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PubMed2004

Clinical outcome of ECT in patients with major depression and comorbid borderline personality disorder.

OBJECTIVE: Previous research suggests that the comorbidity of major depression with a personality disorder, especially borderline personality disorder, is associated with a poorer response to ECT. The authors compared the acute outcome of ECT in depressed patients with borderline personality disorder, with personality disorders other than borderline personality disorder, and with no personality disorder. METHOD: The study subjects were 139 patients with a primary diagnosis of unipolar major depression and scores of at least 20 on the 24-item Hamilton Depression Rating Scale. Patients were treated with suprathreshold right unilateral or bilateral ECT in a standardized manner and were assessed with the Hamilton depression scale within 3 days and 4-8 days after completing ECT. RESULTS: Compared to patients with personality disorders other than borderline personality disorder (N=42) and those with no personality disorder (N=77), patients with borderline personality disorder (N=20) had less symptomatic improvement assessed up to 8 days after ECT. Patients with personality disorders other than borderline personality disorder responded as well to ECT as those with no personality disorder. Borderline personality disorder patients were more likely to be female and to have medication-resistant depression than the patients in the two comparison groups; they were also younger. However, none of these differences accounted for the borderline personality disorder patients' poorer response to ECT. CONCLUSIONS: Patients with borderline personality disorder have a poorer acute response to ECT, but explanations for this finding remain elusive.

Adult↗
PubMed1999

Relationship between borderline personality disorder and Axis I diagnosis in severity of depression and anxiety.

BACKGROUND: This study tested the hypothesis that subjects with borderline personality disorder irrespective of the presence or absence of an Axis I mood or anxiety disorder would exhibit greater severity of depression and anxiety than subjects with either a personality disorder other than borderline personality disorder or no personality disorder. METHOD: Two hundred eighty-three subjects from an outpatient psychiatry clinic were administered the following assessments: the Structured Clinical Interview for DSM-III-R (SCID) for Axes I and II, the Hamilton Rating Scales for Depression and Anxiety, the Beck Depression Inventory, and the Spielberger State-Trait Anxiety Inventory. Subjects were categorized into borderline personality disorder, other personality disorder, and no personality disorder categories and into present versus absent categories on Axis I diagnosis of depression and of anxiety. A 2-factor multiple analysis of variance compared personality disorder status and Axis I diagnosis on severity of depression by observer rating and self-report. The analysis was repeated for anxiety. RESULTS: As hypothesized, significant main effects were found for borderline personality disorder and for both depression and anxiety. Subjects with borderline personality disorder showed greater severity on both depression and anxiety rating scales than did patients with another personality disorder, who showed greater severity than did patients with no personality disorder. Axis I diagnosis was also associated with greater severity on depression or anxiety rating scales. These differences were found for both observer ratings and self-report. An interaction was also found for depression: Subjects with borderline personality disorder but without an Axis I diagnosis of depression rated themselves as more severely depressed on the Beck Depression Inventory than did subjects with another or no personality disorder who also had an Axis I diagnosis of depression. CONCLUSION: Implications from the study are discussed including the need to assess for borderline personality disorder in research studies of depression and anxiety and to integrate treatments for borderline personality disorder into depression and anxiety treatment to maximize clinical outcomes.

Adult↗
PubMed2002

The representation of borderline, avoidant, obsessive-compulsive, and schizotypal personality disorders by the five-factor model.

This study evaluated the accuracy of hypothesized relationships of the five-factor model of personality to four targeted personality disorders in a large multisite sample of patients. Data were gathered from 668 patients, who were assigned to one of five study cells: Borderline, Schizotypal, Avoidant, and Obsessive-Compulsive Personality Disorder, and a Major Depression without personality disorder comparison group. Patients were administered a questionnaire designed to assess the domains and facets of the five-factor model and results were compared among diagnostic groups and between patients and community norms. Although many relationships between personality traits and disorders were obtained, the magnitude of the relationships varied greatly as a function of the comparison group involved. In general, the differences between the personality disorder patients and community norms were far larger than the differences between the specific personality disorder groups. Also, for avoidant personality, it appeared that statistical interactions between personality factors are needed to better differentiate it from other personality disorder groups. The four personality disorder groups studied could each be distinguished from community norms on the personality dimensions of the five-factor model. However, differentiating among the four groups proved more difficult, as each shared the configuration of high Neuroticism, low Agreeableness, and low Conscientiousness. It does not appear that these disorders represent extremes of different personality dimensions, but rather each appears to be a variant of the same extreme configuration. Differences between personality disorders may reflect diverse interactions among the dimensions, rather than differences on single dimensions.

