THE AMERICAN JOURNAL ON ADDICTIONS, Issue 3 2004
Helen M. Pettinati Ph.D.
We previously established that Babor Type A "lower-risk / severity" alcoholics (n = 55) had better treatment response to fourteen weeks of sertraline (200 mg/ day) than placebo, a finding not present for Type B "higher-risk /severity" alcoholics (n = 45). This exploratory study extended these results by examining the original sample for gender differences in response to sertraline pharmacotherapy. Type A alcoholic men, but not Type A alcoholic women, had consistently better outcomes with sertraline compared to placebo on several common drinking measures: time to relapse, days drinking, days drinking heavily, drinks per drinking day, and number of those continually abstinent. There were no significant differences in drinking with sertraline compared to placebo in Type B alcoholic men or women. [source]

PARTNER AGGRESSION SEVERITY AS A RISK MARKER FOR MALE AND FEMALE VIOLENCE RECIDIVISM

JOURNAL OF MARITAL AND FAMILY THERAPY, Issue 3 2006
Erica M. Woodin
Pretreatment aggression severity was examined as a risk marker for recidivism in the treatment of partner aggression. Intact married couples experiencing husband-to-wife partner aggression were recruited from the community and participated in either conjoint group treatment or gender-specific group treatment. Elevated levels of husband and wife physical aggression and wife psychological aggression before treatment predicted the continuation and severity of physical aggression by both spouses during treatment and in the following year, with no significant differences across treatment formats. These results indicate that high levels of psychological and physical aggression signify a poor prognosis for both conjoint and gender-specific group treatment programs, suggesting the need for interventions of greater intensity, duration, and/or focus for individuals highest in psychological and physical aggression. [source]

DOES MATRIX METALLOPROTEINASE ACTIVITY PREDICT SEVERITY OF ACUTE PANCREATITIS?

ANZ JOURNAL OF SURGERY, Issue 9 2006
Murat Aynaci
Background: Matrix metalloproteinases (MMP) modulate end-organ complications of acute pancreatitis, but the correlation between increased MMP production and histological severity of disease remains unclear. We examined the role of MMP and pancreas histology on experimental acute pancreatitis. Methods: Forty male Wistar albino rats were subjected to cerulein-induced pancreatitis (8, 16, 24 and 32 h groups) or sham treatment. The animals were killed at different time points and pancreatic tissues were harvested to assess MMP (1, 2 and 9) activity and inflammatory changes. Results: Compared with other groups, 8 h group had decreased tissue MMP-1 concentrations. MMP-9 concentrations were lower in 24-h and 32-h groups, as were histological severity scores. MMP-2 activity did not differ among groups. Pancreatitis was prominent in 8-h, 16-h and 24-h groups by means of histology. Conclusion: Induction of pancreatitis by cerulein altered pancreatic MMP levels in the early phase of inflammation. Inhibition of MMP-2 and MMP-9 paralleled histological scores. Therefore, MMP may have a predictive value to assess histological severity. [source]

Investigating Driver Injury Severity in Traffic Accidents Using Fuzzy ARTMAP

COMPUTER-AIDED CIVIL AND INFRASTRUCTURE ENGINEERING, Issue 6 2002
Hassan T. Abdelwahab
This paper applies fuzzy adaptive resonance theory MAP (fuzzy ARTMAP) neural networks to analyze and predict injury severity for drivers involved in traffic accidents. The paper presents a modified version of fuzzy ARTMAP in which the training patterns are ordered using the K,means algorithm before being presented to the neural network. The paper presents three applications of fuzzy ARTMAP for analyzing driver injury severity for drivers involved in accidents on highways, signalized intersections, and toll plazas. The analysis is based on central Florida's traffic accident database. Results showed that the ordered fuzzy ARTMAP proved to reduce the network size and improved the performance. To facilitate the application of fuzzy ARTMAP, a series of simulation experiments to extract knowledge from the models were suggested. Results of the fuzzy ARTMAP neural network showed that female drivers experience higher severity levels than male drivers. Vehicle speed at the time of an accident increases the likelihood of high injury severity. Wearing a seat belt decreases the chance of having severe injuries. Drivers in passenger cars are more likely to experience a higher injury severity level than those in vans or pickup trucks. Point of impact, area type, driving under the influence, and driver age were also among the factors that influence the severity level. [source]

