models, older individuals who were in IN were much less likely to switch into MC. Those in MC were more likely to switch to IN, with the greatest likelihood of switching in ages 60-69 (OR = 4.00, 95% CI = 3.32-4.83). Females were less likely to switch from IN to MC (OR = 0.92, 95% CI = 0.87-0.98), CHF patients were less likely to switch from IN to MC (OR = 0.75, 95% CI = 0.68-0.83), and diabetes patients were less likely to switch from MC to IN (OR = 0.77, 95% CI = 0.62-0.96). Hazard ratios calculated using Cox regression were similar to odds ratios for most covariates. However, some coefficients for diseases were significant in Cox models but not in the logistic models. Cox models took 45 times longer in CPU time than logistic regression models.CONCLUSIONS: Logistic regression was a good approximation to Cox regression in identifying many of the factors in switching insurance plan in these data, at a fraction of the computing time. However, Cox models allowed diseases to be time-varying, and so was more sensitive to identifying significant relationships with disease.

Journal Article↗
PubMed2000

Digit preference in year at menopause. Data from the study of women's health across the nation.

PURPOSE: To assess possible digit preference in self-reported year at natural menopause, and to determine whether equal proportions is an appropriate reference distribution.METHODS: Data are from the cross-sectional telephone interview from the Study of Women's Health Across the Nation (SWAN), a multi-site, multi-ethnic study of women aged 40-55. Analyses included 2151 naturally menopausal respondents, who were asked the year their periods stopped. Using a chi-square test, we compared the distribution of the terminal digit for year of final menstrual period (FMP) to an equal proportions (EP) distribution assigning 10% probability of each of the 10 digits. Departures from EP, however, may be accurate and may reflect the observed age distribution of subjects rather than digit preference. Thus, we stratified by year of interview to determine if the distribution was the same across years-suggesting digit preference-or if it varied systematically. We then estimated an expected distribution of terminal digit for year of FMP, using prospectively collected data (not subject to digit preference or recall bias) from the Massachusetts Women's Health Study, applied to the SWAN age distribution. The SWAN terminal digit distribution was compared with this expected distribution.RESULTS: Terminal digit for year at FMP exhibited a strong departure from EP (chi(2) = 841.60, p < 0.001), with highest frequencies for digits 4 and 5. Stratifying by year of interview, the distribution was shifted one digit in 1997 compared with 1996, consistent with unbiased reporting. Using the expected distribution as the reference reduced the chi-square statistic by a factor of 7 (chi(2) = 119.51, p < 0.001).CONCLUSIONS: The distribution of terminal digits for reported year at FMP was far from uniform, but departures from EP were consistent with results expected from an independent prospective study. These results suggest that EP may not be an appropriate reference for studies of digit preference, particularly those with a restricted age range.

Journal Article↗
PubMed2000

Electronic versus paper instruments for daily data collection.

PURPOSE: Collecting daily information on a series of similar, recurring events such as menstrual bleeding, headaches, or insulin levels using paper instruments is subject to problems such as missing or incorrectly recorded data, and retrospective data entry. The authors are developing and evaluating electronic data collection using hand-held personal computers (H/PC) for a variety of health-related applications, including tracking premenstrual syndrome (PMS), fertility awareness, and headaches, to improve accuracy and timeliness of data collection.METHODS: ProCycle is a prototype electronic diary for collection of daily data on menstrual bleeding, medications, and health symptoms. In a 3-month pilot test in 25 regularly cycling women, we compared its performance with a paper calendar regarding missing and incorrect data, data entry lag, data cleaning time, and users' preferences with respect to factors such as remembering to enter data, convenience, and overall preference. Additional programs for PMS, fertility, and headaches are being field tested on subjects from the Boston and New York areas, comparing performance with paper versions.RESULTS: In the pilot test, missing data occurred less frequently with ProCycle than with paper, particularly for any days with missing symptoms (4% vs. 35%, p < 0.05). ProCycle did not permit any data recording mistakes such as circling contradictory responses (e.g., bleeding and no bleeding), compared with incorrect data on 13% of paper calendars. Data entry/cleaning time was 81% lower for ProCycle. 70% of users preferred ProCycle overall, compared with 9% preferring paper (p < 0.01).CONCLUSIONS: Although the initial cost of the H/PC is significantly higher than paper, there are no recurring charges for printing or data entry, and data cleaning is minimal. Electronic instruments on an H/PC provide an efficient, accurate method of data collection, applicable to a number of areas of health-related research involving daily data collection.