Adult↗
PubMed2004

The longitudinal relationship of personality traits and disorders.

Personality disorders are presumed to be stable because of underlying stable and maladaptive personality traits, but while previous research has demonstrated a link between personality traits and personality disorders cross-sectionally, personality disorders and personality traits have not been linked longitudinally. This study explores the extent to which relevant personality traits are stable in individuals diagnosed with 4 personality disorders (schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders) and examines the assumption that these personality disorders are stable by virtue of stable personality traits. This assumption was tested via the estimation of a series of latent longitudinal models that evaluated whether changes in relevant personality traits lead to subsequent changes in personality disorders. In addition to offering large consistency estimates for personality traits and personality disorders, the results demonstrate significant cross-lagged relationships between trait change and later disorder change for 3 of the 4 personality disorders studied.

Adult↗
PubMed2000

Predicting particulate (PM10) personal exposure distributions using a random component superposition statistical model.

This paper presents a new statistical model designed to extend our understanding from prior personal exposure field measurements of urban populations to other cities where ambient monitoring data, but no personal exposure measurements, exist. The model partitions personal exposure into two distinct components: ambient concentration and nonambient concentration. It is assumed the ambient and nonambient concentration components are uncorrelated and add together; therefore, the model is called a random component superposition (RCS) model. The 24-hr ambient outdoor concentration is multiplied by a dimensionless "attenuation factor" between 0 and 1 to account for deposition of particles as the ambient air infiltrates indoors. The RCS model is applied to field PM10 measurement data from three large-scale personal exposure field studies: THEES (Total Human Environmental Exposure Study) in Phillipsburg, NJ; PTEAM (Particle Total Exposure Assessment Methodology) in Riverside, CA; and the Ethyl Corporation study in Toronto, Canada. Because indoor sources and activities (smoking, cooking, cleaning, the personal cloud, etc.) may be similar in similar populations, it was hypothesized that the statistical distribution of nonambient personal exposure is invariant across cities. Using a fixed 24-hr attenuation factor as a first approximation derived from regression analysis for the respondents, the distributions of nonambient PM10 personal exposures were obtained for each city. Although the mean ambient PM10 concentrations in the three cities varied from 27.9 micrograms/m3 in Toronto to 60.9 micrograms/m3 in Phillipsburg to 94.1 micrograms/m3 in Riverside, the mean nonambient components of personal exposures were found to be closer: 52.6 micrograms/m3 in Toronto; 52.4 micrograms/m3 in Phillipsburg; and 59.2 micrograms/m3 in Riverside. The three frequency distributions of the nonambient components of exposure also were similar in shape, giving support to the hypothesis that nonambient concentrations are similar across different cities and populations. These results indicate that, if the ambient concentrations were completely controlled and set to zero in all three cities, the median of the remaining personal exposures to PM10 would range from 32.0 micrograms/m3 (Toronto) to 34.4 micrograms/m3 (Phillipsburg) to 48.8 micrograms/m3 (Riverside). The highest-exposed 30% of the population in the three cities would still be exposed to 24-hr average PM10 concentrations of 47-74 micrograms/m3; the highest 20% would be exposed to concentrations of 56-92 micrograms/m3; the highest 10% to concentrations of 88-131 micrograms/m3; and the highest 5% to 133-175 micrograms/m3, due only to indoor sources and activities. The distribution for the difference between personal exposures and indoor concentrations, or the "personal cloud," also was similar in the three cities, with a mean of 30-35 micrograms/m3, suggesting that the personal cloud accounts for more than half of the nonambient component of PM10 personal exposure in the three cities. Using only the ambient measurements in Toronto, the nonambient data from THEES in Phillipsburg was used to predict the entire personal exposure distribution in Toronto. The PM10 exposure distribution predicted by the model showed reasonable agreement with the PM10 personal exposure distribution measured in Toronto. These initial results suggest that the RCS model may be a powerful tool for predicting personal exposure distributions and statistics in other cities where only ambient particle data are available.

Air Pollution↗
PubMed2001

[Personal identifiability in the Health Sector Database.].