Facets on the psychopathy checklist screening version and instrumental violence in forensic psychiatric patients

CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 4 2010
Jenny Laurell
Background,There is a recognised relationship between psychopathy and instrumental violence, but not all violence by people who meet the criteria for psychopathy is instrumental. Aims,Our aims were to compare offence types among forensic psychiatric patients with and without the Psychopathy Checklist: Screening Version (PCL: SV) criteria for psychopathy. Our specific questions were whether factor 1 , the interpersonal affective dimension , was related to instrumentality and on severity of the violent crime. Our hypothesis was that the relationship between psychopathy and instrumental violence would be dependent on the severity of the violent crime. Methods,Sixty-five male patients at the forensic psychiatric hospital in Sundsvall, all with a violent criminal history, were assessed for psychopathy through interview and records using the PCL: SV. Severity and the instrumentality of their previous violence were coded using the Cornell coding guide for violent incidents. Results,The interpersonal features of psychopathy (the interpersonal facet), and only the interpersonal features were significantly associated with instrumentality and severity of violence. Instrumentality was also significantly related to the severity of the violence, independent of psychopathy score. Conclusions,The results indicated that, at least among forensic psychiatric patients, planning is more likely than not with respect to serious crimes. The specific link between interpersonal features of psychopathy and instrumental and severe violence suggests potential clinical value in recognising subtypes of psychopathy. Copyright © 2010 John Wiley & Sons, Ltd. [source]

Severity of anxiety and work-related outcomes of patients with anxiety disorders

DEPRESSION AND ANXIETY, Issue 12 2009
Steven R. Erickson PharmD.
Abstract Background: This study examined associations between anxiety and work-related outcomes in an anxiety disorders clinic population, examining both pretreatment links and the impact of anxiety change over 12 weeks of treatment on work outcomes. Four validated instruments were used to also allow examination of their psychometric properties, with the goal of improving measurement of work-related quality of life in this population. Methods: Newly enrolled adult patients seeking treatment in a university-based anxiety clinic were administered four work performance measures: Work Limitations Questionnaire (WLQ), Work Productivity and Activity Impairment Questionnaire (WPAI), Endicott Work Productivity Scale (EWPS), and Functional Status Questionnaire Work Performance Scale (WPS). Anxiety severity was determined using the Beck Anxiety Inventory (BAI). The Clinical Global Impressions, Global Improvement Scale (CGI-I) was completed by patients to evaluate symptom change at a 12-week follow-up. Two severity groups (minimal/mild vs. moderate/severe, based on baseline BAI score) were compared to each other on work measures. Results: Eighty-one patients provided complete baseline data. Anxiety severity groups did not differ in job type, time on job, job satisfaction, or job choice. Patients with greater anxiety generally showed lower work performance on all instruments. Job advancement was impaired for the moderate/severe group. The multi-item performance scales demonstrated better validity and internal consistency. The WLQ and the WPAI detected change with symptom improvement. Conclusion: Level of work performance was generally associated with severity of anxiety. Of the instruments tested, the WLQ and the WPAI questionnaire demonstrated acceptable validity and internal reliability. Depression and Anxiety, 2009. © 2009 Wiley-Liss, Inc. [source]

A double-blind study of the efficacy of venlafaxine extended-release, paroxetine, and placebo in the treatment of panic disorder