Journal Article↗
PubMed2000

Use of a chinese herbal medicine for treatment of hiv-associated pathogen-negative diarrhea.

Background: Diarrhea is a frequent problem among persons with advanced HIV disease. In the absence of treatable pathogens, symptomatic relief is all that is available for current therapy. As a result, many patients with HIV and chronic diarrhea have turned to herbal formulas for treatment. We assessed the effectiveness and safety of a Chinese herbal formulation (Source Qi) in reducing the number of stools per day related to HIV-associated, pathogen-negative diarrhea. Methods: Sixteen male patients received treatment with Source Qi in an 8-week, open-label study. Patients tested negative for cryptosporidium and other gastrointestinal pathogens, and had chronic diarrhea, defined as having three or more loose stools/day for >/=14 days (and no other treatable causes for diarrhea). Measurements of diarrhea included numbers of bowel movements/day, abnormal bowel movements/day, and liquid bowel movements/day. Subjects completed daily stool diaries an average of 2 weeks before and up to 8 weeks after starting Source Qi. Paired Wilcoxon tests compared the last week before treatment with each week of treatment. Results: There was a reduction in average number of stools/day in each week of treatment (-0.2 to -0.8), except week 1 (+0.1), with improvements in weeks 2-6 approaching or reaching statistical significance. Conclusions: A modest but sustained decrease in average number of stools/day was observed in patients with HIV-associated, pathogen-negative diarrhea. The entry criteria, 2-week run-in period, lack of benefit in week 1, and sustained benefit thereafter all suggest that the improvement was not due to bias.

Journal Article↗
PubMed2000

The effects of anterior lesions on performance on a story comprehension test: left anterior impairment on a theory of mind-type task.

Participants with unilateral anterior or posterior lesions were compared to a healthy group on a theory of mind-type task that involved explaining the words or actions of story characters in a series of brief vignettes. Participants also carried out a set of non-social neuropsychological tests. Those with left anterior brain lesions (n=6) showed impairment relative to those with right anterior (n=13), left (n=4) and right (n=8) posterior lesions and healthy participants (n=60) in story comprehension, and their errors commonly involved failure to make non-literal interpretations. The left anterior lesion participants also showed impairment on some measures of executive function. The implications of the findings for our understanding of impairments in story comprehension after brain injury are discussed in terms of models of executive function and theory of mind.

Adult↗
PubMed2000

Child sexual abuse and bulimic symptomatology: relevance of specific abuse variables.

OBJECTIVE: This study examined specific aspects of child sexual abuse in relation to symptom severity among hospitalized patients diagnosed with bulimia nervosa. METHOD: Participants were 45 hospitalized bulimic women who reported a history of child sexual abuse. Structured interviews were conducted in order to obtain detailed information regarding specific features of the abusive event(s). Participants also completed instruments that measured depression and eating pathology. RESULTS: There were no significant differences in severity of depression or eating disturbance among women reporting differing abusive experiences including intrafamilial versus extrafamilial abuse, abuse with or without the use of physical force, one versus multiple incidents, early abuse versus abuse occurring after age 14, contact versus noncontact abuse, disclosed versus undisclosed, and combined physical/sexual abuse versus sexual abuse alone. CONCLUSION: The specific characteristics of child sexual abuse are not related to the level of symptomatology for hospitalized bulimic patients. This study suggests that differences in the nature of the abuse may not be as important as the fact that the abuse occurred in the first place.

Adolescent↗
PubMed2000

Relationship among antioxidant activity, vasodilation capacity, and phenolic content of red wines.

The relationship among antioxidant activity, based on the electron-spin resonance determination of the reduction of Fremy's radical, vasodilation activity, and phenolic content was investigated in 16 red wines. The wines were selected to provide a range of origins, grape varieties, and vinification methods. Sensitive and selective HPLC methods were used for the analysis of the major phenolics in red wine: free and conjugated myricetin, quercetin, kaempferol, and isorhamnetin; (+)-catechin, (-)-epicatechin, gallic acid, p-coumaric acid, caffeic acid, caftaric acid, trans-resveratrol, cis-resveratrol, and trans-resveratrol glucoside. Total anthocyanins were measured using a colorimetric assay. The total phenolic content of the wines was determined according to the Folin-Ciocalteu colorimetric assay and also by the cumulative measurements obtained by HPLC. The 16 wines exhibited a wide range in the values of all parameters investigated. However, the total phenol contents, measured both by HPLC and colorimetrically, correlated very strongly with the antioxidant activity and vasodilation activity. In addition, the antioxidant activity was associated with gallic acid, total resveratrol, and total catechin. In contrast, only the total anthocyanins were correlated with vasodilation activity. The results demonstrate that the different phenolic profiles of wines can produce varying antioxidant and vasodilatant activities, which opens up the possibility that some red wines may provide enhanced health benefits for the consumer.

