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PubMed1997

Effect of cataract extraction on the results of automated perimetry in glaucoma.

OBJECTIVE: To investigate the effect of cataract extraction on the results of automated perimetry in persons with glaucomatous visual field loss. SUBJECTS: Subjects from a retrospective study of visual field progression who underwent cataract extraction during follow-up were identified. Subjects came from the glaucoma service of a hospital-based tertiary referral center. METHODS: Subjects had at least 7 Humphrey 24-2 or 30-2 visual fields over 5 years or more, with an abnormal glaucoma hemifield test result on the first 2 examinations. Visual field data were transferred to a microcomputer and comparison of the visual fields immediately before and after cataract extraction was performed. RESULTS: Sixty-five eyes of 50 subjects (mean age, 71.8 years) were included in the analysis. A mean improvement in mean deviation (MD) of 1.68 dB (P<.001), and a mean worsening in corrected pattern SD (CPSD) of 0.54 dB (P=.09) was observed. The mean unweighted change in threshold in the 52 points of program 24-2 was 1.58 dB, corresponding to a 43.9% increase in sensitivity. A significant correlation between improvement in visual acuity and improvement in MD was also found. A mean increase in CPSD of 1.61 dB (P=.005) occurred in subjects with dense scotomas (minimum threshold value < or = 5 dB) and preoperative CPSD of 8 dB or less. CONCLUSIONS: In persons with glaucomatous visual field defects, cataract extraction produces only a modest improvement in MD. After cataract surgery, the CPSD index worsened in many subjects with dense scotomas. This suggests that the development of cataract can mask progressive glaucomatous visual field loss in such persons.

Aged↗
PubMed2003

State and trait influences on mood regulation in bipolar disorder: blood flow differences with an acute mood challenge.

BACKGROUND: Even in remission, patients with bipolar disorder (BD) remain sensitive to external stressors that can trigger new episodes. Imitating such stressors by the controlled transient exposure to an emotional stimulus may help to identify brain regions modulating this sensitivity. METHODS: Transient sadness was induced in 9 euthymic and in 11 depressed subjects with BD. Regional blood flow (rCBF) changes were measured using (15)O-water positron emission tomography. RESULTS: Common changes in both groups were increased rCBF in anterior insula and cerebellum and decreased rCBF in dorsal-ventral-medial frontal cortex, posterior cingulate, inferior parietal, and temporal cortices. Decreases in dorsal ventral medial frontal cortices occurred in both groups, but subjects in remission showed a greater magnitude of change. Unique to remitted subjects with BD were rCBF increases in dorsal anterior cingulate and in premotor cortex. Lateral prefrontal rCBF decreases were unique to depressed subjects with BD. At baseline, remitted subjects showed a unique increase in dorsal anterior cingulate and orbitofrontal cortex. CONCLUSIONS: Common rCBF changes in remitted and depressed subjects identifies potential sites of disease vulnerability. Unique cingulate and orbitofrontal changes both at baseline and with induced sadness seen in the absence of prefrontal rCBF decreases may identify regional interactions important to the euthymic state in this population.

Adult↗
PubMed1998

Clinical and biochemical outcomes of type 2 diabetes mellitus in Canterbury, New Zealand: a 6-year cohort study.

There is a paucity of data regarding outcomes of Type 2 diabetes mellitus. A cohort of 447 Type 2 diabetic subjects (208 male, 239 female; age range 30-82 years, median 62 years; and of predominantly European origin) was characterised in a clinic survey in 1989. Individual status (dead or alive) at 1 June 1995 was ascertained. At 6 years, 289 subjects were confirmed as alive and 133 as dead--only 25 were untraceable. Of those subjects identified as alive, follow-up clinical and biochemical data were obtained for 253 (87.5%) individuals. In those subjects, glycated haemoglobin deteriorated from 63.1 +/- 18.7 mmol/mol haem in 1989 to 71.7 +/- 24.4 in 1995, P < 0.0001. An increased prevalence of retinopathy was evident at 6-year follow-up, 59.7% cases in 1995 compared with 39.5% in 1989, P < 0.001. Similarly there was an increased prevalence of coronary artery disease (CAD) (33.6 vs 18.2% of cases), albuminuria (26.5 vs 19% of cases; P < 0.001), and hypertension (71.5 vs 54.9% of cases; P < 0.001) in 1995 vs 1989, respectively. Multiple logistic regression analysis showed that glycated haemoglobin (odds ratio (OR) for 18 mmol/mol haem change, 1.78; 95% CI, 1.15-2.85), hypertension (OR, 3.33; 95% CI, 1.40-8.41) and known duration of diabetes (OR for 7 year change, 2.12; 95% CI, 1.24-3.80) were predictors for development of retinopathy. There is therefore a deterioration in glycaemic control in Type 2 diabetes over 6 years and an increased prevalence of complications that present strategies in a multidisciplinary specialist diabetes clinic are unable to prevent on a sustainable basis.