DEPRESSION AND ANXIETY, Issue 1 2007
Mark H. Pollack M.D.
Abstract To date, no large-scale, controlled trial comparing a serotonin,norepinephrine reuptake inhibitor and selective serotonin reuptake inhibitor with placebo for the treatment of panic disorder has been reported. This double-blind study compares the efficacy of venlafaxine extended-release (ER) and paroxetine with placebo. A total of 664 nondepressed adult outpatients who met DSM-IV criteria for panic disorder (with or without agoraphobia) were randomly assigned to 12 weeks of treatment with placebo or fixed-dose venlafaxine ER (75,mg/day or 150,mg/day), or paroxetine 40,mg/day. The primary measure was the percentage of patients free from full-symptom panic attacks, assessed with the Panic and Anticipatory Anxiety Scale (PAAS). Secondary measures included the Panic Disorder Severity Scale, Clinical Global Impressions,Severity (CGI-S) and ,Improvement (CGI-I) scales; response (CGI-I rating of very much improved or much improved), remission (CGI-S rating of not at all ill or borderline ill and no PAAS full-symptom panic attacks); and measures of depression, anxiety, phobic fear and avoidance, anticipatory anxiety, functioning, and quality of life. Intent-to-treat, last observation carried forward analysis showed that mean improvement on most measures was greater with venlafaxine ER or paroxetine than with placebo. No significant differences were observed between active treatment groups. Panic-free rates at end point with active treatment ranged from 54% to 61%, compared with 35% for placebo. Approximately 75% of patients given active treatment were responders, and nearly 45% achieved remission. The placebo response rate was slightly above 55%, with remission near 25%. Adverse events were mild or moderate and similar between active treatment groups. Venlafaxine ER and paroxetine were effective and well tolerated in the treatment of panic disorder. Depression and Anxiety 24:1,14, 2007. © 2006 Wiley-Liss, Inc. [source]

Long-term safety of biologics in dermatology

DERMATOLOGIC THERAPY, Issue 1 2009
Xinaida T. Lima
ABSTRACT The use of biologics in dermatology has increased rapidly. Although most are relatively safe when correctly used and monitored, there are known side effects and adverse events that occur. Selection of patients should be done on a case-by-case basis. Severity of disease, comorbidity profile, drug profile, and cost-effectiveness should be all taken into consideration while deciding to start and/or maintain one of these therapies. Dermatologists should be aware of the benefits and limitations of this class of drugs, as well as the appropriate monitoring. The authors propose a concise overview of the safety profiles of some of the biologics currently used in the dermatologic field. [source]

Is bipolar II depression phenotypically distinctive?

ACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2009
G. B. Parker
Objective:, We examine the depressive symptom profile of bipolar II disorder patients compared with a comparator (composite) group of those with unipolar depression, with stratification by melancholic and non-melancholic subtypes. Method:, Out-patients (n = 394) attending a specialist depression clinic comprised the sample. Data on severity and prototypic status of depressive symptoms were analysed. Results:, Age-matched analyses revealed minimal differentiation between bipolar II and composite unipolar groups. Stratified analyses suggested that ,bipolar II depression' more closely approximated melancholic depression in terms of psychomotor and cognitive slowing. Severity-based analyses and prototypic symptom patterns yielded differing results, suggesting that definition of bipolar II depression is influenced by rating strategies, and age. Conclusion:, We found limited differentiation of bipolar II depression from unipolar, melancholic and non-melancholic depression. Differences suggested previously may reflect age, gender and severity differences, highlighting the need for appropriately matched groups in defining bipolar II depression. [source]

Severity of personality disorders and suicide attempt

ACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2009
H. Blasco-Fontecilla
Objective:, Severity of personality disorders (PDs) may be more useful in estimating suicide risk than the diagnosis of specific PDs. We hypothesized that suicide attempters with severe PD would present more attempts and attempts of greater severity/lethality. Method:, Four hundred and forty-six suicide attempters were assessed. PD diagnosis was made using the International Personality Disorder Questionnaire , Screening Questionnaire. PDs were classified using Tyrer and Johnson's classification of severity (no PD, simple PD, diffuse PD). Severity/lethality of attempts was measured with the Suicide Intent Scale, Risk-Rescue Rating Scale and Lethality Rating Scale. Results:, Attempters with severe (diffuse) PD had more attempts than the other groups. After controlling for age and gender, this difference remained significant only for the younger age group and women. There was no relationship between severity of PDs and severity/lethality of attempts. Conclusion:, Younger female attempters with severe PD are prone to repeated attempts. However, the severity of PD was not related to the severity/lethality of suicide attempts. [source]

Comment on "Endothelially Derived Nitric Oxide Affects the Severity of Early Acetaminophen-induced Hepatic Injury in Mice"

ACADEMIC EMERGENCY MEDICINE, Issue 9 2006
Kari Scantlebury MD
No abstract is available for this article. [source]

Motor impairments in young children with cerebral palsy: relationship to gross motor function and everyday activities

