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PubMed2001

The role of psychological functioning in morbid obesity and its treatment with gastroplasty.

BACKGROUND: The authors evaluated the psychological characteristics of the morbidly obese. The condition-specific and quality-of-life characteristics of a large sample of vertical banded gastroplasty (VBG) patients were evaluated. The role that these psychological characteristics play in moderating the success of gastroplasty surgery, as well as the impact of surgery on quality of life, was examined. METHODS: This is a cross-sectional evaluative study of a clinical samples, with longitudinal follow-up and with non-surgical comparison groups. 89 morbidly obese individuals were assessed before VBG (but after having been accepted for surgery) and again 1.27 years after surgery. This group represents 98% of the patients who received VBG (i.e., a 2% dropout rate). We used established psychological measures (quality of life, adjustment to obesity, functional impairment, and eating attitudes), including a scale developed by our group specifically for morbid obesity, to identify distinct psychological profiles of the morbidly obese before surgery. RESULTS: The three profile groups differed significantly in psychological characteristics, ranging from high functioning (little emotional distress, functional impairment or dysfunctional eating) to poor functioning (high emotional distress, functional impairment and dysfunctional eating). The subgroups did not differ on pre-surgical weight, and did not differ from morbidly obese groups not seeking surgery. For the surgery group, regardless of pre-surgery psychological profile, VBG produced significant weight loss, maintained at 1 year after surgery. As well, surgery resulted in significant improvements in quality of life and psychological adjustment, especially in the profile group initially presenting with psychological disturbance. CONCLUSION: There was no evidence to suggest that those with pre-surgical psychological difficulties did more poorly with VBG. These data call into question screening out individuals with psychological problems from gastroplasty surgery. Furthermore, psychological difficulties, if they exist, appear more related to the nature of morbid obesity than to the character of the individual. Psychological difficulties pre-surgery were normalized following surgery.

Adolescent↗
PubMed1999

Age-within-school-class and adolescent gun-carrying.

BACKGROUND: Intentional injuries (suicide and homicide) are a leading causes of morbidity and mortality in the United States. Firearms cause approximately 70% of these fatal intentional injuries. Risk factors associated with gun-carrying in adolescent populations include male gender, smoking, alcohol use, drug use, and number of sexual partners. Current knowledge of these and other risk factors has provided limited benefit because many are no more obvious to the clinician a priori than is the tendency to carry guns. Increasing relative age of a student within school class is an easily measured parameter that has been associated with behavioral problems, absenteeism, negative self-image, and high dropout rates. OBJECTIVE: To characterize the association between relative student age-within-class and tendency to carry firearms. DESIGN: The Massachusetts Youth Risk Behavior Survey, which collects data on demographic characteristics, risk behaviors, and health outcomes. PARTICIPANTS: A randomly selected group of 3153 Massachusetts students in grades 9 through 11. PRIMARY OUTCOME MEASURE: The odds of firearms-carrying comparing older to average-age and younger students. RESULTS: Using multivariate logistic regression, seven risk factors predicted gun-carrying with statistically significant results: older age-within-class (OR: 2.12; 95% CI: 1.09-4.12), male gender (OR: 4.95; 95% CI: 3.01-8.15), black race (OR: 2.49; 95% CI: 1.20-5.14), gang membership (OR: 7.22; 95% CI: 4.51-11.56), missing school out of concern for safety (OR: 2.50; 95% CI: 1.30-4.80), seeking medical treatment after a fight (OR: 4.47; 95% CI: 2.56-7. 78), and fighting without seeking medical treatment (OR: 5.73; 95% CI: 3.09-10.60). CONCLUSION: Older 9th-, 10th-, and 11th-grade students are more likely than their classmates to carry firearms. This information may prove helpful in identifying high-risk students and targeting prevention strategies.

Adolescent↗
PubMed2004

Sibling effects, environmental influences, and university attendance: a follow-up study.

In 2002 Marjoribanks examined relations among sibling variables, environmental influences, and school dropout. In this follow-up study, relations were examined between sibling variables (number of children in the family, birth order position) and university attendance. Data were collected from 8,005 (4,116 women, 3,889 men) Australian young adults (M age=20.1 yr., SD=0.5). Logistic regression analyses in the two studies indicated that (a) young adults from Asian, Middle Eastern, and middle-class families were less likely to drop out of school and more likely to attend a university than were young Australians from Anglo-Australian, English, European, and working-class backgrounds, and (b) after taking into account differences in family background and learning environment measures, there continued to be small but significant relations between the number of children in families, birth-order position, and the likelihood that young people would drop out of school or attend a university.

