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Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. ARCHIVES OF GENERAL PSYCHIATRY 1995; 52:1048-60. [PMID: 7492257 DOI: 10.1001/archpsyc.1995.03950240066012] [Citation(s) in RCA: 5671] [Impact Index Per Article: 195.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated life-time prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode. METHODS Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey. RESULTS The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years. CONCLUSIONS Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumas.
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Bliwise DL, Hughes M, McMahon PM, Kutner N. Observed sleep/wakefulness and severity of dementia in an Alzheimer's disease special care unit. J Gerontol A Biol Sci Med Sci 1995; 50:M303-6. [PMID: 7583801 DOI: 10.1093/gerona/50a.6.m303] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND This study tested the hypothesis that behaviorally defined sleep disturbance among residents in a Special Care Unit (SCU) for Alzheimer's disease (AD) was related to the severity of their dementia. Previously, sleep laboratory studies have reported such relationships when sleep has been recorded polysomnographically over several nights. Observational studies of sleep have not shown such relationships, presumably because of the impression involved in determining sleep/wake state behaviorally. METHODS Nightly sleep data based on observations made every two hours by nursing staff for a period of 13 to 18 months were examined for 47 AD residents with a mean age of 80.7 +/- 6.5 years. Level of dementia and functional capacity were assessed with the Mattis Dementia Rating Scale (DRS) and the Katz Activities of Daily Living Scale (ADL). RESULTS Data indicated that these SCU residents experienced a moderately disturbed night of sleep an average of 24% +/- 10% of their nights in the facility and a severely disturbed night of sleep on 7% +/- 6% of those nights. More profound dementia was associated with more sleep disturbance; however, incapacity in ADLs, age, gender, and psychoactive medications were unrelated to such disturbances. CONCLUSIONS The results indicate that patterns of relationships noted between laboratory-based measures of sleep and variables such as severity of dementia can be detected using behavioral observations of sleep, provided that the number of nights of observation are sufficiently large to offset the measurement error involved in their use.
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Palombo F, Gallinari P, Iaccarino I, Lettieri T, Hughes M, D'Arrigo A, Truong O, Hsuan JJ, Jiricny J. GTBP, a 160-kilodalton protein essential for mismatch-binding activity in human cells. Science 1995; 268:1912-4. [PMID: 7604265 DOI: 10.1126/science.7604265] [Citation(s) in RCA: 403] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
DNA mismatch recognition and binding in human cells has been thought to be mediated by the hMSH2 protein. Here it is shown that the mismatch-binding factor consists of two distinct proteins, the 100-kilodalton hMSH2 and a 160-kilodalton polypeptide, GTBP (for G/T binding protein). Sequence analysis identified GTBP as a new member of the MutS homolog family. Both proteins are required for mismatch-specific binding, a result consistent with the finding that tumor-derived cell lines devoid of either protein are also devoid of mismatch-binding activity.
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Bliwise DL, Watts RL, Watts N, Rye DB, Irbe D, Hughes M. Disruptive nocturnal behavior in Parkinson's disease and Alzheimer's disease. J Geriatr Psychiatry Neurol 1995; 8:107-10. [PMID: 7794473 DOI: 10.1177/089198879500800206] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Disruptive nocturnal behavior, often referred to as sundowning, is a commonly encountered clinical problem in most forms of dementia. This study compared disruptive nocturnal behavior in patients with Alzheimer's disease (AD) and Parkinson's disease (PD). Questionnaire data were collected from 60 AD and 48 PD caregivers. Respondents were asked to record the typical time of day when any of seven disruptive behaviors were evidenced in their patients, if at all. Two scores were computed: (1) a sundowning score (number of nocturnal disruptive behaviors, range 0-7), and (2) a total score (number of disruptive behaviors without regard to time, range 0-7). Results indicated PD patients were more likely than AD patients to exhibit disruptive nocturnal behavior. The dose, timing, or number of years on antiparkinsonian medication were not related to nocturnal disruptive behavior within the PD patient group. These findings raise the possibility that sundowning in PD patients may be a manifestation of dopaminergic depletion within the basal ganglia or other abnormalities involving the cholinergic, serotoninergic and/or noradrenergic systems in the brainstem.
