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Biomedical subjects

S Feldman

Publications and source records attributed to S Feldman.

At least 55 records · Page 3Linked to original sources
PubMed1998

Behavioral health services: carved out and managed.

This article highlights the financial pressures that led to an examination of how mental healthcare was provided and paid for, and discusses the rise, characteristics, and functioning of carved-out behavioral healthcare. The typical characteristics of managed behavioral health carve outs (MBHCOs), including contracts, payment arrangements, provider networks, and data collection are discussed and illustrated using the example of United Behavioral Health. The article details the function of the MBHCO on cost and utilization, access, quality, and the relationship of behavioral health services to general medical care and other human services, but cautions that further research is needed to evaluate the qualitative aspects of care.

Capitation Fee↗
PubMed1998

Role of serotonin in the amygdala in hypothalamo-pituitary-adrenocortical responses.

In view of the fact that the amygdala (AMG) and hypothalamic serotonin (5-HT) have an excitatory effect on the hypothalamo-pituitary-adrenal (HPA) axis, we have investigated the role of 5-HT in the AMG on this response. In intact freely moving rats, a mildly stressing short photic stimulation caused depletion of median eminence CRH-41, due to its release into the portal circulation and a rise in serum ACTH and corticosterone levels. This effect was significantly inhibited in rats in which 5-HT was depleted in the AMG following local 5,7-dihydroxytryptamine administration, which did not affect hypothalamic 5-HT content. Also, local pretreatment with ketanserin (a 5-HT2 receptor antagonist) in the AMG had the same inhibitory effect on the HPA axis response. These results indicate that AMG 5-HT has an important role in the activation of the HPA axis following neural stimulation and that 5-HT2 receptors are involved.

5,7-Dihydroxytryptamine↗
PubMed1998

Predicting risk of complications with gynecologic laparoscopic surgery.

OBJECTIVE: To determine the incidence and predictors of risk for operative complications, conversions to laparotomy, and postoperative admissions after laparoscopic procedures. METHODS: We obtained demographic information on and medical histories of a consecutive series of 843 women who underwent laparoscopic surgery for all procedures other than tubal ligation at Brigham and Women's Hospital during 1994. All major complications after surgery were recorded. Major operative complications were defined as bowel, bladder, ureter, or vascular injuries or significant abdominal wall or other internal bleeding. Categorical analysis was used to compare differences in the rates of operative complications, conversions to laparotomy, and postoperative admissions after laparoscopy. We also estimated the influence of medical history and specific laparoscopic procedures on the risk of adverse complications after surgery. RESULTS: Operative complications and conversion to laparotomy occurred in 1.9% and 4.7% of laparoscopic procedures, respectively. Complications included four bowel, two bladder, one ureteral, two vascular, and five abdominal wall injuries. There were 165 patients (19.6%) admitted postoperatively. Aside from the type of operative procedure, increasing age was the most important predictor of complications. Relative to all other operative procedures, women treated for endometriosis or ovarian cystectomy had generally low rates of operative complications, conversions to laparotomy, and postoperative admissions. In contrast, 12.5% of women undergoing laparoscopically assisted vaginal hysterectomy experienced operative injuries or abdominal bleeding and 90% were hospitalized postoperatively. CONCLUSION: Serious operative complications after gynecologic laparoscopy were rare in this patient population. The more complex laparoscopic procedures resulted in proportionately greater rates of operative complications, conversions to laparotomy, and postoperative admissions to the hospital.

Adolescent↗
PubMed1998

The excitatory effects of the amygdala on hypothalamo-pituitary-adrenocortical responses are mediated by hypothalamic norepinephrine, serotonin, and CRF-41.

The hypothalamic neural mechanisms that are involved in the facilitatory effects of the amygdala (AMG) on the hypothalamo-pituitary-adrenocortical (HPA) axis have been investigated in rats. Stimulation of the central AMG nucleus caused a depletion of hypothalamic CRF-41, presumably due to its release into the portal circulation, and a subsequent rise in plasma ACTH and corticosterone (CS) levels. These effects were inhibited in rats in which hypothalamic norepinephrine (NE) or serotonin (5-HT) was depleted by catecholamine or serotonin neurotoxins, respectively. Furthermore, the administration of prazosin, an alpha1, but not of atenolol, which is a beta-blocker, as well as administration of the 5-HT2 blocker ketanserin inhibited the ACTH and CS responses to AMG stimulation. These results indicate that the facilitatory effects of the AMG on the HPA axis are mediated by hypothalamic NE via alpha1 receptors and by 5-HT via 5-HT2 receptors, as well as by CRF-41 in the paraventricular nucleus.

5,7-Dihydroxytryptamine↗
PubMed1998

Decline in rates of seropositivity for measles, mumps, and rubella antibodies among previously immunized children treated for acute leukemia.