INTRODUCTION: Personal identifiability is a fundamental question in the debate about the Bill and Act on the Health Sector Database (HSD). If the data are personally identifiable, Iceland's international committments dictate that a priori consent be obtained from patients for the use of their health records data. The HSD Act presumes that one way encryption renders the data non-personally identifiable and that therefore an a priori consent is not required. RESULTS: The history of the concept of personal identifiability during the debate on the HSD reveals changes made to the concept. In the first instance a reference was made to Recommendation R(97)5 of the Council of Europe Committee of Ministers which was changed by adopting a direct translation of the definition of personal data from the Directive 95/46/EC of the European Parliament and of the Council. These changes were made in response to the Data Protection Commission's opinion on the HSD Bill submitted to the Minister of Health that overturned the ideology previously used regarding indentifiability of persons. Information is identifiable if there exists a key and it makes no difference who holds the key. One way encryption was then adopted as a method that was supposed to mean that a key does not exist. Nevertheless, the database proponents now admit that a key exists. The making of keys for opening up the database is discussed. The database is a longitudinal collection and linkage of records on each individual and therefore the method of encryption must remain stable. Therefore, anyone with access to the method can easily make a lookup-table containing side by side the names and the personal numbers produced by the encryption. Although it may be hard to go from a personal number directly back to a name, given the table it always is possible to look up what personal number belongs to a certain person or what person stands behind a certain personal number. This is a key. If the method of encryption was lost or access to it was not available it would nevertheless be possible to make a key. The intention is to encrypt the genealogy of the entire nation using the same encryption method used for the HSD. The genealogy of the nation with names is also generally available. The patterns of family trees become unique when one family is connected to another through marriage and childbirth. A comparison of the encrypted genealogy containing personal numbers with the same genealogy containing names is therefore a method for making a key. Finally a key can be made from the context of general information. Even if the names were irreversibly removed there will be enough available bits of general information connected to a personal number to allow re-identification of the person in a large number of instances. This amounts to making a key. CONCLUSIONS: The information in the Health Sector Database is personal information. Therefore it is both right and reasonable to obtain an a priori consent of patients for the transfer of their health data to the database as Iceland's international obligations stipulate. Anything less is unreasonable.

English Abstract↗
PubMed2001

Treatment utilization by patients with personality disorders.

OBJECTIVE: Utilization of mental health treatment was compared in patients with personality disorders and patients with major depressive disorder without personality disorder. METHOD: Semistructured interviews were used to assess diagnosis and treatment history of 664 patients in four representative personality disorder groups-schizotypal, borderline, avoidant, and obsessive-compulsive-and in a comparison group of patients with major depressive disorder. RESULTS: Patients with personality disorders had more extensive histories of psychiatric outpatient, inpatient, and psychopharmacologic treatment than patients with major depressive disorder. Compared to the depression group, patients with borderline personality disorder were significantly more likely to have received every type of psychosocial treatment except self-help groups, and patients with obsessive-compulsive personality disorder reported greater utilization of individual psychotherapy. Patients with borderline personality disorder were also more likely to have used antianxiety, antidepressant, and mood stabilizer medications, and those with borderline or schizotypal personality disorder had a greater likelihood of having received antipsychotic medications. Patients with borderline personality disorder had received greater amounts of treatment, except for family/couples therapy and self-help, than the depressed patients and patients with other personality disorders. CONCLUSIONS: These results underscore the importance of considering personality disorders in diagnosis and treatment of psychiatric patients. Borderline and schizotypal personality disorder are associated with extensive use of mental health resources, and other, less severe personality disorders may not be addressed sufficiently in treatment planning. More work is needed to determine whether patients with personality disorders are receiving adequate and appropriate mental health treatments.

Adolescent↗
PubMed2004

Dimensions of personality disorders in offenders.

BACKGROUND: Owing to criticisms of current concepts of personality disorders such as high comorbidity, criteria overlap and arbitrary thresholds of categorical diagnoses, a dimensional assessment is proposed that considers interrelations between different personality disorders. Results of previous factor analyses using dimensional personality disorder scores have indicated that one underlying dimension shows strong similarities to the concept of psychopathy and is similarly related to criminal recidivism. AIM: The authors examined the underlying dimensions of ICD-10 personality disorders, to analyse their association with criminal behaviour in general, and with specific criminal history variables. METHOD: Study samples included 105 offenders and 80 non-criminal controls. Personality disorders were measured using a clinical structured interview (IPDE), measures of personality using self-report (NEO-FFI, IPC, HDHQ), and criminal history variables obtained from court records. RESULTS: Three underlying personality disorder factors could be identified, which showed identical structures in both the forensic and the non-forensic sample. Factor 1 comprised emotionally unstable, histrionic, paranoid and dissocial traits and showed strong similarity to the construct of psychopathy. Factor 2 was defined by anankastic personality disorder scores and an inverse relation to schizoid personality features. Factor 3 showed high negative loadings of anxious and dependent personality disorders. Self-report measures of personality and criminal history variables yielded different associations with the three PD dimensions. Offenders with high scores on factor 1 were highly aggressive, violent and impulsive. CONCLUSIONS: The findings generally replicated previous analyses using DSM-III personality disorder scores. Differences can be explained by the different constructs of personality disorders included in ICD-10. Although a diagnosis of psychopathy is not currently included in these diagnostic systems, the authors' findings indicate that a highly inter-related pattern of personality disorder scores constitutes psychopathic personality disorder and can be used to identify impulsive, hostile and violent offenders.

