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PubMed1987

Assessment of postmortem respiratory ciliary motility and ultrastructure.

Acquired and congenital abnormalities in the mucociliary transport system result in respiratory dysfunction and clinical disease. Although upper and lower respiratory epithelium can be analyzed premortem, it is uncertain whether postmortem analyses provide a valid indicator of the premortem status of the ciliary apparatus. To address this question, we studied nasal ciliary motility and ultrastructure from 2 patients 16 h after death. After placement of the epithelial samples in Krebs-Henseleit solution and warming to body temperature, normal ciliary motility and frequency were observed in both samples. The specimen then could be stored within the solution at 4 degrees C for subsequent reanalysis on later days for as long as 60 h after collection with no deterioration in ciliary motility, as assessed by video motion analysis. Quantitative assessment of the ciliary ultrastructure did not reveal any abnormality in microtubular arrangements, and good tissue preservation was seen. These studies demonstrate that postmortem collection of nasal epithelium samples can provide a valid assessment of premortem ciliary structure and function.

Aged↗
PubMed1995

Unstable genes--unstable mind?

OBJECTIVE: Over the past 3 years, reports of DNA alteration in myotonic dystrophy, fragile X syndrome (types A and E), Kennedy's disease, Huntington's disease, spinocerebellar ataxia type 1, and dentatorubral-pallidoluysian atrophy have identified a new class of human mutation, referred to as trinucleotide repeat amplification. All available evidence suggests that this unstable trinucleotide repeat DNA is the biological basis of the clinical phenomenon of genetic anticipation. Two components of anticipation, greater severity and earlier age at onset in subsequent generations, have been widely observed in schizophrenia and bipolar affective disorder. Thus, a reanalysis of the genetics of major psychosis from the perspective of unstable DNA is of significant interest. METHOD: The authors reviewed the available literature on anticipation and related phenomena in major psychosis and reevaluated the family, twin, and adoption study data. RESULTS: The unstable DNA concept competes well with the traditional multifactorial polygenic theory; many deviations from a single gene mode of inheritance in psychiatric twin and family studies, which previously served as strong proof for more than one etiologic gene, can be easily explained by the non-Mendelian behavior of unstable DNA. In addition, this new paradigm provides a simple explanation for unclear issues in the genetics of major psychosis, such as the identical rate of psychosis in the offspring of discordant monozygotic twins. CONCLUSIONS: The major advantage of the unstable DNA hypothesis over the multifactorial polygenic theory lies in the possibility of falsifying the unstable DNA hypothesis by two independent laboratory strategies: a classical linkage analysis and a set of novel methods for the direct detection of unstable DNA sites.

Adult↗
PubMed1995

Risk factors for PTSD-related traumatic events: a prospective analysis.

OBJECTIVE: The authors previously identified suspected risk factors for traumatic events related to posttraumatic stress disorder (PTSD) on the basis of data gathered retrospectively. In this study, they tested that model prospectively. METHOD: A random sample of 1,200 persons was drawn from all 21- to 30-year-old members of a large health maintenance organization. In 1989, 1,007 of these persons were interviewed, and suspected risk factors were measured. In 1992, 979 were reinterviewed, and the 3-year incidence of exposure to traumatic events was ascertained. RESULTS: Nineteen percent of the sample reported traumatic events during the 3-year follow-up. A history of past exposure to traumatic events signaled an increase in the liability to exposure during follow-up, independent of suspected risk factors. Two predictors of exposure, neuroticism and extroversion, identified retrospectively, also predicted exposure prospectively. The odds for exposure among males and persons with less than a college education were marginally significant. Early misconduct and a family history of psychiatric disorder-predictors of exposure in the retrospective data-were not significant predictors at 3-year follow-up. Blacks had a higher incidence of exposure during follow-up than whites. An exploratory reanalysis suggested that the discrepancy between the retrospective and prospective results may be explained by the inclusion of childhood exposure in the lifetime retrospective inquiry. CONCLUSIONS: The assumption that PTSD-related traumatic events are random phenomena was unsupported. Among young adults, those with less education, blacks, and those with high neuroticism and extroversion scores are more likely than others to be exposed to traumatic events and are thus at greater risk for PTSD.

Adult↗
PubMed2002

Gender differences in the prevalence of somatic versus pure depression: a replication.

OBJECTIVE: Using data from the Epidemiologic Catchment Area (ECA) study, the author attempted to replicate the finding of the National Comorbidity Survey that the prevalence of depression associated with somatic symptoms was much higher among women than men. METHOD: The author reanalyzed data from the ECA study. He divided respondents into those who met criteria for major depression and exhibited appetite and sleep disturbances and fatigue (somatic depression) and those who met depression criteria but did not exhibit all of these somatic criteria (pure depression). RESULTS: The reanalysis revealed that the prevalence of somatic depression but not pure depression was much higher among women than men. Somatic depression was associated with high rates of pain; among women, it was associated with high rates of anxiety disorders and chronic dysphoria. CONCLUSIONS: The gender difference in depression may result from a difference in a specific type of depression-anxious somatic depression.