Adult↗
PubMed2005

Influence of 516G>T polymorphisms at the gene encoding the CYP450-2B6 isoenzyme on efavirenz plasma concentrations in HIV-infected subjects.

We examined 516G>T polymorphisms at the gene encoding the cytochrome P450 in 100 human immunodeficiency virus-positive subjects who were receiving efavirenz (EFV). Elevated plasma EFV concentrations were found in 40% of subjects with the polymorphic homozygous genotype and 19% of subjects with the heterozygous genotype. Conversely, 20% of subjects with the wild-type genotype had subtherapeutic concentrations of EFV. CYP2B6-516 genotyping may help to identify subjects who have plasma EFV concentrations that are outside of the therapeutic range.

Adult↗
PubMed1991

Cognitive response to a cold pressor challenge in high and low blood pressure reactive subjects.

To examine the relationship between cognitive and cardiovascular reactions to a cold pressor challenge, 20 high and 20 low blood-pressure-reactive males were identified. Subjects were trained using a think-aloud procedure and asked to report their thoughts aloud during task presentation. In comparison to low-reactors, high-reactive subjects exhibited greater increases in systolic and diastolic blood pressure, but not heart rate, in response to the task. High-reactive subjects reported fewer distracting self-statements than low-reactors during the task. No group differences in positive, neutral, or negative self-statements were observed. These findings corroborate the importance of distraction strategies in mediating acute cardiovascular reactions to stress.

Adaptation, Psychological↗
PubMed1991

Muscle adaptation and disability in late poliomyelitis.

Persons who suffered poliomyelitis 3 or more decades ago now report functional decline and symptoms designated as "post-polio syndrome". The objects of this investigation were to identify subjects fulfilling the criteria of this syndrome, to describe their motor impairment and resulting disabilities/handicaps, to study the adaptive changes in the muscle structure and effects of a resistance exercise program. Forty-one late-polio subjects, 40-65 years old, volunteered for the studies of motor impairment, subgroups of those volunteered to further studies of long-term and short-term adaptations. Seventy-five per cent of the subjects met the criteria for the post-polio syndrome. Complete manual muscle tests and dynamometer measurements of knee muscle strength revealed severe motor impairment predominantly in the lower extremities, the strength of the latter correlating to the degree of mobility handicap. In biopsies from the vastus lateralis muscle, type grouping was frequent. Half of the subjects demonstrated over 70% occurrence of type I fibers with negative significant correlation to strength in the female subjects. Cross-section areas of muscle fibers were on average twice the normal, with negative significant correlation to strength values in male subjects. Muscle enzymatic activity values showed large individual variations; oxidative activities (citrate synthase) were low or very low, while average glycolytic activities were nearly normal. Macro EMG and single-fiber EMG measurements in the vastus lateralis muscle demonstrated large macro motor unit potentials and increased fiber density. Neuromuscular transmission was disturbed as identified by jitter and blockings in most subjects regardless of the occurrence of new muscular symptoms. A statistically significant increase in strength (25-30%) resulted from a 6 weeks' heavy resistance exercise program, utilizing a dynamometer, without any obvious side-effects. Strength improvement was maintained for 6-12 months after training while fatigue index increased. A substantial impact on intermediate (secondary or instrumental) ADL, most severely affecting the quality of mobility, was generally found, while little effect was found on primary ADL as revealed by the Katz' ADL index, the Functional Status Questionnaire and the WHO ICIDH Classification of Handicap. The impaired motor function confirms findings in earlier studies. It also corresponds with the locomotor disabilities and handicaps. The negative correlation of strength to cross-section fiber area might result from excessive use of remaining fibers leading to a prominent hypertrophy in the weakest subjects. Enzyme activities probably reflect the pattern of everyday activities with little demands on endurance.(ABSTRACT TRUNCATED AT 400 WORDS)