We prospectively determined the measles-mumps-rubella (MMR) antibody status of 39 previously vaccinated children before and after administering protocol-directed chemotherapy for acute leukemia. At diagnosis the seropositivity rates for measles and mumps-specific immunoglobulin G were > or = 90%, while the seropositivity rate for rubella was 85%. After treatment, rates of seropositivity for measles antibody declined by 13% (90% of patients to 77%; P = .13); for mumps antibody, by 18% (97%-79%; P = .02); and for rubella antibody, by 21% (85%-64%; P = .03). These findings suggest that some survivors of acute leukemia during childhood have an increased susceptibility to MMR viruses and would benefit from posttreatment evaluation of their immune statuses and from possible revaccination.

Acute Disease↗
PubMed1998

Measles, mumps, and rubella serology in premature infants weighing less than 1,000 grams.

BACKGROUND: This study was done to determine antibodies to measles, mumps, and rubella within the first 2 weeks of life and 3 months of age in premature infants. METHODS: All premature infants (< 32 weeks' gestation) weighing less than 1,000 g and admitted to the neonatal intensive care unit were eligible for inclusion in the study. Measles, mumps, and rubella titers were obtained from the mother and from the infant during the first 2 weeks of life and at 3 months of age. RESULTS: A total of 44 maternal-infant pairs were enrolled. At birth, 45% of the infants were seronegative for measles, 55% for mumps, and 48% for rubella. Maternal samples revealed seronegativity in 14%, 3%, and 17%, respectively. By 3 months of age, 100% of infants were seronegative for mumps and rubella, and 94% were seronegative for measles. CONCLUSIONS: The majority of prematurely born infants are seronegative for measles, mumps, and rubella by 3 months of age and therefore are presumably susceptible to infection during the first year of life.

Adult↗
PubMed1998

Postpartum and vulvar necrotizing fasciitis. Early clinical diagnosis and histopathologic correlation.

OBJECTIVE: To review the clinical course and correlate histopathologic findings of obstetrics and gynecology patients with necrotizing fasciitis STUDY DESIGN: Seven-teen patients with postpartum or vulvar necrotizing fasciitis were identified from 1981 to 1996. Medical records were retrospectively reviewed. Information was available for all patients until death or discharge from the hospital. Histopathologic material on 15 patients was available for review. RESULTS: Five postpartum patients were diagnosed and surgically debrided one to nine days after cesarean delivery, with no mortality. Twelve patients with vulvar necrotizing fasciitis were diagnosed and surgically debrided <1-10 days after presentation to a physician, with three deaths (25%). On histopathologic review, all cases had prominent lobular and septal panniculitis. Thirteen cases had histologic evidence of fasciitis. CONCLUSION: Early diagnosis and aggressive surgical debridement in patients with postpartum and vulvar necrotizing fasciitis may improve the outcome. Histopathologic findings are remarkably consistent and may help to confirm the diagnosis.

Adult↗
PubMed1998

No increase of hypoglycaemia upon transfer of aged longstanding type 1 diabetic patients to human insulin: a prospective randomized study. The Investigators of the Transfert Study.

To assess the frequency and severity of hypoglycaemia following transfer to human insulin, 94 aged Type 1 diabetic patients on animal insulin were randomly assigned either to continue their usual insulin (group A, n = 48) or convert to equivalent preparations of human insulin (group B, n = 46). At inclusion, the two groups showed no differences in age (58.1 +/- 2.2 vs. 54.4 +/- 2.3 years), duration of diabetes (20.8 +/- 1.4 vs. 19.6 +/- 1.6 years) (mean +/- SEM), and glycosylated haemoglobin (HbA1c) values (9.1 +/- 0.2% vs. 8.9 +/- 0.2%). There were 43 eligible patients in group A and 41 in group B. After three months of treatment, HbA1c values were not significantly different between the two groups (8.6 +/- 0.2% vs. 8.5 +/- 0.2%), and there was no difference in the frequency and intensity of hypoglycaemic episodes. Quality of life, as assessed by a questionnaire, was similar at inclusion and after three months. However, the anxiety level was significantly lower in group B. Type 1 diabetic patients were efficiently and safely switched from animal to human insulin without aggravating the incidence of hypoglycaemia, in spite of two major risk factors, i.e. advanced age and diabetes of long duration.

Aged↗
PubMed1997

Effect of glucocorticoids on the adrenocortical axis responses to electrical stimulation of the amygdala and the ventral noradrenergic bundle.