Adult↗
PubMed1997

Culture, universals, and the personal.

This chapter summarizes a part of the case that can be made that the individual construction of a personal domain of choice and privacy generalizes across cultures and is not restricted to persons who live within Western or so-called modern societies. The research findings reported here are consistent with the view that persons seek to establish such areas of control in order to maintain a differentiated personal identity and a sense of personal agency. Children, adolescents, and adults from the United States and traditional cultures have been found to identify a class of behaviors and issues as being outside the legitimate sphere of social or moral regulation. Mothers from Western and traditional cultural settings recognize and foster their children's claims to areas of personal choice and privacy. Across cultures, as children mature and move toward adulthood, they lay claim to a broader range of issues and actions as personal matters. Research on adolescent-parent conflict with U.S. and Chinese samples has indicated that these shifts associated with adolescent claims to freedom are the source of most family conflicts. Anthropological accounts of adolescent-parent conflicts in 160 cultures have provided evidence that such conflicts are widespread (Schlegel and Barry, 1991). Finally, we are beginning to obtain evidence that parental overcontrol of personal issues is associated with symptoms of psychological problems in their adolescent children. These research findings are consistent with the proposal (Nucci, 1996) that establishment of a personal domain is an intrinsic feature of normal human development, resulting from the inevitable attempt by individuals to account for and differentiate between their own motives, values, and experiences and those of others. The evidence also points to the fact that such personal issues are coexistent with concerns for interpersonal harmony and social integration. Thus, it is not surprising that the work summarized here also suggests considerable social-class and cultural variation in how the personal is expressed. Such variation is consistent with the assumption that the personal is constructed out of social interactions (Nucci, 1996) that entail reciprocal interchange between individual and societal structures (Turiel, 1996). In Spiro's analysis (1984), the results of such reciprocal structural interaction cannot be accounted for by reducing the analysis of psychological structures in terms of cultural structures and vice versa. Thus, any accurate interpretation of the impact of culture on psychological development must be constrained by features that are peculiar to psychological systems. Extending this to the cross-cultural study of the personal domain, a case can be made for the need to explore such issues at the level of the individual, rather than at the level of the cultural shared-symbol system. On the other hand, this nonreductionist approach and the available evidence rule out the reification of the personal as a culturally empty set of psychological issues. As illustrated in studies of the distribution of rights in relation to gender and social hierarchy among Druze Arabs (Wainryb and Turiel, 1994), the interplay between the personal and the cultural system of roles and obligations provides a rich and contradictory portrait that can be understood only by shifting perspective from the social to the individual and back again without favor.

Adolescent↗
PubMedDate not supplied

Affective instability and impulsivity in borderline personality and bipolar II disorders: similarities and differences.

OBJECTIVES: many studies have reported a high degree of comorbidity between mood disorders, among which are bipolar disorders, and borderline personality disorder and some studies have suggested that these disorders are co-transmitted in families. However, few studies have compared personality traits between these disorders to determine whether there is a dimensional overlap between the two diagnoses. The aim of this study was to compare impulsivity, affective lability and intensity in patients with borderline personality and bipolar II disorder and in subjects with neither of these diagnoses. METHODS: patients with borderline personality but without bipolar disorder (n=29), patients with bipolar II disorder without borderline personality but with other personality disorders (n=14), patients with both borderline personality and bipolar II disorder (n=12), and patients with neither borderline personality nor bipolar disorder but other personality disorders (OPD; n=93) were assessed using the Affective Lability Scale (ALS), the Affect Intensity Measure (AIM), the Buss-Durkee Hostility Inventory (BDHI) and the Barratt Impulsiveness Scale (BIS-7B). RESULTS: borderline personality patients had significantly higher ALS total scores (P<0.05) and bipolar II patients tended to have higher ALS scores than patients with OPD (P<0.06). On one of the ALS subscales, the borderline patients displayed significant higher affective lability between euthymia and anger (P<0.002), whereas patients with bipolar II disorder displayed affective lability between euthymia and depression (P<0.04), or elation (P<0.01) or between depression and elation (P<0.01). A significant interaction between borderline personality and bipolar II disorder was observed for lability between anxiety and depression (P<0.01) with the ALS. High scores for impulsiveness (BISTOT, P<0.001) and hostility (BDHI, P<0.05) were obtained for borderline personality patients only and no significant interactions between diagnoses were observed. Only borderline personality patients tended to have higher affective intensity (AIM, P<0.07). CONCLUSIONS: borderline personality disorder and bipolar II disorder appear to involve affective lability, which may account for the efficacy of mood stabilizers treatments in both disorders. However, our results suggest that borderline personality disorder cannot be viewed as an attenuated group of affective disorders.