Activities of Daily Living↗
PubMed2001

Suppression of cellular immunity in men with a past history of posttraumatic stress disorder.

OBJECTIVE: High rates of medical morbidity have been reported in subjects with posttraumatic stress disorder (PTSD). The authors examined immune function in subjects in remission from past PTSD. METHOD: The initial study group was composed of 1,550 Japanese male workers. Japanese versions of the Events Check List, the Impact of Event Scale-Revised, and the Diagnostic Interview Schedule for DSM-IV were used to identify subjects who had a past history of PTSD. Twelve of the workers were identified as having such a history. These men were matched in age and smoking habits, which affect immunity, to 48 comparison subjects who had similar stressful life experiences but no current or past history of PTSD. Natural killer (NK) cell activity, lymphocyte subset counts, and production of interferon gamma (IFN-gamma) and interleukin-4 (IL-4) were measured in the 60 men by means of phytohemagglutinin stimulation. RESULTS: The number of lymphocytes, number of T cells, NK cell activity, and total amounts of IFN-gamma and IL-4 were significantly lower in the 12 men with a past history of PTSD. CONCLUSIONS: PTSD leaves a long-lasting immunosuppression and has long-term implications for health.

Adult↗
PubMed2006

Predicting major hemorrhage in patients with pelvic fracture.

BACKGROUND: Pelvic fractures can be an important source of major hemorrhage in victims of blunt trauma. However, no rapid and reliable noninvasive method exists for predicting which subjects will have major hemorrhage. The objective of this study is to use information available upon presentation to the trauma center to develop a clinical prediction rule to identify subjects with pelvic fracture who are at high risk of major hemorrhage. METHODS: A retrospective cohort study was performed on all subjects with pelvic fracture from blunt force mechanism at a single level one trauma center during a 4.3 year period. Chart review identified findings from initial pelvic radiographs and from emergency department care including mechanism of injury, and hemodynamic status. Major hemorrhage was defined by angiographic findings, transfusion requirement and pelvic hemorrhage volume. Logistic regression was used to formulate a clinical prediction rule to stratify subjects based on probability of major hemorrhage. RESULTS: Complete data were available on 627 of 783 eligible subjects. Predictors of major hemorrhage included emergency department hematocrit 30 or less, pulse rate of 130 or greater, displaced obturator ring fracture and pubic symphyseal wide diastasis. Combinations of predictors defined groups with probability of major hemorrhage from 1.6% to 66%. CONCLUSIONS: Probability of major pelvic fracture related hemorrhage can be estimated from initial pelvic radiograph, pulse, and hematocrit.

Adult↗
PubMed1988

Antibodies to amyloid A protein in rheumatic diseases.

Circulating autoantibodies against amyloid A protein (AA) were demonstrated by enzyme immunoassay in 18/62 patients with rheumatoid arthritis (RA) and in 9/27 patients with systemic lupus erythematosus (SLE). In the subset of RA patients who had developed amyloid, the frequency of antibodies to AA was lower than in those without amyloid (P less than 0.05). The antibody levels showed some variation in serial serum samples during follow-up (1-4 years) of patients with amyloidosis or SLE, but did not correlate with disease activity. In contrast to the patients with rheumatic diseases, patients with inflammatory bowel disease and acute bacterial peritonitis had antibody levels within the range of the healthy control subjects. The results show that autoantibodies to protein AA may occur in rheumatic diseases; their occurrence does not, however, identify subjects with tissue amyloid deposits. Absorption experiments suggest that the antibodies may be directed to circulating amyloid A protein.