Adolescent↗
PubMed1988

An outcome study comparing refusers and acceptors of treatment for alcoholism.

Fifteen matched pairs of alcoholics who had either refused or completed day treatment were reassessed sixteen months after the initial assessment. The treated group had improved significantly more than the untreated group on measures related directly to alcohol abuse, in their utilization of inpatient psychiatric services, and the use of family physician's services. The treated group had also used disulfiram for significantly longer periods of time. The treatment refusers had nonetheless achieved statistically significant, albeit modest, reduction in their consumption of alcohol compared to their pre-assessment levels. Both groups showed equal amount of change on a number of psychosocial measures, such as employment, use of minor tranquilizers and non-prescription drugs, legal problems and symptoms of depression. These findings are discussed in the context of the effectiveness of a day program, the use of disulfiram and certain pretreatment characteristics of the patient.

Adult↗
PubMed2005

Switching female schizophrenic patients to quetiapine from conventional antipsychotic drugs: effects on hyperprolactinemia.

INTRODUCTION: Conventional antipsychotic medications are associated with elevated prolactin levels, resulting in hyperprolactinemia and a number of unwanted side effects. Several atypical antipsychotics, on the other hand, are less likely to evoke hyperprolactinemia. The aim of this study was to investigate the prevalence of hyperprolactinemia induced by conventional antipsychotic drugs, examine changes in serum prolactin levels and psychiatric symptoms after switching to quetiapine, and identify the relevant characteristics of patients who may be suitable to switch to quetiapine. METHOD: Sixty-nine of 74 consecutive female patients who had received conventional antipsychotic drugs were initially included in the study. Of these, 49 (71 %) patients suffered from hyperprolactinemia, of which a further 25 were subsequently switched to quetiapine. Psychiatric symptoms were assessed by the Positive and Negative Syndrome Scale (PANSS), and serum prolactin levels were measured just before and at 4 and 8 weeks after switching. RESULTS: Eight of the 25 (32 %) "switch" patients dropped out due to psychotic exacerbation during the 8 weeks. In the remaining 17 (68 %) patients, serum prolactin levels were significantly decreased without any significant change in PANSS scores after switching. The 17 patients who completed the switch had previously demonstrated significantly lower positive symptom scores compared to the 8 dropout patients. CONCLUSION: The present findings suggest that 71 % of female patients receiving conventional antipsychotic drugs may suffer from hyperprolactinemia and that approximately two-thirds of patients can be switched to quetiapine, resulting in an improvement in hyperprolactinemia. The main characteristic of the switched patients may be fewer positive symptoms.

Antipsychotic Agents↗
PubMed1993

Phase III clinical trial with Norplant II (two covered rods): report on five years of use.

The subdermal implant NORPLANT II contraceptive was studied for its safety, efficacy and acceptability over a period of 5 years of use in a phase III multicentre clinical trial. A total of 1,466 women were observed for 52,849 women-months of use. Only four pregnancies were reported during the study period, giving a method failure rate of 0.8 per 100 users at 5 years of use. The continuation rates were 61.4, 49.0 and 42.1 per 100 users at 3, 4 and 5 years of use, respectively. The majority of the discontinuations were due to bleeding irregularities which accounted for 22.2, 26.3 and 28.5 per 100 users at 3, 4 and 5 years of use, respectively. The next common reason was planning pregnancy which was observed mainly in women having one child. The discontinuations due to infection, expulsion or displacement of device were very low (0.2-0.3 per 100 users). Due to vigorous efforts made by the centers to follow the subjects, the lost-to-follow-up rate was very low (1.6% at 5 yr).

Adolescent↗
PubMed1996

Client follow-up at the Adelaide sexually transmitted disease clinic.