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Greenberg AS, Avila D, Hughes M, Hughes A, McKinney EC, Flajnik MF. A new antigen receptor gene family that undergoes rearrangement and extensive somatic diversification in sharks. Nature 1995; 374:168-73. [PMID: 7877689 DOI: 10.1038/374168a0] [Citation(s) in RCA: 516] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Immunoglobulin and T-cell receptor (TCR) molecules are central to the adaptive immune system. Sequence conservation, similarities in domain structure, and usage of similar recombination signal sequences and recombination machinery indicate that there was probably a time during evolution when an ancestral receptor diverged to the modern-day immunoglobulin and TCR. Other molecules that undergo rearrangement have not been described in vertebrates, nor have intermediates been identified that have features of both these gene families. We report here the isolation of a new member of the immunoglobulin superfamily from the nurse shark, Ginglymostoma cirratum, which contains one variable and five constant domains and is found as a dimer in serum.
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Warner LA, Kessler RC, Hughes M, Anthony JC, Nelson CB. Prevalence and correlates of drug use and dependence in the United States. Results from the National Comorbidity Survey. ARCHIVES OF GENERAL PSYCHIATRY 1995; 52:219-29. [PMID: 7872850 DOI: 10.1001/archpsyc.1995.03950150051010] [Citation(s) in RCA: 257] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To analyze nationally representative data on the lifetime and 12-month prevalences of use of and dependence on illegal drugs (marijuana/hashish, cocaine/crack, heroin, hallucinogens), nonmedical prescription psychotropic drugs (sedatives, tranquilizers, stimulants, analgesics), and inhalants; and to examine data on the sociodemographic correlates of use and dependence. METHODS The data come from the National Comorbidity Survey, a structured diagnostic interview administered to persons aged 15 to 54 years that generates reliable diagnoses according to the definitions and criteria of DSM-III-R. RESULTS Of the respondents, 51.0% used one of the above drugs at some time in their lives, and 15.4% did so in the past 12 months. These estimates are similar to those obtained in the 1991 National Household Survey of Drug Abuse, where lifetime prevalence was 45.2% and 12-month prevalence was 16.7% among respondents in the age range 15 to 54 years. Of National Comorbidity Survey respondents, 7.5% (14.7% of lifetime users) were dependent at some time in their lives and 1.8% were dependent in the past 12 months. The prevalence estimate for lifetime dependence was reduced to 5.3% when calculated the percentage of respondents in the age range of 28 to 54 years who reported an onset of dependence as of 10 years earlier (ie, when they were 18 to 44 years old) was computed. This is similar to the Epidemiologic Catchment Area Study estimate of 5.1% among respondents in the age range 18 to 44 years, a comparison that matches the two studies on year of assessment, age of risk, and cohort. Males were significantly more likely to report both lifetime and 12-month use and dependence. Use and dependence were found to be more common in cohorts born after World War II than those born before the end of the war. The demographic predictors of lifetime use differed from the predictors of lifetime dependence among users, and these, in turn, differed from the predictors of recent dependence among people with a lifetime history of dependence. CONCLUSIONS Drug use and dependence are highly prevalent in the general population. The fact that there are differences in the correlates of first use, dependence among users, and persistence of dependence means that future research aimed at pinpointing modifiable risk factors must be based on disaggregated analyses of separate stages of progression.