Adult↗
PubMed1995

Continuities between psychiatric disorders in adolescents and personality disorders in young adults.

OBJECTIVE: Personality disorders are a major mental health problem, but little information about their etiology and natural history is available. This study examined continuities between axis I disorders in adolescents and personality disorders in young adults. METHOD: The authors interviewed 145 young adults (mean age, 19.6 years) who had been diagnosed with a variety of DSM-III emotional and disruptive disorders during adolescence (mean age, 13.7 years). The Personality Disorder Examination was used to establish whether the subjects currently suffered from personality disorders. RESULTS: Subjects who had had disruptive disorders during adolescence showed high rates of all types of personality disorders (40% had a personality disorder at follow-up), while subjects who had had emotional disorders had a lower rate of personality disorders (12%). Men were more likely to have cluster A personality disorders, and women were more likely to have cluster C personality disorders. Disruptive diagnoses were associated with cluster B personality disorders, but emotional disorders did not show an association with cluster C personality disorders. Oppositional disorder did not increase the likelihood of passive-aggressive personality disorder. There was an association between attention deficit disorder with hyperactivity and borderline personality disorder. CONCLUSIONS: The rate of personality disorders was lower among young adults who had had emotional disorders during adolescence than among those who had had disruptive disorders, suggesting either that treatment for emotional disorders is more effective or that the personality psychopathology in these adolescents is not as severe as that in adolescents with disruptive disorders.

Adolescent↗
PubMedDate not supplied

Factors influencing entry-level occupational therapists' attitudes toward persons with disabilities.

Negative attitudes exhibited by rehabilitation professionals could have adverse consequences for persons with disabilities in their achievement of desired outcomes. Because occupational therapists are in a position to exert considerable influence in the therapeutic relationship, this study explored entry-level occupational therapy practitioners' equal status contact with and attitudes toward persons with disabilities. METHOD. Questionnaires were sent to 402 entry-level occupational therapists. These questionnaires consisted of: a demographic scale, the Disability Social Distance Scale, the Contact With Disabled Persons Scale, and a Similarity Scale (constructed for this study to evaluate the concept of equal status). Data analysis explored the relationship between 172 respondents' equal status perception and contact with persons with disabilities and their attitudes toward persons with disabilities. RESULTS. Respondents exhibited generally positive attitudes toward persons with disabilities. Perceived equality, personal and professional contact, and the majority of demographic factors were not significantly correlated with their attitudes toward persons with disabilities. Respondents who specified working with persons without disabilities in the wellness capacity exhibited more positive attitudes than those working with persons with biomechanical and neurological disabilities. In addition, respondents who had a greater frequency of professional contact with persons with disabilities also appeared to experience more personal contact with persons with disabilities. CONCLUSION. Entry-level occupational therapists' attitudes toward persons with disabilities may not only be influenced by parameters of the contact variable but also by the profession's holistic philosophy, the occupational therapy educational curricula, and the personal characteristics of those who choose to pursue a career in occupational therapy.

Adolescent↗
PubMedDate not supplied

[Relations between mood disorders and personality. Recent data].

In the field of studies of links between mood disorders and personality, the need to study only completely remitted patients has been demonstrated recently. Indeed, the clinically depressed state strongly influences the assessment of some personality traits in a more pathological direction (for instance for emotional stability, extraversion, interpersonal dependency, ego strength). The studies concerning unipolar depression have been mainly made according to two methodological approaches which results are relatively consistent. The first one uses batteries of standard self-report personality inventories such as the Hirschfeld and Klerman battery which includes the Guilford-Zimmerman Temperament Survey, the Interpersonal Dependency Inventory, the shortened version of the Lazare-Klerman-Armor Personality Inventory and two subscales of the MMPI. This approach shows that compared to normal population, recovered depressive, have less emotional strength more interpersonal dependency and a more introverted personality. The second approach uses diagnostic criteria of personality disorders according to DSM III. The clinical evaluation can be performed with the help of the Structured Interview for DSM III Personality Disorders (SIDP) or with of the help the Millon Clinical Multiaxial Inventory (MCMI), a self rated questionnaire. The most frequent personality disorder among recovered unipolar patients is dependent personality, followed by the avoidant and histrionic personalities and lastly the schizoïd, schizotypal, borderline, compulsive and passive-aggressive personalities. But the interpretation of all these results must be cautious given that a recent study dealing with premorbid personality invites one to consider that not only depression influences personality assessment during illness, but also that depression may result in personality change after recovery. Few studies are available concerning bipolar patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Depressive Disorder↗
PubMedDate not supplied