In the present study we examined the negative feedback effect of exogenous and endogenous glucocorticoids (GC) on the responses of the hypothalamo-pituitary-adrenocortical (HPA) axis to electrical stimulation of the central amygdaloid nucleus (AMG) and the ventral noradrenergic bundle (VNAB). Injection of dexamethasone (DEX 5-50 microg/kg BW) 3.5 h prior to the electrical stimuli inhibited the serum ACTH and corticosterone (CS) responses in a dose dependent manner. At a dose of 50 microg/kg BW DEX, the stress induced responses was completely abolished. Pretreatment with a subcutaneous injection of corticosteroid type II receptor antagonist (RU-38486) 30 mg/kg BW, enhanced the ACTH and CS responses to both stimuli. In contrast, the type I receptor antagonist (RU-28381) did not affect neither the responses to both stimuli nor the inhibitory effect exerted by DEX. Electrical stimulation of both the AMG and VNAB caused a significant depletion of CRF-41 content of the median eminence (ME). Pretreatment with DEX (50 microg/kg BW) inhibited the electrical stimuli-induced depletion of ME CRH-41. These results suggest that: (1) the HPA axis responses to electrical stimuli of the AMG and the VNAB are sensitive to the negative feedback of GC; (2) the feedback effect exerted by GC is mediated by type II GC receptors; (3) CRH-41 released from the ME plays a dynamic role in mediating pituitary-adrenocortical responses to the electrical stimuli; (4) the inhibitory effect of exogenous DEX is mediated by a reduction of CRF-41 release from the ME.

Adrenal Cortex↗
PubMed1997

Hypothalamic mechanisms mediating glutamate effects on the hypothalamo-pituitary-adrenocortical axis.

The effect of local administration of glutamate into the hypothalamic paraventricular nucleus (PVN) on the hypothalamo-pituitary adrenocortical (HPA) axis was studied in male rats. Glutamate caused CRH-41 depletion from the median eminence (ME) and a consequent rise in ACTH and corticosterone (CS) serum levels. In rats pretreated with systemic dexamethasone (dex) these effects were completely inhibited. The administration of the glucocorticoid receptor antagonist RU-38486 abolished the inhibitory effect of dex on the adrenocortical discharge. In addition, the depletion of hypothalamic norepinephrine (NE) and serotonin (5-HT) by specific neurotoxins administered into the ventral noradrenergic blundle or into the raphe nuclei respectively, inhibited the response of serum ACTH and CS following PVN glutamate administration. These data indicate that glutamate stimulated the HPA axis via the release of ME CRH-41 into the portal circulation. This response is steroid sensitive involving type II glucocorticoid receptors. Hypothalamic NE and 5-HT participate in the glutamate induced HPA axis activation.

Adrenal Cortex↗
PubMed1997

The role of private-for-profit managed behavioral health in the public sector.

Managed behavioral health, once largely confined to private sector employees, has been growing rapidly in the public sector. Throughout the country, behavioral health services, particularly for Medicaid enrollees, are coming under the management of private-for-profit firms. The authors discuss these developments, and the controversies that have come about as a result. Several public/private models of managed behavioral health services are identified.

California↗
PubMed1997

Immunogenicity of hepatitis B vaccine in healthy very low birth weight infants.

We studied the immunogenic response to hepatitis B vaccine of infants weighing < or = 1500 gm at birth. Infants were divided into two groups: those weighing < or = 1000 gm (n = 22) and those weighing 1001 to 1501 gm (n = 28). When immunized early (3 days of age, n = 25), these infants had a response rate (defined as antibody to hepatitis B surface antigen titer > 10 mIU/ml) of 68%, whereas when the first vaccine was given at 1 month of age (n = 25), a 96% response rate was noted, irrespective of birth weight and weight at the time of immunization (p < 0.02).

Hepatitis B↗
PubMed1997

Depressed autoantibody synthesis in Trypanosoma cruzi-infected rats born to mothers undergoing this infection during pregnancy.

Earlier work indicated that Trypanosoma cruzi infection in pregnant rats decreased the amount of myocardial damage that developed in their chronically infected offspring. Given the suspected role of autoimmune mechanisms in the generation of chronic myocarditis, we evaluated whether this maternal intervention was likely to affect the synthesis of autoantibodies in infected young. Autoantibodies were investigated against molecules exhibiting cross-reactivity with T. cruzi antigens or not, that is cerebroside sulphate (sulphatide) and actin, respectively. Female '1' rats (75 days old) that had been mated with syngeneic sires were separated into two groups, one challenged with living trypomastigotes at 7, 14 and 21 days following mating, and the other one given physiologic saline at the same intervals. At the time of weaning, offspring were injected with 10(6)/T. cruzi to constitute two infected groups: young born to infected mothers (InMoTc) and young delivered by uninfected mothers (CoMoTc). Serum antibodies were investigated by ELISA at 30 and 60 days post-infection, which represents acute and chronic infection, respectively. T. cruzi infection was associated with the production of anti-sulphatide antibodies, but the phenomenon was significantly less evident in InMoTc young and virtually unnoticeable during their chronic infection. Unlike the anti-sulphatide results, levels of anti-actin antibodies showed no differences between CoMoTc and InMoTc rats when compared during acute or chronic infection. The decreased production of anti-sulphatide autoantibodies of InMoTc offspring may be due to a modification of the immune repertoire of offspring because of the contact with parasite antigens during ontogeny.

Actins↗