Adult↗
PubMed2003

Peripubertal suicide attempts in offspring of suicide attempters with siblings concordant for suicidal behavior.

OBJECTIVE: The authors sought to determine 1) whether the risk for familial transmission of suicidal behavior is greater with increased family loading for suicide attempts, and 2) whether the transmission of suicidal behavior is mediated by impulsive aggression. METHOD: A reanalysis of a high-risk study compared the offspring of three mood disorder proband groups: suicide attempters with a sibling who also attempted suicide (N=19), suicide attempters whose siblings never made a suicide attempt (N=73), and nonsuicidal probands whose siblings also never engaged in suicidal behavior (N=73). Probands and offspring were assessed with respect to psychopathology, suicide attempt history, impulsive aggression, and exposure to familial adversity. RESULTS: Offspring of suicide attempters with siblings concordant for suicidal behavior showed a higher risk of suicide attempt than did offspring of nonsuicidal probands and had an earlier age at onset of suicidal behavior than offspring of suicide attempters with siblings discordant for suicidal behavior. Probands from sibling pairs concordant for suicidal behavior and their offspring reported greater lifetime impulsive aggression compared with each of the other two proband/offspring groups. In the offspring, impulsive aggression was the most powerful predictor of early age at first suicide attempt. CONCLUSIONS: Familial loading for suicide attempts may affect rates of transmission as well as age at onset of suicidal behavior, and its effect may be mediated by the familial transmission of impulsive aggression.

Adolescent↗
PubMed1986

Chronic mental patients in nursing homes: reexamining data from the National Nursing Home Survey.

A reanalysis of data from the 1977 National Nursing Home Survey, including data not available earlier, led to an estimate that 668,000 chronic mentally ill patients reside in nursing homes. Several subpopulations of nursing home residents were also identified and compared, which showed, for instance, that residents with only mental disorders were younger, were less likely to need the help of another person in daily activities, and were much less likely to be totally dependent than residents with only physical disorders. However, not surprisingly, mentally ill residents were more likely to have behavior problems and to have much longer stays. Residents diagnosed as senile, with or without a physical disorder, more closely resembled the purely physically ill than the purely mentally ill patients. The data illustrate the wide range of needs of mentally ill nursing home residents and reinforce the importance of assessing and improving the appropriateness of care offered.

Adaptation, Psychological↗
PubMed1993

Clinical significance of inpatient family intervention: conclusions from a clinical trial.

OBJECTIVE: To test whether the statistically significant results of a randomized clinical trial of an inpatient family intervention were clinically significant for hospital practice, the authors reanalyzed outcome data using a measure of clinical significance based on the extent to which patients had recovered during the course of the intervention. METHODS: A total of 169 hospitalized subjects and their families were randomly assigned to a psychoeducational inpatient family intervention or to a comparison group. Patient and family outcome measures were assessed at admission, discharge, and six and 18 months after admission. Analyses of statistically significant differences in outcome suggested that inpatient family intervention was effective for certain patient subgroups identified by gender and diagnosis. Global Assessment Scale scores two or more standard deviations above the pretreatment (admission) mean were used as indicators for clinically significant improvement. RESULTS: The reanalysis confirmed that inpatient family intervention was associated with clinically significant improvement at discharge, especially for female patients and patients with chronic schizophrenia and bipolar disorder. These effects were maintained six months after admission before attenuating at 18 months. CONCLUSIONS: Inpatient family intervention results in clinically meaningful outcomes for certain subgroups of patients and their families.

Adult↗
PubMed1991

Qualitative descriptions of error recovery patterns across reading level and sentence type: an eye movement analysis.

Purposes of the present study included describing a variety of error recovery patterns based on eye movement (EM) measures of sentence parsing across reading level and error type. A qualitative pattern analysis of EM mappings was completed for students with reading disabilities (n = 10) and nondisabled students (n = 10) who were parsing control and erred sentences. Independent variables included error type (syntactically ambiguous, semantically anomalous, and control sentences) and reading proficiency level. Dependent variables consisted of seven eye movement measures. Chi-square analyses were performed to examine group differences across frequencies per pattern. Results suggest that the error recovery strategies deployed by both groups were similar in pattern and frequency; patterns were largely organized, strategic, and efficient, as predicted. Evidence for seven newly defined strategies was found, with indications of multiple strategies within sentences by both groups. Strategies tended to be error "reanalysis" (vs. "recovery") heuristics, in that readers from both groups used regressions to reanalyze regions of inconsistency rather than regions of disambiguation. Earlier conclusions regarding disorganized processing and individual differences among adolescents with reading disabilities are discussed.