Absorption↗
PubMed2005

Clinical risk indices, prediction of osteoporosis, and prevention of fractures: diagnostic consequences and costs.

The primary aim of this study was to validate the Osteoporosis Self-Assessment Tools for Asians (OSTA) instrument in Thai women, and to evaluate its utility in terms of economic costs and fracture prediction. Femoral neck and lumbar spine BMD was measured by dual energy X-ray absorptiometry in 322 Thai women, aged 60+/-10 years (mean+/-SD; range: 45-84 years). The women were classified as having osteoporosis if their BMD T-scores were < or =-2.5. The OSTA score was calculated for each woman using her age and weight according to the formula: 0.2(weight-age). Women with OSTA scores < or =-1 and >-1 were classified as "high risk" and "low risk," respectively. The prevalence of osteoporosis was 33% by femoral neck or lumbar spine BMD. Using the OSTA score, 165 (51.2%) women were classified as high risk. The sensitivity, specificity and positive predictive value of OSTA was 82% 64% and 53%, respectively. If the OSTA score is used to identify women with high risk of fracture, and assuming that the incidence of fracture among osteoporotic and non-osteoporotic women are 2% and 1% per year, respectively, the OSTA score can identify 59% of fracture cases correctly, and 41% are expected to be missed. Furthermore, if the high-risk subjects identified by OSTA are to be treated, and if the treatment reduces fracture incidence by 50%, and assuming that the treatment cost is $1 per day, then the cost to prevent one fracture is estimated to be $48,530. Results of this study suggest that, in the Thai population, the OSTA score had high sensitivity but low specificity and low positive predictive value in the identification of osteoporotic women. Its use in the general population can result in a high false-positive rate and incur significant cost to the community.

Absorptiometry, Photon↗
PubMed2002

Haptic discrimination of object shape in humans: contribution of cutaneous and proprioceptive inputs.

Using two-dimensional (2D) angles composed of two straight, 8-cm-long arms that formed an angle, we investigated the importance of cutaneous feedback from the exploring index finger, and proprioceptive feedback from the shoulder (scanning movements made with the outstretched arm), to the human ability to discriminate small differences in the angles. Using a two-alternative forced-choice paradigm, subjects identified the larger angle in each pair explored (standard angle, 90 degrees; comparison angles, 91 degrees to 103 degrees). Subjects were tested under four experimental conditions: (1) active touch (reference condition); (2) active touch with digital anaesthesia; (3) passive touch (a computer-controlled device displaced the angle under the subject's immobile digit); and (4) passive touch with digital anaesthesia. When only proprioceptive feedback from the shoulder was available (condition 2), there was a significant increase in discrimination threshold, from 4.0 degrees in the reference condition (condition 1) to 7.2 degrees, indicating that cutaneous feedback from the exploring digit contributed to task performance. When only cutaneous feedback from the finger was available (condition 3), there was also a significant increase in threshold from 4.2 degrees in the active condition to 8.7 degrees. This suggested that proprioceptive feedback from the shoulder, potentially from a variety of deep (muscle and joint) but also cutaneous receptors, contributed to the ability to discriminate small changes in 2D angles. When both sources of feedback were eliminated (condition 4), subjects were unable to discriminate even the largest difference presented (13 degrees). The results suggest that this sensory task is truly an integrative task drawing on sensory information from two different submodalities and so, following the definition of Gibson, is haptic in nature. The results are discussed in relation to the potential neural mechanisms that might underlie a task that requires integration across two anatomically separate body parts and two distinct modalities.

Adult↗
PubMed1992

Dietary restraint and responsiveness to sensory-based food cues as measured by cephalic phase salivation and sensory specific satiety.