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Davis RL, Hughes M, Gubler KD, Waller PL, Rivara FP. The use of cranial CT scans in the triage of pediatric patients with mild head injury. Pediatrics 1995; 95:345-9. [PMID: 7862471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Recent evidence suggests that patients with a normal cranial CT scan after head injury can be safely discharged home from the emergency department. However, supporting data from previous studies has relied on incomplete patient follow-up. We utilized a statewide comprehensive hospital abstract reporting system (CHARS) to assess whether children with normal CT scans after head injury subsequently developed intracranial sequelae in the month following their initial injury. DESIGN Retrospective case-series study, with comprehensive statewide follow-up for 1 month. SETTING The emergency department of a Level 1 Trauma Center in Seattle, Washington. PARTICIPANTS All children (n = 400) with head injury, Glasgow Coma Score of 13 to 15, and initial normal CT scan seen over a 4.5-year time period. All were matched against CHARS to evaluate admissions within 30 days after emergency department disposition. For readmissions, International Classification of Diseases (9th revision) discharge and procedure information was collected. All children were also matched against the state death files. RESULTS Four children were readmitted for neurologic reasons within 1 month following injury. One child on coumadin for heart disease developed a symptomatic subdural hematoma 5 days after head injury, requiring neurosurgical drainage. One child developed a symptomatic hemorrhagic contusion 3 days after injury, requiring observation only. Two children were readmitted 1 day after injury for concussive symptoms; both were discharged home after observation only. There were no deaths among the study population. CONCLUSIONS Among children with a normal cranial CT scan after mild head injury, delayed intracranial sequelae requiring intervention are extremely uncommon. In otherwise stable patients, a normal cranial CT scan can identify patients to be safely discharged from the emergency department, and would be more cost-effective than 1 to 2 days of hospital observation.
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Hughes M, McCollum J, Sheftel D, Sanchez G. How parents cope with the experience of neonatal intensive care. CHILDRENS HEALTH CARE 1994; 23:1-14. [PMID: 10132662 DOI: 10.1207/s15326888chc2301_1] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Thirty-two mothers and 25 fathers described their coping efforts during the initial weeks of their preterm infants' hospitalization in a neonatal intensive care unit. Utilizing procedures developed by Lazarus and Folkman (1984) in which coping is linked with a specific stressful event, parents reported what they did to cope with the stressor they perceived to be the most stressful. They also completed the Ways of Coping Questionnaire (Folkman & Lazarus, 1988). Results showed that there were similarities and differences in the types of coping strategies used by mothers and fathers. In addition, factors such as neonatal morbidity and appraisal of control were differentially associated with the use of certain types of coping strategies. Implications for future research and clinical practice are discussed.
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Hughes M, Vassilakos A, Andrews DW, Hortelano G, Belmont JW, Chang PL. Delivery of a secretable adenosine deaminase through microcapsules--a novel approach to somatic gene therapy. Hum Gene Ther 1994; 5:1445-55. [PMID: 7711137 DOI: 10.1089/hum.1994.5.12-1445] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Many current gene therapy protocols require genetic modification of autologous cells. An alternate approach is to use universal recombinant cell lines engineered to secrete in vivo the desired gene products. Enclosing these cells within immunoprotective devices before implantation would prevent rejection of the nonautologous donor cells. To overcome the limitation that not all therapeutic gene products are secreted, we now propose to fuse a signal sequence to the amino terminus of a nonsecreted protein such as human adenosine deaminase (ADA), thus directing the product into a secretory pathway for release from the cells. A fusion gene constructed between the cDNA of the beta-lactamase signal sequence and human ADA expressed a product after in vitro transcription and translation that was immunologically similar to the human protein. Mouse fibroblasts transfected with the fusion gene demonstrated secreted ADA activity that resembled the human cytosolic enzyme in its heat stability, pH optimum, KM, electrophoretic mobility, and immunologic reactivity. Hence, the secreted enzyme expressed from the fusion gene is antigenically and enzymatically similar to the authentic human form. When transfected mouse fibroblasts or myoblasts were enclosed in permselective alginate-poly-L-lysine alginate microcapsules, ADA activity was secreted from the microcapsules and the cells remained viable for over 5 months. Hence, a secretable and functional human ADA has been constructed that can be delivered from recombinant cells within immunoprotective capsules. The success of this strategy provides the prototype for engineering nonsecreted gene products for therapy via this novel method of somatic gene therapy.