Attention↗
PubMed1993

Psychoeducational characteristics of children and adolescents with insulin-dependent diabetes mellitus.

In recent years, researchers have observed selective neuropsychological impairment associated with insulin-dependent diabetes mellitus in childhood. At increased risk are children who develop diabetes before the age of 5, who experience severe hypo- and hyperglycemia, or who have frequent episodes of mild to moderate hypoglycemia. This article explores the existing literature to establish frequency and consistency of general and specific neurocognitive deficits in this pediatric patient population, as well as the impact of these deficits on school achievement and learning disabilities. Studies are integrated to identify contributing diabetes and nondiabetes factors. This is followed by a reanalysis of the data from two studies of diabetic children to determine the learning disability characteristics of this population and the factors contributing to dysfunctional school performance. Findings are discussed in terms of the impact of different factors reflecting adequacy of diabetes control on specific psychoeducational abilities.

Adolescent↗
PubMed1994

Are a blood alcohol concentration of 256mg/dl and minimal signs of impairment reliable indications of alcohol dependence?

This article describes a drunk-driving scenario where a woman was apprehended for driving under the influence (DUI) with a blood alcohol concentration (BAC) of 256mg/dl. The correctness of this result was vigorously challenged by a medical expert witness for the defence, who was actually a specialist in alcohol diseases. Despite reanalysis to confirm the BAC as well as a DNA profile to prove the identity of the blood specimen, the woman was acquitted of the charge of drunk driving by the lower court. However, she was subsequently found guilty in the High Court of Appeals with a unanimous decision and sentenced to four weeks imprisonment. This case report illustrates some of the problems surrounding the use of expert medical evidence by the defence to challenge the validity of the prosecution evidence based solely on a suspect's BAC. In situations such as these, an expert witness should be called by the prosecution to clarify and, if necessary, rebut medical and/or scientific opinions that might mislead the court and influence the outcome of the trial.

Adult↗
PubMed1987

The importance of considering alternative structural equation models in evaluation research.

The availability of the LISREL computer program and similar software (for example, COSAN, EQS) have made structural equation modeling accessible to researchers interested in program evaluation. An article was published in the December 1985 issue of this journal that used LISREL to investigate the relationship between family medicine residents' moral reasoning and their clinical performance with patients (Sheehan et al., 1985). We present a reanalysis of the data from that study to illustrate the importance of considering alternative structural equation models in evaluation research.

Ethics, Medical↗
PubMed1998

An illustration of item homogeneity scaling and multilevel analysis techniques in the evaluation of drug prevention programs.

Many reports of successful school-based intervention programs can be criticized for their choice of a unit of analysis and for the neglect of measurement errors. This article is an illustration of how different conclusions can be reached from different choices of units of analyses and/or of different treatment of the data. This is done by a reanalysis of a well-reported data set. The data is thoroughly taken apart, using different statistical techniques. The result of the analyses shows that earlier reported effects of a normative school-based drug prevention program were not found. The subsequent search for moderator effects of the same program, such as a lowering effect on the relationship between the pre- and posttest or on the relationship between respondents' use and the use of their friends, was not successful either. It is concluded that the null hypothesis of zero effects should be retained. More successful was a search for individual characteristics that show significant relationships with respondents' alcohol use. Among them was the abuse of alcohol by adults in respondents' direct social environment and the use of friends.

Adolescent↗
PubMed1993

Obtaining and evaluating data sets for secondary analysis in nursing research.

Secondary analysis of existing data offers many advantages to the nurse researcher. Data from large-scale studies may be reanalyzed and refined by secondary analysts with a fresh perspective, thus enhancing the original study's contribution to scientific knowledge. High-quality data can be obtained for comparatively little expenditure of time and money. The secondary analyst, however, must exercise care in evaluating and analyzing a data set to maximize the internal and external validity of the reanalysis. Because the secondary analyst's lack of involvement in data collection procedures may decrease insight into the original study's limitations, vigilant skepticism should accompany all phases of the research process in secondary data analysis, just as it should in all other research. Miller (1982) advised, "Begin by assuming the worst and seek out the same kinds of information about sample selection procedures, sample size, response rates, field procedures, and coding conventions that you would insist on if you were collecting your own data" (p. 722). By systematically evaluating potential data sets according to rigorous predetermined criteria, the nurse researcher can minimize the possible pitfalls inherent in secondary analysis. On the other hand, investigators who use secondary sources appropriately can make significant contributions to nursing science at less cost than that engendered by traditional research methods.