Responsiveness to sensory-based food cues was examined in restrained and unrestrained, normal-weight subjects identified with the Three-Factor Eating Questionnaire. Salivary flow rate was measured with no food present and while subjects viewed hot pizza. In the presence of food, restrained eaters had a mean salivary flow rate (0.388 g/min) greater than twice that of the unrestrained eaters (0.186 g/min). During sensory specific satiety testing, subjects tasted and rated the pleasantness of 9 foods, then received a meal of either cheese and crackers or cookies. Changes in pleasantness for the tasted foods were evaluated at 2, 20, and 40 min following the meal. Both restrained and unrestrained subjects displayed similar patterns of sensory specific satiety, i.e., the pleasantness foods which were eaten decreased relative to foods tasted but not eaten. These patterns were unaffected by the type of food consumed in the test meal. These data demonstrate that restrained eaters show moderately enhanced salivary responses but no changes in sensory-specific satiety to food stimuli, suggesting that heightened responsiveness to the sensory properties of foods may not be a generalized phenomenon in restrained eaters.

Adult↗
PubMed2006

Wheat allergy: a double-blind, placebo-controlled study in adults.

BACKGROUND: Wheat is believed to be an uncommon cause of food allergy in adults; the number of studies that address IgE mediated wheat allergy in adults is all too few. OBJECTIVE: Determine how many subjects with a history of wheat allergy have real allergy by double-blind, placebo-controlled food challenge; identify the symptoms manifested during the challenge; determine the lowest provocation dose; determine the performance characteristics of wheat skin prick test and specific IgE; identify subjects with real wheat allergy for potential immunoblotting studies. METHODS: Patients underwent skin test with commercial wheat extract; specific wheat IgE was determined. Subjects were challenged with 25 g wheat. Subjects who were positive to raw wheat challenge underwent cooked wheat challenge. RESULTS: Thirty-seven double-blind placebo-controlled wheat challenges were performed on 27 patients. A total of 13 of 27 (48%) patients had a positive result. Eleven subjects with positive raw wheat challenge underwent cooked wheat challenge: 10 were positive. The provocation dose range was 0.1 to 25 g. Twenty-seven percent of the subjects allergic to wheat had a provocation dose that was < or =1.6 g. CONCLUSION: Wheat causes real food allergy in adults. More than a quarter of the patients allergic to wheat reacted to less than 1.6 g wheat. Specific IgE was more sensitive than skin test for wheat; however, specificity and predictive values were low for both tests. Thus, these tests should not be used to validate diagnosis of wheat allergy.

Adolescent↗
PubMed2005

Hepatitis B virus infection in adolescents in a rural township--15 years subsequent to mass hepatitis B vaccination in Taiwan.

In Taiwan, decrease of both infection and carrier rates of hepatitis B virus (HBV) have been documented especially in metropolitan areas after universal HBV vaccination. This study investigated HBV infection status in a rural township 15 years after the program began. Three cross-sectional studies were conducted in 1999, 2000 and 2003, to recruit all the students of the only junior middle school, born from July 1984 to June 1991, in a township in central Taiwan. Serum samples were tested for HBsAg, anti-HBs and anti-HBc. Subjects identified to be neither positive for HBsAg nor anti-HBs were given a booster dose of HBV vaccine. Subjects lacking an anamnestic anti-HBs response were given a complete 3-dose vaccination. A total of 1454 (98.5%) students responded. The prevalence rate of HBsAg decreased 57% [from 12.5% in 1984 to 5.4% in 1991, P < 0.005 (chi2-test for linear trends)], and anti-HBc positive rate dropped 68% (from 31.9 to 10.2%, P < 0.001). An anamnestic anti-HBs response developed after a vaccine booster among 433 (72%) anti-HBs negative and 12 (66.7%) anti-HBc alone subjects. And 93 (94.9%) anti-HBs negative and 1 (16.7%) anti-HBc alone subject developed a primary anti-HBs response after catch-up vaccination. Viremia was detected for two anti-HBc alone subjects without anamnestic or primary response. The vaccination program has decreased the number of those infected and carrier rates in either urban or rural areas in Taiwan. However, the prevalence of HBsAg and anti-HBc in rural area were much higher than urban area.

Adolescent↗
PubMed2002

Caregivers' stresses when living together or apart from patients with chronic schizophrenia.