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Hughes M. Cholesterol and violent death. Diets, violence, and civilization. BMJ (CLINICAL RESEARCH ED.) 1994; 309:1228. [PMID: 7987160 PMCID: PMC2541683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Hatton J, Hughes M, Raymond CH. Management of bacterial urinary tract infections in adults. Ann Pharmacother 1994; 28:1264-72. [PMID: 7849342 DOI: 10.1177/106002809402801110] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE To provide a comprehensive review of the diagnosis and therapeutic management considerations in patients with urinary tract infections (UTIs). DATA SOURCES A MEDLINE search was used to identify pertinent English language literature, including reviews. Infectious disease textbooks were used for background information. STUDY SELECTION Clinical trials evaluating drug therapy in a variety of patient populations with UTIs were reviewed. DATA EXTRACTION Background information was obtained from comprehensive reviews. Drug dosing strategies and efficacy comparisons were extracted from the investigations in this area. DATA SYNTHESIS Information was processed to provide general guidelines and resources for practitioners to use in managing UTIs. CONCLUSIONS There are a number of useful antibiotics for the management of UTIs. The distinctions between infection severity and underlying risk factors within a given population influence the appropriateness of drug selection and duration of treatment.
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Gatrad AR, Birch N, Hughes M. Preschool weights and heights of Europeans and five subgroups of Asians in Britain. Arch Dis Child 1994; 71:207-10. [PMID: 7979492 PMCID: PMC1029972 DOI: 10.1136/adc.71.3.207] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Heights and weights of five subgroups of Asian (545) and European children (685) were recorded after birth, at 1 year, 2 years, and at 5 years. Asian children were divided into Muslim Gujarati, Muslim Pakistani, Muslim Bangladeshi, Hindu, and Sikh. Although the Europeans were significantly the heaviest at birth (3.42 kg boys and 3.26 kg girls) when compared with any of the other groups, it was the Sikhs who had the best weight gain. They were also the heaviest at 5 years when compared with other groups, including the Europeans (20.13 kg and 19.22 kg for Sikh boys and girls respectively compared with 18.83 kg and 18.42 kg for European boys and girls respectively). Hindus had the lightest birth weight. Their weight at 5 years (17.41 kg boys and 16.93 kg girls) and that of the Muslim Gujaratis (17.27 kg boys and 17.20 kg girls) was comparable and was lowest, whereas that of the Bangladeshis at this age was the greatest among the Muslims (18.56 kg for boys and 17.87 kg for girls). Sikh boys and girls were found to be the tallest of all the groups, including the Europeans, at all periods of measurements--including at 5 years when the Sikh boys and girls were 3 cm and 1.5 cm taller than the European boys and girls. Hindus were the shortest of all the groups throughout the period of study.