Personal exposure to particles in Banská Bystrica, Slovakia.

Epidemiological studies have associated adverse health impacts with ambient concentrations of particulate matter (PM), though these studies have been limited in their characterization of personal exposure to PM. An exposure study of healthy nonsmoking adults and children was conducted in Banska Bystrica, Slovakia, to characterize the range of personal exposures to air pollutants and to determine the influence of occupation, season, residence location, and outdoor and indoor concentrations on personal exposures. Twenty-four-hour personal, at-home indoor, and ambient measurements of PM10, PM2.5, sulfate (SO4(2-)) and nicotine were obtained for 18 office workers, 16 industrial workers, and 15 high school students in winter and summer. Results showed that outdoor levels of pollutants were modest, with clear seasonal differences: outdoor PM10 summer/winter mean = 35/45 microg/m3; PM2.5 summer/winter mean = 22/32 microg/m3. SO4(2-) levels were low (4-7 microg/m3) and relatively uniform across the different sample types (personal, indoor, outdoor), areas, and occupational groups. This suggests that SO4(2-) may be a useful marker for combustion mode particles of ambient origin, although the relationship between personal exposures and ambient SO4(2-) levels was more complex than observed in North American settings. During winter especially, the central city area showed higher concentrations than the suburban location for outdoor, personal, and indoor measures of PM10, PM2.5, and to a lesser extent for SO4(2-), suggesting the importance of local sources. For PM2.5 and PM10, ratios consistent with expectations were found among exposure indices for all three subject groups (personal>indoor>outdoor), and between work type (industrial>students>office workers). The ratio of PM2.5 personal to indoor exposures ranged from 1.0 to 3.9 and of personal to outdoor exposures from 1.6 to 4.2. The ratio of PM10 personal to indoor exposures ranged from 1.1 to 2.9 and the ratio of personal to outdoor exposures from 2.1 to 4.1. For a combined group of office workers and students, personal PM10/PM2.5 levels were predicted by statistically significant multivariate models incorporating indoor (for PM2.5) or outdoor (for PM10) PM levels, and nicotine exposure (for PM10). Small but significant fractions of the overall variability, 15% for PM2.5 and 17% for PM10, were explained by these models. The results indicate that central site monitors underpredict actual human exposures to PM2.5 and PM10. Personal exposure to SO4(2-) was found to be predicted by outdoor or indoor SO4(2-) levels with 23-71% of the overall variability explained by these predictors. We conclude that personal exposure measurements and additional demographic and daily activity data are crucial for accurate evaluation of exposure to particles in this setting.

Adult↗
PubMedDate not supplied

Assessing the importance of different exposure metrics and time-activity data to predict 24-H personal PM2.5 exposures.

Personal PM(2.5) data from two recent exposure studies, the Scripted Activity Study and the Older Adults Study, were used to develop models predicting 24-h personal PM(2.5) exposures. Both studies were conducted concurrently in the summer of 1998 and the winter of 1999 in Baltimore, MD. In the Scripted Activity Study, 1-h personal PM(2.5) exposures were measured. Data were used to identify significant factors affecting personal exposures and to develop 1-h personal exposure models for five different micro-environments. By incorporating the time-activity diary data, these models were then combined to develop a time-weighted microenvironmental personal model (model M1AD) to predict the 24-h PM(2.5) exposures measured for individuals in the Older Adults Study. Twenty-four-hour time-weighted models were also developed using 1-h ambient PM(2.5) levels and time-activity data (model A1AD) or using 24-h ambient PM(2.5) levels and time-activity data (model A24AD). The performance of these three models was compared to that using 24-h ambient concentrations alone (model A24). Results showed that factors affecting 1-h personal PM(2.5) exposures included air conditioning status and the presence of environmental tobacco smoke (ETS) for indoor micro-environments, consistent with previous studies. ETS was identified as a significant contributor to measured 24-h personal PM(2.5) exposures. Staying in an ETS-exposed microenvironment for 1 h elevated 24-h personal PM(2.5) exposures by approximately 4 microg/m 3 on average. Cooking and washing activities were identified in the winter as significant contributors to 24-h personal exposures as well, increasing 24-h personal PM(2.5) exposures by about 4 and 5 microg/m 3 per hour of activity, respectively. The ability of 3 microenvironmental personal exposure models to estimate 24-h personal PM(2.5) exposures was generally comparable to and consistently greater than that of model A24. Results indicated that using time-activity data with 1-h exposure information, either as micro-environment-specific exposures (model M1AD) or as ambient concentrations (model A1AD), improves our ability to estimate 24-h personal PM(2.5) exposure over the model using 24-h averaged ambient levels alone (model A24). Model performance was higher in the summer than in the winter season. In addition, higher crude R(2) values were reported for subjects participating in both seasons, where the R(2) values equaled.53,.55,.46, and.38 for models M1AD, A1AD, A24AD, and A24, respectively. The low predictive ability of the microenvironmental exposure models in the winter might, in part, be attributed to the narrow dynamic range of personal PM(2.5) exposures.