Antioxidants↗
PubMed2000

Adult spinal cord injury without radiological abnormality.

Spinal cord injury without radiological abnormality is rare in adults. A case is described of a 61 year old man who fell 15 feet from a ladder striking his head on a wall who presented with neck pain and with motor and sensory neurological abnormalities in his limbs. Plain radiographs of the neck revealed no fractures or dislocations. Further imaging with computed tomography and magnetic resonance imaging revealed an osteophyte fracture with associated cord contusion at the C5 level. Careful neurological examination is essential in all cases of potential spinal injury.

Accidental Falls↗
PubMed1999

Biochemical and immunologic comparison of virus-like particles for a rotavirus subunit vaccine.

A parenterally administered rotavirus vaccine composed of virus-like particles (VLPs) is being evaluated for human use. VLPs composed of bovine VP6 and simian VP7 (SA11, G3) proteins (6/7-VLPs) or of bovine VP2, bovine VP6, and simian VP7 (SA11, G3) proteins (2/6/7-VLPs) were synthesized and purified from Sf9 insect cells co-infected with recombinant baculoviruses. 6/7- and 2/6/7-VLP administered parenterally (i.m.) in mice had comparable immunogenicity, but the 2/6/7-VLPs were more homogeneous and stable. The inclusion of the VP2 capsid contributed to particle formation and stability. The adjuvant QS-21 significantly enhanced the immunogenicity of 2/6/7-VLPs over A10H or saline alone. Equivalent serum neutralizing antibody responses were induced over the range of 1-15 microg/dose of 2/6/7-VLPs administered with the range of 5-20 microg/dose of QS-21. The immunogenicity of 2/6/7-VLPs and inactivated SA11 virus were comparable. 2/6/7-VLPs are a promising candidate for a parenterally delivered rotavirus subunit vaccine.

Adjuvants, Immunologic↗
PubMed1999

High angiogenic activity in cells isolated from cystic hygroma: role of bFGF.

BACKGROUND: Cystic hygromas are characterized by a proliferation of small vessels and lymphatics with intervening fibrous tissue. Studies have shown malignant tumors and some benign neoplasms are dependent on angiogenesis, the induction of new capillaries from preexisting vessels. Growth and progression of these tumors are associated with a disturbance in the balance of angiogenic inducers and inhibitors. We have postulated that cells derived from cystic hygromas are angiogenic due to secretion of higher levels of angiogenic inducers that promote vascular proliferation. DESIGN: A large cystic mass was surgically removed and a portion of the sterile tumor was immediately placed in the medium. The tissue was minced, washed in phosphate-buffered saline, and grown to near confluence. Conditioned medium was collected under serum-free conditions after 48 hours. Secreted proteins were concentrated, quantitated, and analyzed in an in vitro endothelial cell migration assay and by Western blot. Antibody to factor VIII-related antigen was performed to confirm endothelial cell origin of the cultured cells. MAIN OUTCOME MEASURES: In vitro angiogenic activity of secreted proteins in a capillary endothelial migration assay was tested by using blocking antibodies to angiogenic inducer, basic fibroblast growth factor, and angiogenic inhibitor, thrombospondin-1. Total protein levels of thrombospondin-1 were determined by Western blot. RESULTS: Cells isolated from cystic hygroma are angiogenic in vitro and this angiogenic activity is due to secretion of high levels of angiogenic inducer, basic fibroblast growth factor, and lower levels of naturally occurring angiogenic inhibitor, thrombospondin-1. CONCLUSIONS: Cystic hygromas may represent another neoplasm dependent on angiogenesis. The angiogenic activity is due in part to elevated levels of potent angiogenic inducer, basic fibroblast growth factor. Antiangiogenic therapy directed at the endothelial cell may help suppress the growth of cystic hygromas.