Ratings of stress and burden and mental symptoms which were screened by the General Health Questionnaire (GHQ) caseness were collected from two types of primary caregivers either living with (n = 37) or separately from (n = 48) a patient with a chronic schizophrenic disorder. The stress levels and burden of caregivers living apart were similar to those who were living together with patients and around 25 percent of both groups met GHQ criterion for having a mental disorder. Multiple regression analyses of all subjects identified stress with the patient's disorder and strain in their own marital relationships as most predictive of their subjective global stress ratings. These results suggest that mental health services should aim to assist key caregivers of people with chronic schizophrenic disorders to manage stress whether or not the patient lives in the same household as the caregiver.

Caregivers↗
PubMed2004

Association between primary hyperparathyroidism and increased body weight: a meta-analysis.

Although primary hyperparathyroidism is frequently asymptomatic, it has been associated with an increased prevalence of hypertension, insulin resistance, dyslipidemia, cardiovascular mortality, and cancer. Previously we reported that patients with primary hyperparathyroidism are heavier than age-matched controls. Increased body weight could contribute to the association between primary hyperparathyroidism and these extraskeletal complications. We searched MEDLINE for English language studies published between 1975 and 2003 that reported body weight or body mass index in subjects with primary hyperparathyroidism and a healthy age- and sex-comparable eucalcemic control group. Seventeen eligible studies were identified. Subjects with primary hyperparathyroidism were 3.34 kg (95% confidence interval, 1.97-4.71; P < 0.00001) heavier than controls in 13 studies reporting body weight. In four studies reporting body mass index, subjects with primary hyperparathyroidism had an increased body mass index of 1.13 kg/m(2) (-0.29 to 2.55; P = 0.12) compared with controls. Standard mean difference analysis showed that subjects with primary hyperparathyroidism had an increased weight or body mass index of 0.3 sd (0.19-0.40; P < 0.00001) compared with controls. We conclude that patients with primary hyperparathyroidism are heavier than their eucalcemic peers, and that increased body weight may contribute to the reported associations between primary hyperparathyroidism and some extraskeletal complications.

Body Weight↗
PubMed1999

Preliminary investigation of the confidence of sport spectators: importance of time, difficulty of the game, and team identification.

Three factors believed to play a role in the confidence sport spectors have in their team were examined: time until the competition began, the difficulty of the competition, and the fans' scores on identification with the team. 31 college students were asked to complete the Confidence subscale of the Competitive State Anxiety Inventory-2 on five separate occasions: 3 days before, 12 hours before, 3 hours before, immediately prior to, and at half-time of two basketball contests. Subjects also completed the Sport Spectator Identification Scale during the first testing session. Analysis indicated that subjects' confidence changed significantly as the competition approached but only for the more difficult contest. Further, highly and lowly identified subjects exhibited different patterns of confidence as the difficult competition approached.

Adult↗
PubMed1999

Characteristics of dependent and nondependent regular users of codeine.

Although codeine is a widely used medication, the problems of codeine abuse and dependence have not been well-studied. This study characterized regular codeine users (using at least 3 days per week for 6 months, excluding those using codeine for the treatment of cancer pain) through a self-completed questionnaire. Recruitment through newspaper advertisements resulted in a total of 339 eligible questionnaires. Thirty-seven percent of subjects met DSM-IV criteria for codeine dependence. Dependent subjects (mean age, 40 +/- 10 years) were using an average of 179 (+/-171) mg of codeine per day. Codeine was predominantly used in the form of combination products with acetaminophen. Dependent subjects identified specific problems causally related to their codeine use such as depression (23%), anxiety (21%), and gastrointestinal disturbances (13%). The dependent subjects reported problems with other drugs more than did nondependent users (alcohol, 57% vs. 26%; cannabis, 23% vs. 5%; sedative/hypnotics, 33% vs. 12%; and heroin, 11% vs. 2%, respectively). Most were taking codeine primarily for a chronic pain problem (81%), although the dependent subjects currently found codeine less effective for treating pain than did the nondependent subjects and were more likely to use codeine for pleasurable effects, to relax, or to prevent withdrawal symptoms. This study showed that dependence is associated with the regular use of codeine. Pain is a key issue with these users; however, they are probably not receiving optimal treatment. There is a need to identify individuals experiencing problems with their codeine use and to develop optimal prevention and treatment strategies.

Adolescent↗