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O’Callaghan D, Horgan JH, Kellett J, Graham J, Deb B, Caldwell MTP, O'Callaghan P, Byrne PJ, Hennessy TPJ, Crean P, Walsh M, Gearty G, Boyle DM, Higginson JDS, Salathia K, Chandler R, Shah P, Lavin F, Daly K, Steele IC, Nugent AM, Vallely SR, Campbell NPS, Nicholls DP, Coghlan JG, Flitter WD, Daly R, Wright GD, Ilsley CD, Slate T, Foley DP, Melkert R, Keane D, Serruys PW, Foley JB, Sridhar K, Brown RIG, Penn IM, Umans VA, de Jaegere P, Galvin J, Codd M, Hennessy A, Leavey S, Keelan E, McCarthy C, Sugrue D, Craig BG, Mulholland HC, Kearney P, Erbel R, Koch L, Ge J, Görge G, Meyer J, Anderson D, Marrinan M, Sulke N, Cooke R, Jackson G, Sowton E, McEneaney DJ, Anderson J, Adgey AAJ, Marks P, Walsh TN, Leavey, Crowley JJ, Kenny A, Dardas P, Shapiro LM, Delanty N, Moran N, Catella F, FitzGerald GA, Fitzgerald DJ, Umans V, Moore D, Weston A, Hughes M, Maurer B, Cleland J, McGee HM, Graham I, Cullen C, Dempsey G, Wright G, Martin L, MacKenzie G, Adgey J, Lawson JA, Herity NA, Allen JD, Silke B, Northridge DB, Jackson NC, Metcalfe MJ, Dargie HJ, Gates ARC, Huang CLH, Gresham A, Carpenter TA, Hall LD, Johnston PW, Jossinet J, Imam Z, Sheahan R, Newman D, Dorian P, Meleady R, Tan KS, O’Brien C, Graham IH, Maderna P, Fitzgerald D, O'Callaghan DM, Rafferty SM, Canton MC, Connolly BF, Buchalter MB, Shandall A, Rees A, Rajan L, Sheehan R, Ghaisas N, Geraty G. Irish Cardiac Society. Ir J Med Sci 1994. [DOI: 10.1007/bf02942835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ray SG, Connelly DT, Hughes M, Bellamy CM, Charles RG. Stability of the DDD pacing mode in patients 80 years of age and older. Pacing Clin Electrophysiol 1994; 17:1218-21. [PMID: 7937227 DOI: 10.1111/j.1540-8159.1994.tb01488.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We reviewed the records of 119 consecutive patients aged 80 years or older (mean age 84 +/- 3.7 years) in whom a dual chamber pacemaker was implanted between 1984 and 1991. Follow-up data was available up to February 1993. Immediate postimplantation complications were rare. Nine patients were lost to follow-up, all within 6 months of implantation. An additional seven patients died within 6 months of implantation. Long-term follow up for at least 6 months from implantation was available for 103 of the 119 patients (87%). Of these 89 (86%) remained in functioning DDD mode for a mean of 22 +/- 15 months from implantation. Nine patients were reprogrammed to VVI mode, six due to atrial fibrillation and three due to failure of atrial sensing or pacing. One patient was programmed DVI for failure of atrial sensing; 94 of 112 patients (84%) whose status was definitely known in February 1993 remained in functioning DDD mode until death or last follow-up. Cumulative survival in DDD mode was 78% at 30 months. We conclude that DDD pacing is stable in the great majority of patients in their ninth and tenth decades who present with rhythms amenable to dual chamber pacing and who have no history of sustained atrial fibrillation.