Data Collection↗
PubMedDate not supplied

Preference-based antithrombotic therapy in atrial fibrillation: implications for clinical decision making.

BACKGROUND: Patient preferences and expert-generated clinical practice guidelines regarding treatment decisions may not be identical. The authors compared the thresholds for antithrombotic treatment from studies that determined or modeled the treatment preferences of patients with atrial fibrillation with recommendations from clinical practice guidelines. METHODS: Methods included MEDLINE identification, systematic review, and pooling with some reanalysis of primary data from relevant studies. RESULTS: Eight pertinent studies, including 890 patients, were identified. These studies used 3 methods (decision analysis, probability tradeoff, and decision aids) to determine or model patient preferences. All methods highlighted that the threshold above which warfarin was preferred over aspirin was highly variable. In 6 of 8 studies, patient preferences indicated that fewer patients would take warfarin compared to the recommendations of the guidelines. In general, at a stroke rate of 1% with aspirin, half of the participants would prefer warfarin, and at a rate of 2% with aspirin, two thirds would prefer warfarin. In 3 studies, warfarin must provide at least a 0.9% to 3.0% per year absolute reduction in stroke risk for patients to be willing to take it, corresponding to a stroke rate of 2% to 6% on aspirin. CONCLUSIONS: For patients with atrial fibrillation, treatment recommendations from clinical practice guidelines often differ from patient preferences, with substantial heterogeneity in their individual preferences. Since patient preferences can have a substantial impact on the clinical decision-making process, acknowledgment of their importance should be incorporated into clinical practice guidelines. Practicing physicians need to balance the patient preferences with the treatment recommendations from clinical practice guidelines.

Aged↗
PubMed1981

Physician and medical student bias in evaluating diagnostic information.

Four possible froms of bias in the evaluation of diagnostic information are evaluated. Reanalysis of a previously published experiment, in which radiologists evaluated excretory urograms, shows that the radiologists' assessment of the likelihood of a tumor being present was inappropriately influenced by the importance of ruling the tumor out. A new experiment is described in which fourth-year medical students and practicing pediatricians completed workups of hypothetical patients. In this study, both students and physicians subjectively distorted information in the latter part of the workup to support opinion formed up to that point. Also in evaluating diagnoses, students to a large degree and physicians to a lesser degree tended to ignore rates of disease prevalence. A fourth possible bias, that early, unreliable historical information dominates later, more reliable laboratory data, was not confirmed. Suggestions for overcoming the demonstrated biases, as well as other cognitive biases in the processing of diagnostic information, are made.

Central Nervous System Diseases↗
PubMed1985

Radionuclide detection of biliary atresia. Illustration of a structural method to guide test evaluation.

This paper illustrates the conceptual framework for test evaluation developed in the preceding paper. Reanalysis of published data, guided by this framework, contradicts preliminary conclusions about the limited statistical discrimination of a radionuclide scan to discriminate neonatal hepatitis from biliary atresia. It also clarifies the need in future evaluations to consider a number of factors not mentioned in many previous studies.

Biliary Atresia↗
PubMedDate not supplied

The high cost and low efficacy of weekly viral cultures for pregnant women with recurrent genital herpes: a reappraisal.

The use of weekly cultures to prevent neonatal infection among infants of pregnant women who have histories of genital herpes has been controversial since a decision analysis study in 1983 suggested that this strategy was not cost-effective and would avert relatively few cases of neonatal herpes simplex virus infection. Using more recent and better data, the authors reanalyzed this approach to reducing neonatal herpes infection. The reanalysis revealed that a national screening program would prevent only 1.8 cases of neonatal herpes in the United States annually, at a cost of more than 37 million dollars per case averted. The program would cost nearly 7 million dollars per quality-adjusted life year gained when only infant deaths are taken into consideration. When maternal deaths from excess cesarean deliveries are taken into account, over 44 million dollars would be spent for every quality-adjusted life-year gained. On the basis of the strategy's limited benefits and low cost-effectiveness, the authors support the American College of Obstetrics and Gynecology's position of abandoning the recommendation for weekly prenatal herpes cultures.

Cesarean Section↗
PubMed1993

Toward a definition of a successful dieter.

The purpose of the research was to examine the characteristics of successful weight losers and to compare the findings with a control group of unsuccessful weight losers. The project was designed around a definition of successful dieters, based on the Metropolitan Life Insurance weight tables. The definition, in fact, was not particularly useful. This article describes the difficulties associated with using the original definition as the inclusion criteria for sample selection, the reanalysis of data using the Body Mass Index (BMI), and finally, the creation of a new definition developed from the construction of weight history based on changes in the BMI as an adult. This article presents the final outcome of what a definition of a successful dieter should consist in future research.

Adult↗