Aged↗
PubMed2005

Prevalence of symptomatic peripheral arterial disease, modifiable risk factors, and appropriate use of drugs in the treatment of peripheral arterial disease in older persons seen in a university general medicine clinic.

BACKGROUND: Persons with peripheral arterial disease (PAD) have a high incidence of cardiovascular morbidity and mortality. METHODS: We investigated the prevalence of symptomatic PAD, modifiable risk factors, and use of drugs in persons 60 years and older seen in a university general medicine clinic. Symptomatic PAD was documented if the person had a documented history of surgery for PAD, if the person had intermittent claudication or other lower extremity symptoms associated with absent or weak arterial pulses or an ankle-brachial index of <0.90, if the person had an abdominal aortic aneurysm, or if the person had symptomatic documented extracranial carotid arterial disease. RESULTS: There were 620 women and 386 men, mean age 72+/-9 years (range 60-95 years), and 95% were white. Symptomatic PAD was present in 103 of 386 men (27%) and in 106 of 620 women (17%) (p<.001). The prevalence of current cigarette smoking (31% versus 12% in those without PAD, p<.001) and ex-cigarette smoking (40% versus 26%) in those without PAD, p<.001) was higher among persons with PAD. Compared with persons without PAD, those with PAD also had a higher prevalence of hypertension (90% versus 76% in persons without PAD, p<.001), diabetes mellitus (45% versus 22%, p<.001), dyslipidemia (88% versus 60%, p<.001), coronary artery disease (63% versus 25%, p<.001), and stroke (36% versus 11%, p<.001). In persons with PAD, antiplatelet drugs were used in 85%, lipid-lowering drugs for dyslipidemia in 67%, beta blockers in 60%, and angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers in 62%. The average of the last two blood pressures was <140/90 mmHg in 55% of persons with PAD treated for hypertension. The last hemoglobin A1c in diabetics was <7% in 52% of persons with PAD. CONCLUSIONS: Older persons with PAD have a high prevalence of modifiable risk factors, CAD, and stroke. The use of antiplatelet drugs, lipid-lowering drugs for dyslipidemia, beta blockers, and ACE inhibitors or angiotensin-receptor blockers, reduction of blood pressure to <140/90 mmHg in hypertensive persons, and reduction of hemoglobin A1c in diabetics to <7% in older persons with PAD needs to be increased in all clinical settings.

Adrenergic beta-Antagonists↗
PubMed2006

Reality orientation: its use and effectiveness within older person mental health care.