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Verlinsky Y, Handyside A, Grifo J, Munné S, Cohen J, Liebers I, Levinson G, Arnheim N, Hughes M, Delhanty J. Preimplantation diagnosis of genetic and chromosomal disorders. J Assist Reprod Genet 1994; 11:236-43. [PMID: 7711387 DOI: 10.1007/bf02214343] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Hughes M, Franks IM. Dynamic patterns of movement of squash players of different standards in winning and losing rallies. ERGONOMICS 1994; 37:23-29. [PMID: 8112279 DOI: 10.1080/00140139408963619] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The aim of this work was to analyse and compare the dynamic motions of squash players of varying technical abilities, and link these to the tactics that the different standard players adopt. A computerized tracking system utilized mixed images on the VDU of both the tracking surface, and the subject during competitive matchplay. Four groups of squash players were categorized Elite (international); Provincial (provincial representatives); Club A/B (players at either the A or B level in the inter-club leagues in British Columbia); and Club C/D (players at the C or D level in the inter-club leagues in British Columbia). Six competitive matches of different players were analysed for each group. Each game in each match was analysed separately and means-per-rally calculated for: positional data, X and Y; lateral and longitudinal velocities, Vx and Vy; average velocities, V; distances travelled, D; and accelerations, A. The longitudinal position in the winning rallies for all groups was closer to the front wall than that in the losing rallies (p < 0.10), supporting previous research and demonstrating the operational validity of this methodology. The Elite and Provincial groups had significant differences in all the velocities and the accelerations between the winning rallies and losing rallies (p < 0.10), confirming the hypothesis that their tactic was to attempt to reduce their opponents' playing time by taking the ball as early as possible and use all of the court.(ABSTRACT TRUNCATED AT 250 WORDS)
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Kessler RC, McGonagle KA, Nelson CB, Hughes M, Swartz M, Blazer DG. Sex and depression in the National Comorbidity Survey. II: Cohort effects. J Affect Disord 1994; 30:15-26. [PMID: 8151045 DOI: 10.1016/0165-0327(94)90147-3] [Citation(s) in RCA: 264] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Data from a nationally representative sample of the general population are used to study cohort differences in the prevalence of DSM-III-R Major Depressive Episode (MDE). We document increasing lifetime prevalence of MDE among both men and women in more recent cohorts, but no major change in the sex ratio over the 40-year period retrospectively covered in the survey. We find a cohort difference in 12-month MDE, with older women much more likely than older men to have recurrent episodes. This sex difference in recurrence plays an important part in the elevated 12-month prevalence of depression among women compared to men in the 45-54 age range.
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Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU, Kendler KS. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. ARCHIVES OF GENERAL PSYCHIATRY 1994; 51:8-19. [PMID: 8279933 DOI: 10.1001/archpsyc.1994.03950010008002] [Citation(s) in RCA: 7135] [Impact Index Per Article: 237.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND This study presents estimates of lifetime and 12-month prevalence of 14 DSM-III-R psychiatric disorders from the National Comorbidity Survey, the first survey to administer a structured psychiatric interview to a national probability sample in the United States. METHODS The DSM-III-R psychiatric disorders among persons aged 15 to 54 years in the noninstitutionalized civilian population of the United States were assessed with data collected by lay interviewers using a revised version of the Composite International Diagnostic Interview. RESULTS Nearly 50% of respondents reported at least one lifetime disorder, and close to 30% reported at least one 12-month disorder. The most common disorders were major depressive episode, alcohol dependence, social phobia, and simple phobia. More than half of all lifetime disorders occurred in the 14% of the population who had a history of three or more comorbid disorders. These highly comorbid people also included the vast majority of people with severe disorders. Less than 40% of those with a lifetime disorder had ever received professional treatment, and less than 20% of those with a recent disorder had been in treatment during the past 12 months. Consistent with previous risk factor research, it was found that women had elevated rates of affective disorders and anxiety disorders, that men had elevated rates of substance use disorders and antisocial personality disorder, and that most disorders declined with age and with higher socioeconomic status. CONCLUSIONS The prevalence of psychiatric disorders is greater than previously thought to be the case. Furthermore, this morbidity is more highly concentrated than previously recognized in roughly one sixth of the population who have a history of three or more comorbid disorders. This suggests that the causes and consequences of high comorbidity should be the focus of research attention. The majority of people with psychiatric disorders fail to obtain professional treatment. Even among people with a lifetime history of three or more comorbid disorders, the proportion who ever obtain specialty sector mental health treatment is less than 50%. These results argue for the importance of more outreach and more research on barriers to professional help-seeking.