This study investigated the extent to which doctor-client communication is associated with follow-up rates at Clinic 275, an Adelaide sexually transmitted diseases (STD) clinic. At Clinic 275, clients are routinely screened for the major STDs at their first visit. They are then asked to return in one week's time for their results and further treatment if necessary. Over a four-week period in April-May 1994, the clinical consultations between doctors and 100 clients attending for their first visit in an episode of care were observed and recorded. Data from the observation schedules were matched with data collected from interviews, either when clients returned for their follow-up visit (n = 78) or from a telephone interview when they failed to return (n = 20). In addition, 18 clients who failed to return for follow-up (but were not part of the original observation sample) were interviewed. Sociodemographic factors did not affect follow-up rates. Of those who did not return for follow-up, social and environmental reasons were cited by about two-thirds. Reasons given by the remaining clients indicate that failure to return for follow-up was related to discrepancies in doctor-client communication in that they were confused about the need to return to obtain test results. In addition, approximately half could not name the infections for which they had been tested. Changes in clinic practice may prove a more useful method of increasing follow-up rates than seeking to identify the characteristics of noncompliant individuals.

Appointments and Schedules↗
PubMed2005

The therapeutic effect of clinical trials: understanding placebo response rates in clinical trials--a secondary analysis.

BACKGROUND AND PURPOSE: Placebo response rates in clinical trials vary considerably and are observed frequently. For new drugs it can be difficult to prove effectiveness superior to placebo. It is unclear what contributes to improvement in the placebo groups. We wanted to clarify, what elements of clinical trials determine placebo variability. METHODS: We analysed a representative sample of 141 published long-term trials (randomized, double-blind, placebo-controlled; duration > 12 weeks) to find out what study characteristics predict placebo response rates in various diseases. Correlational and regression analyses with study characteristics and placebo response rates were carried out. RESULTS: We found a high and significant correlation between placebo and treatment response rate across diseases (r = .78; p < .001). A multiple regression model explained 79% of the variance in placebo variability (F = 59.7; p < 0.0001). Significant predictors are, among others, the duration of the study (beta = .31), the quality of the study (beta = .18), the fact whether a study is a prevention trial (beta = .44), whether dropouts have been documented (beta = -.20), or whether additional treatments have been documented (beta = -.17). Healing rates with placebo are lower in the following diagnoses; neoplasms (beta = -.21), nervous diseases (beta = -.10), substance abuse (beta = -.14). Without prevention trials the amount of variance explained is 42%. CONCLUSION: Medication response rates and placebo response rates in clinical trials are highly correlated. Trial characteristics can explain some portion of the variance in placebo healing rates in RCTs. Placebo response in trials is only partially due to methodological artefacts and only partially dependent on the diagnoses treated.

Data Interpretation, Statistical↗
PubMed1975

Recruitment and progress of minority medical school entrants 1970-1972.

This is a report on a national study of minority group applicants and entrants to the 1970, 1971, and 1972 entering classes of U.S. medical colleges. The aim of the investigation was to further understanding of the factors involved in attempting to increase minority representation in education for the practice of medicine. Data from the Association of American Medical Colleges are used to examine characteristics of successful and unsuccessful minority applicants to medical school. Socieconomic, personal, institutiona, and geographical factors that relate to the recruitment and progress of minority students in medicine are analyzed and evaluated. Differences between Caucasian and minority group students affecting admissions, retention, and promotion are documented. The investigators also compare the projections of a 1970 AAMC task force report with actual occurrences in the national effort to expand educational opportunities in medicine for blacks and other underrepresented minority students (that is, American Indians, Mexican Americans, and mainland Puerto Ricans). This comparison shows substantial progress toward the projected figures but a need for renewed commitment if they are to be reached. Suggestions are offered for improving the recruitment and progress of minority medical school entrants by such means as the AAMC Simulated Minority Admissions Exercises and by ongoing programs at individual medical schools. The study also yielded such pertinent findings as the following: 1. Confirmation that the racial characterizations self-reported by medical school applicants have a high degree of accuracy and an increasing degree of completeness. 2. An encouraging increase in the number of black premedical students who will potentially apply for the medical school classes entering in 1976 and 1977. 3. Growth in the enrollment of low-income medical students, most of it explained by the increase in the numbers of minority group members who have been admitted in recent years. 4. More mobility among blacks than Caucasians with regard to attending medical schools in other than their region of legal residence. 5. A higher proportion of women, of older, and of married students among minority medical school matriculants than among Caucasian matriculants. 6. A slightly higher medical school retention rate for Caucasians than for students from underrepresented minority groups, possibly explained in part by the greater diversity in the socioeconomic and educational backgrounds of the latter. 7. A positive relationship for blacks between the size of undergraduate college attended and successful completion of the first year of medical school.

Black or African American↗