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Biomedical subjects

S R Rapp

Publications and source records attributed to S R Rapp.

32 records · Page 2Linked to original sources
PubMed1994

Patient measurement of psoriasis disease severity with a structured instrument.

The Psoriasis Area and Severity Index (PASI) is used by dermatologic investigators to assess psoriasis disease severity. PASI measures are time-consuming and require trained personnel. We developed and evaluated a structured PASI-like instrument for self-measurement of psoriasis disease severity for use in future large-scale epidemiologic studies. The instrument consisted of a silhouette of a body for patients to shade in affected areas and of three modified visual analog scales for recording the redness, thickness, and scaliness of an average lesion. The resulting "patient PASI" score was compared to investigator PASI measurements in 43 patients with mild to severe psoriasis. Patients and investigator also recorded a subjective global severity score. The patient PASI score was highly predictive of the investigator PASI score (r2 = 0.71, p < 0.0001) and the investigator global score (r2 = 0.37, p < 0.0001). The patient global score was also predictive of the investigator PASI (r2 = 0.18, p < 0.0053) and the investigator global score (r2 = 0.10, p < 0.044), but these relationships exhibit wide predicted confidence intervals. Following the initial evaluation by 18.4 +/- 9.1 d of therapy, one-way t tests for paired samples (pre and post) showed significant improvements in the patient PASI (p < 0.003) and investigator PASI (p < 0.05). We conclude that although patients' overall scores may not allow for accurate prediction of clinical disease severity in a single individual, this structured instrument facilitates prediction of psoriasis disease severity in a population.

Adult↗
PubMed1994

Family networks: predictors of nursing home entry.

Despite the importance of kin in caring for older relatives, few studies have examined the relationship between the family network and the risk of nursing home placement. Data from a cohort of noninstitutionalized elderly persons living in New Haven in 1982 were used to predict nursing home admission through 1985. Logistic regression analyses show that older persons who have regular contact with kin have a lower risk of institutionalization. For men, the spouse is most important in reducing the risk of entry; for women, having regular contact with at least one family member--of any relation--reduces the risk of entry.

Aged↗
PubMed1993

Nerve growth factor facilitates regeneration across nerve gaps: morphological and behavioral studies in rat sciatic nerve.

The rat sciatic nerve does not possess a high potential for regeneration through silastic tubes when the interstump nerve gap is greater than 10 mm. In this study, the effect of NGF treatment on regeneration of the rat sciatic nerve in 10- and 15-mm silastic chambers was compared. In addition, regeneration in 15-mm silastic chambers was compared to regeneration in 15-mm semipermeable chambers. Sections of tubing were implanted and filled with NGF or a control solution of cytochrome C (Cyt. C). Tube implants were removed at various postoperative times and regeneration was assessed histologically and behaviorally. NGF treatment promoted regeneration success rate. It enhanced the initial outgrowth of nonneuronal cells and neuronal fibers into the chamber producing more cellular, organized regenerates. At 2 weeks, in 10-mm chambers, NGF-treated regenerates had fourfold more unmyelinated fibers than controls. At 3 weeks, NGF-treated regenerates possessed threefold more myelinated fibers than controls. After 4 weeks all regenerates had similar numbers of myelinated nerves at the chamber's midpoint. This initial "head start" was sustained peripherally as indicated by the earlier return of sensory function (response to a noxious temperature stimulus) in NGF-treated animals. Finally, regeneration success rate in 15-mm semipermeable tubes is greater than that in 15-mm silastic chambers (NGF and Cyt. C). However, regenerates in silastic chambers possessed twofold more myelinated fibers than regenerates in semipermeable chambers. The positive effects of NGF on neural regeneration and recovery of sensory function provide support for the potential use of NGF in treating peripheral nerve injuries.

Animals↗
PubMed1992

Selective induction of intercellular adhesion molecule-1 by interferon-gamma in human airway epithelial cells.

To evaluate the factors controlling migration of leukocytes into pulmonary airway epithelium, we determined the biochemical mechanisms responsible for the regulation of intercellular adhesion molecule-1 (ICAM-1) expression on cultured monolayers of human tracheal epithelial cells (HTECs) or SV40 virus-transformed human bronchial epithelial cells (BEAS-2B). Validation experiments with human umbilical vein endothelial cells (HUVECs) demonstrated little detectable ICAM-1 expression on unstimulated cells or on cells incubated with interferon-gamma (IFN-gamma), but HUVEC monolayers responded to interleukin-1 beta (IL-1 beta) or tumor necrosis factor-alpha (TNF-alpha) with significant increases in ICAM-1 and ICAM-1-dependent adherence of polymorphonuclear leukocytes (PMNs). HTEC monolayers also exhibited no significant basal ICAM-1 expression but, in contrast to HUVEC monolayers, had marked increases in ICAM-1 expression and ICAM-1-dependent PMN adherence only after incubation with IFN-gamma (and not after IL-1 beta or TNF-alpha) treatment. BEAS-2B cells also exhibited relatively selective IFN-gamma stimulation of ICAM-1 expression and ICAM-1-dependent PMN adherence but (like late passage HTEC) showed significant basal ICAM-1 expression. Differences in IFN-gamma effect on ICAM-1 levels between HUVEC and HTEC monolayers were not due to differences in number or responsiveness of IFN-gamma receptors, because both cell types exhibited a similar number of receptors and other IFN-gamma-dependent responses of HUVECs remained active. In all analyses, ICAM-1 mRNA levels correlated closely with detection of ICAM-1 on the cell surface.(ABSTRACT TRUNCATED AT 250 WORDS)

Cell Adhesion↗
PubMed1992

Self-efficacy, aftercare and relapse in a treatment program for alcoholics.