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Duncan PW, Chandler J, Studenski S, Hughes M, Prescott B. How do physiological components of balance affect mobility in elderly men? Arch Phys Med Rehabil 1993; 74:1343-9. [PMID: 8259903 DOI: 10.1016/0003-9993(93)90090-w] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The purpose of this study was to assess the relationship between physiological components of balance and mobility in elderly men without significant disease. Our a priori hypothesis was that physical function is influenced more by accumulated modest impairments than by a single deficit. We examined 39 ambulatory men (> 69 years). Subjects were classified functionally as high, intermediate, or low. Assessment included mobility functions (6-minute walk, mobility skills, reach, 10ft walk time) and physiological components of balance: sensory (vibration, proprioception, vision, vestibular), effector (ankle, knee, hip strength, range of motion), and central processing (response time to perturbations). All mobility functions were significantly (p < .05) different between groups. Impairments in components of postural control were rarely different between groups: the major differences were in ankle strength and visual fields. The number of impaired domains differed across the three groups. Nineteen percent of the low group had at least three domains impaired; none of the intermediate or high groups were impaired in three domains. Fifty-six percent of the low, 20% of the intermediate, and 7% of the high were impaired in two or more domains. Variability in specific mobility measures was also predicted by the number of impaired domains. The decline in physical function may be better explained by the accumulation of deficits across multiple domains than by any single specific impairment.
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Jain P, Hughes M, Korlipara G, Lillis O, Dervan JP, Cohn PF. The effects of chronic oral milrinone therapy on early postinfarction left ventricular remodeling. Am Heart J 1993; 126:543-51. [PMID: 8362707 DOI: 10.1016/0002-8703(93)90402-u] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Left ventricular remodeling following acute transmural myocardial infarction may result in early left ventricular enlargement. To characterize the effects of milrinone on components of early left ventricular dilation, rats (n = 120) underwent left coronary artery ligation or sham surgery. In the immediate postoperative period, rats received either no treatment or milrinone (3.17 +/- 0.08 mg/kg/day) dissolved in drinking water for 20 days. Twenty-one days after the initial surgery, hemodynamic measurements were made. The rats were then put to death and the hearts arrested in diastole were excised and fixed at a constant pressure for morphometric analysis. To examine the effects of milrinone on the relative contribution of infarcted and noninfarcted segments to early left ventricular dilation after acute myocardial infarction, a subgroup of infarcted rats chosen randomly was put to death 3 days after the initial surgery for morphometric analysis. Compared with infarcted untreated rats, infarcted milrinone-treated rats had a lower left ventricular volume (1.41 +/- 0.07 ml/kg vs 2.16 +/- 0.19 ml/kg, p < 0.001), lower left ventricular wall stress (0.64 +/- 0.03 vs 0.91 +/- 0.06, p < 0.001), and a lower expansion index (1.61 +/- 0.12 vs 2.61 +/- 0.22, p < 0.001). Morphometric analysis revealed that the noninfarcted segment length did not differ between the two infarcted groups either 3 days or 21 days after left coronary artery ligation. Infarct segment length also did not differ between the two infarcted groups at 3 days, but at 21 days infarct segment was shorter in the milrinone-treated group compared with the untreated group (p < 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)
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Abrew KM, Hughes M. Dermoid cyst of the caecum. CEYLON MEDICAL JOURNAL 1993; 38:92-3. [PMID: 8370097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Dermoid cysts of the caecum are rare and only four cases have been reported in the literature. They are sequestration cysts and are lined by squamous epithelium with skin appendages. Aetiologically these cysts may represent squamous metaplasia of enterogenous cysts or sequestration cysts due to epidermal inclusion at the time of closure of the neural groove.
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325
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Blackwell N, Bangham L, Hughes M, Melzack D, Trotman I. Treatment of resistant pain in hypertrophic pulmonary arthropathy with ketorolac. Thorax 1993; 48:401. [PMID: 8511741 PMCID: PMC464442 DOI: 10.1136/thx.48.4.401] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Pain associated with hypertrophic pulmonary osteoarthropathy (HPOA) may be extremely disabling and resistant to treatment. The successful use of ketorolac, a new non-steroidal anti-inflammatory drug, given by subcutaneous infusion is reported in two patients with uncontrolled pain caused by HPOA.
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