Adolescent↗
PubMed1999

Problem-solving in real-life-type situations: the effects of anterior and posterior lesions on performance.

Clinical studies have described patients who show marked impairments in everyday life, including planning, problem-solving and decision-making. Several factors potentially contribute to such impairments, including difficulties in generating possible problem solutions, and difficulties in selecting an appropriate solution. The present study describes the performance of participants with unilateral anterior or posterior lesions compared to healthy controls in ability to solve real-life-type problems. These covered a range of everyday interpersonal situations, and were presented both in video and story format. Participants also carried out a set of more abstract neuropsychological tests. Those with brain lesions showed impairment relative to controls in both everyday problem-solving and on more abstract tests involving executive function and memory. The anterior group was impaired on more aspects of everyday problem-solving than the posterior group, showing reduced fluency in generating possible solutions, and also impairment in selecting appropriate problem solutions. The implications of the findings for our understanding of impairments in everyday life problem-solving after brain injury are discussed.

Adolescent↗
PubMed1999

Early prediction of persisting post-concussion symptoms following mild and moderate head injuries.

OBJECTIVES: King (1996) reported that a combination of emotional, organic and neuropsychological measures taken at 7-10 days following mild and moderate head injury may significantly help predict patients most likely to suffer persisting post-concussion symptoms (PCS) at three months post-injury. This study investigated a cross-validation sample (N = 57) to determine whether the results would be replicated for the early prediction of longer-term sufferers (i.e. those with persisting symptoms at 6 months post-injury). DESIGN: Multiple regression analyses were used in which scores on the Hospital Anxiety and Depression Scale, Impact of Event Scale, Short Orientation Memory and Concentration Test, Rivermead Post-Concussion Symptoms Questionnaire and Post-Traumatic Amnesia taken at 7-10 days post-injury were the independent measures. Scoring on the Rivermead Post-Concussion Symptoms Questionnaire taken at 6 months post-injury was the dependent measure. METHODS: Sixty-six consecutive patients admitted to any trauma ward in Oxfordshire with a mild or moderate head injury were recruited from a largescale randomized controlled sample. The assessment measures were administered at 7-10 days post-injury and the Rivermead Post-Concussion Symptoms Questionnaire at 6 months post-injury. Nine patients were unable to be followed up, leaving an active sample of 57. RESULTS: The cross-validation data confirmed that a similar combination of measures to that found in the original study best predicted persisting PCS but that the strength of prediction diminished for the longer term prediction (i.e. 6 months post-injury). CONCLUSIONS: The Hospital Anxiety and Depression Scale, Impact of Even Scale and Post-Traumatic Amnesia in combination are recommended as useful prognostic screening instruments for predicting persisting PCS, but great caution is required if they are used to aid predictions beyond 3 months post-injury.

Adolescent↗
PubMed1998

Covert fears, anxiety and depression in congenital heart disease.

UNLABELLED: This study compared anxiety, fears, depression and behavioural problems as occurring in children with congenital heart disease, comparing them with samples of normal children. It further considered the influence of maternal anxiety, as well as analyzing a subgroup of children with cyanotic forms of congenital heart disease to determine if they were at higher risk than acyanotic children for the problems identified. METHOD: We recruited 40 consecutive children with congenital heart disease without obvious psychosocial problems from the Cardiology clinic at the Alberta Children's Hospital. Of the 40 children, 39 families consented to have the children participate, of which 24 were cyanotic and 15 acyanotic. Children completed the revised versions of the Fear Survey Scale-Revised and the Child Manifest Anxiety Scale as well as the Child Depression Inventory. Mothers completed the Child Behaviour Checklist, and the State Trait Anxiety Scale. RESULTS: Children with congenital heart diseases demonstrated more medical fears, and more physiological anxiety, than the normative samples. More specifically, children with cyanotic forms of congenital heart disease demonstrated more fears of the unknown, physiological anxiety, depression, and delinquent behaviors than the acyanotic children with congenital heart disease. Mothers of the children with cyanotic forms of congenital heart disease scored higher on both the state and trait scales, with higher maternal anxiety correlating with higher anxiety, medical fears and behavioral problems in the child. CONCLUSION: In a clinical setting, children with congenital heart diseases who do not present with psychological adjustment problems are still at risk for covert physiological anxiety, medical fears, depression and behavioral problems. The children with cyanotic malformations represent a subgroup at higher risk for these problems, which may be further exacerbated by increased maternal anxiety.

Adult↗