The role of self-efficacy in the prediction of relapse following alcoholism treatment was examined in a 12-month follow-up evaluation. Self-efficacy was assessed at intake to inpatient treatment and again at discharge. The drinking status of male alcoholics completing treatment then was assessed during six intervals over the course of the posttreatment year. Results indicated a significant increase in self-efficacy from intake to discharge. Additional analyses showed that lower intake self-efficacy ratings were associated with relapse by either 6- or 12-months posttreatment. Discharge self-efficacy, on the other hand, was not related to relapse status at either posttreatment point. A subsequent analysis of the pattern of relapses across the six follow-up intervals was conducted using survival analysis. Results revealed that only intake self-efficacy was predictive of the follow-up interval during which a relapse occurred. Individuals high in self-efficacy at intake showed the greatest resistance to relapse across time. The maintenance of aftercare further reduced the risk of relapse. The results are discussed with respect to self-efficacy theory and the problem of ceiling effects in posttreatment self-efficacy assessments.

Alcoholism↗
PubMed1991

Comorbid psychiatric disorders in elderly medical patients: a 1-year prospective study.

Cross-sectional studies have revealed a high prevalence of comorbid psychological problems among geriatric medical patients, a low rate of detection by primary care professionals, and greater psychosocial dysfunction and poorer physical health associated with comorbidity. Less is known about the course and impact of psychiatric comorbidity. Psychiatric status, physical health status, psychosocial functioning, and health care utilization for a sample of geriatric patients (n = 102) were assessed on admission to a medical hospital and again one year later. Results revealed a very stable and high prevalence of comorbid psychological problems, especially depression, a low rate of treatment by mental health professionals, greater physical impairment consistently associated with psychiatric comorbidity, but few health care utilization differences. A closer look at depression revealed that it typically began in late life and did not readily resolve.

Aged↗
PubMed1989

Geriatric depression: physicians' knowledge, perceptions, and diagnostic practices.

An evaluation of physicians' (medical residents) knowledge revealed that whereas they considered detection and treatment of comorbid depression to be important, they knew few of the diagnostic criteria and etiological factors, rarely screened their patients for depression, and viewed current treatments as only marginally efficacious. Implications for graduate training are discussed.

Adult↗
PubMed1989

Substituting nonsomatic for somatic symptoms in the diagnosis of depression in elderly male medical patients.

The authors examined the sensitivity and specificity of a modified version of the Research Diagnostic Criteria (RDC) for major, minor, and intermittent depressive disorder in 150 elderly male medical inpatients. Four somatic RDC symptoms were replaced with four nonsomatic symptoms. The sensitivity of the modified criteria was 87%, the specificity was 97%, and 96% of patients were correctly classified. Misclassifications were of mildly depressed patients. These results provide empirical support for the use of alternative, nonsomatic depressive symptoms when somatic symptoms are ambiguous indicators of depression.

Age Factors↗
PubMed1985

Riboflavin as a tracer of medication compliance.

Three experiments were conducted to evaluate the accuracy of urine ultraviolet fluorescent tests for riboflavin, which has been used as a tracer for medication compliance in several clinical drug trials. Observer accuracy in discriminating riboflavin-positive or negative urine samples was found to vary with the method of observation, dose of riboflavin, observer experience, and time postingestion. The results showed that, while the 5-mg dose used in previous clinical trials was too small to permit reliable assessment of compliance, larger doses of riboflavin could produce nearly 100% accuracy for minimally trained observers who used a matching-to-sample observation procedure. The findings are discussed in terms of the potential clinical and research applications of this type of simple but reliable compliance assessment procedure.

Adult↗
PubMedDate not supplied

Social support increases in the year after inpatient treatment of depression.

High levels of social support are reported to protect against major depressive episode (MDE), but little is known about how social support changes during MDE. In this study, we measured total social support and four subtypes of social support in 75 psychiatric inpatients at the time of admission and one year later. The four subtypes of social support were tangible support, affectionate support, positive social interaction, and emotional/informational support. The majority of the sample were women (81%) with a mean age of 53.7+/-14.9 years. The severity of depressive symptoms improved over the year and was accompanied by a significant increase in two types of social support -- positive social interaction, and emotional/informational support. There was no significant change in tangible support or affectionate support. Linear regression showed that changes in all four subtypes were correlated with changes in depressive severity after adjustment for age, gender, and baseline clinical characteristics. While Instrumental Activities of Daily Living (IADL) scores also improved throughout the period of observation, and while the change in IADL scores were significantly associated with changes in social support, change in IADL scores were no longer significantly associated with change in social support after adjustment for change in depression severity. These results suggest that supportive relationships improve after psychiatric hospitalization for MDE, and these changes are best explained by reduction in depression severity.

Activities of Daily Living↗