AIM: The aim of this study was to find out how psychiatric nurses use reality orientation and perceive its effectiveness in older person mental health care. BACKGROUND: The study described in this article relates to how effective reality orientation is and how it is used, within older person mental health care. As a technique, reality orientation originated in North America in the 1950s. It has been defined as an approach which may decrease confusion and dysfunctional behaviour patterns in people with dementia. Although there exists some confusion as to how reality orientation should be delivered, it is generally agreed that reality orientation may be delivered in two ways. Firstly, through constantly orientating patients to time, place and person (24-hour reality orientation) and, secondly, orientating patients to reality within a group setting. METHODS: Six psychiatric nurses practicing in an older person mental health care inpatient unit took part in in-depth semi-structured interviews. These six nurses all practiced upon the same older person care unit, which was part of a larger psychiatric hospital randomly selected from psychiatric hospitals in Dublin, Ireland, to take part in the study. The six nurses were also part of a larger cohort of nurses who helped the author explore how psychiatric nurses use and perceive reality orientation as used in older person and acute inpatient mental health care. This was a descriptive qualitative study, using the technique of constant comparative analysis as outlined by Strauss and Corbin as a way to code interview data and arrange themes that represented what participants had talked about in the interviews. More particularly, this form of analysis closely resembled the type of open coding as outlined by Strauss and Corbin. The analysis of interview data was presented to interview participants prior to the formal acceptance of these themes as a valid representation of what interviewees talked about. FINDINGS: Upon analysis, interview data yielded five themes. Firstly, reality orientation means interacting with patients about the patient's current environment and issues in their predicament. Secondly, the sampled nurses use reality orientation frequently in their nursing work, with reality orientation being most often used in the mornings and evenings. Thirdly, reality orientation is implemented through interacting with the patient. It may also be implemented as part of other approaches, such as occupational therapy. Fourthly, improvements in the areas of orientation and behaviour functioning may be possible through the use of reality orientation, although more contemporary research is required to validate this. Finally, participants talked of the need for psychiatric nurses practicing in older person settings to become more aware of what reality orientation entails as an approach, such awareness may be increased through more reality orientation-based research. CONCLUSIONS: Interview data point to reality orientation being used frequently through nurse-patient interaction. Participants talked about how using reality orientation may hold benefits for patients; however, on a more cautionary note, participants also raised the need for a greater clinical awareness of reality orientation as an approach for use in caring for older persons with mental health problems. RELEVANCE TO CLINICAL PRACTICE: Psychiatric nurses practicing in older person care environments often have to provide care to persons having difficulty comprehending reality. For example, a person who is confused through suffering from an organic brain disorder such as Alzheimer's disease, or who is expressing a delusion through suffering from a functional mental illness such as depression. Taking this into consideration, there is an onus on psychiatric nurses to be able to care for older persons having difficulties comprehending the reality they are living in. Participants in this study identified reality orientation as an approach which can be used by psychiatric nurses in attempting to help older persons experiencing mental health problems cope with not being able to comprehend and recognize their surroundings. Participants also suggested that reality orientation may hold some benefits for older disorientated person, such as facilitating a greater level of orientation. On a more cautionary note, participants talked of the need for psychiatric nurses caring for older persons with mental health problems to become more aware of the use of reality orientation in clinical practice.

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PubMed1997

Three-year trials of personal therapy among schizophrenic patients living with or independent of family, II: Effects on adjustment of patients.

OBJECTIVE: Previous analyses of the personal and social adjustment of outpatients with schizophrenia have either relied on the assessment of unrepresentative patients who survived without relapse or used analyses that included relapse assessments, a potential confound when different rates of relapse existed among treatment conditions. The authors' goal was to conduct a study of the effects of personal therapy on outcome that was designed to take into consideration the effects of relapse. METHOD: They evaluated the effectiveness of personal therapy over 3 years after hospital discharge among 151 patients with schizophrenia or schizoaffective disorder. The patients were randomly assigned to receive personal therapy or contrasting therapies in one of two concurrent trials. One trial included patients who were living with family (N = 97); the other included patients who were living independent of family (N = 54). Patients were assessed at 6-month intervals over 3 years of treatment on measures of personal and social adjustment; patients who relapsed and restabilized and those who did not relapse were included. RESULTS: Personal therapy had positive effects on broad components of social adjustment (role performance) but had few differential effects on symptoms, and patients receiving personal therapy remained more anxious than patients who received family or supportive therapy. For patients who were living with family, personal therapy led to better outcomes in overall performance than did the other treatments. Although family therapy had only one positive effect on patients' social adjustment, the personal adjustment (residual symptoms) of patients who received family therapy appeared to improve more than that of patients receiving personal or supportive therapy. For patients not living with family, personal therapy was more successful than supportive therapy in improving work performance and relationships out of the home. Longitudinal effects of personal therapy on symptoms were similar to those of family and supportive therapies, particularly in the first 2 years, but personal therapy effect sizes increased over time on measures of social adjustment. CONCLUSIONS: Personal therapy has pervasive effects on the social adjustment of patients with schizophrenia that are independent of relapse prevention. Supportive therapy, with or without family intervention, produces adjustment effects that peak at 12 months after discharge and plateau thereafter. However, personal therapy, a definitive psychosocial intervention, continues to improve the social adjustment of patients in the second and third years after discharge. Brief treatment would appear to be less effective than a long-term, disorder-relevant intervention for schizophrenia.

Adaptation, Psychological↗