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 9 2004
Sigrid Østensjø MSc PT
In this study we assessed the distribution of spasticity, range of motion (ROM) deficits, and selective motor control problems in children with cerebral palsy (CP), and examined how these impairments relate to each other and to gross motor function and everyday activities. Ninety-five children (55 males, 40 females; mean age 58 months, SD18 months, range 25 to 87 months) were evaluated with the modified Ashworth scale (MAS), passive ROM, the Selective Motor Control scale (SMC), the Gross Motor Function Measure (GMFM), and the Pediatric Evaluation of Disability Inventory (PEDI). Types of CP were hemiplegia (n=19), spastic diplegia (n=40), ataxic diplegia (n=4), spastic quadriplegia (n=16), dyskinetic (n=9), and mixed type (n=7). Severity spanned all five levels of the Gross Motor Function Classification System (GMFCS). The findings highlight the importance of measuring spasticity and ROM in several muscles and across joints. Wide variability of correlations of MAS, ROM, and SMC indicates a complex relationship between spasticity, ROM, and selective motor control. Loss of selective control seemed to interfere with gross motor function more than the other impairments. Further analyses showed that motor impairments were only one component among many factors that could predict gross motor function and everyday activities. Accomplishment of these activities was best predicted by the child's ability to perform gross motor tasks. [source]

Endothelially Derived Nitric Oxide Affects the Severity of Early Acetaminophen-induced Hepatic Injury in Mice

ACADEMIC EMERGENCY MEDICINE, Issue 5 2006
Steven D. Salhanick MD
Abstract Objectives: The precise mechanism of hepatocellular toxicity following acetaminophen (APAP) poisoning remains unclear. Nitric oxide is implicated in APAP toxicity as an inflammatory signaling molecule and as a precursor to the free radical peroxynitrate. The effects of inducible nitric oxide synthase (iNOS)-derived NO in APAP toxicity are known; however, the role of endothelial nitric oxide synthase (eNOS)-derived NO is unknown. The authors sought to evaluate the effect of eNOS-derived NO during APAP toxicity. Methods: C57BL6/J mice deficient in eNOS (eNOS KO) or iNOS (iNOS KO) and wild-type mice (WT) were treated with 300 mg/kg APAP. Alanine aminotransferase levels and plasma nitrate and nitrite levels were measured. Hypoxia inducible factor (HIF)-1, and Glucose Transporter 1 (Glut-1) levels were determined by Western blot. Results: Alanine aminotransferase levels were significantly elevated in all treated animals. Alanine aminotransferase levels were significantly lower in eNOS KO and iNOS KO than in treated WT animals. Plasma nitrate/nitrite levels were significantly higher in WT animals than in iNOS KO and eNOS KO animals. HIF-1, expression was increased in WT mice and decreased in iNOS KO mice. Glut-1 is a downstream, indirect marker of HIF function. Glut-1 expression was increased in WT and eNOS KO mice. Conclusions: Deficiency of either iNOS or eNOS results in decreased NO production and is associated with reduced hepatocellular injury following APAP poisoning. HIF-1, and Glut-1 levels are increased following APAP poisoning, implying that HIF-1, is functional during the pathogenic response to APAP poisoning. [source]

A placebo-controlled trial of mirtazapine for the management of methamphetamine withdrawal

DRUG AND ALCOHOL REVIEW, Issue 3 2008
CHRISTOPHER C. CRUICKSHANK
Abstract Introduction and Aims. As an antidepressant with sedative and anxiolytic properties, mirtazapine may be an appropriate pharmacotherapy for methamphetamine withdrawal. This study sought to examine whether mirtazapine improves retention and alleviates methamphetamine withdrawal symptoms in an out-patient setting. Design and Methods. An out-patient double-blind, randomised placebo-controlled trial of mirtazapine for the treatment of methamphetamine withdrawal was conducted (15 mg nocte for 2 days, 30 mg nocte for 12 days). Both groups were offered narrative therapy counselling. Measures recorded on days 0, 3, 7, 14 and 35 included: treatment retention, Amphetamine Cessation Symptoms Assessment, the Athens Insomnia Scale, the Brief Symptom Inventory, the Depression,Anxiety,Stress Scale (DASS), Severity of Dependence scale and the Opiate Treatment Index Drug Use subscale. Results. Thirty-one participants were recruited (18 placebo, 13 mirtazapine) and 52% completed the 2-week medication phase. No significant differences between the mirtazapine and placebo groups in retention, or any symptom measure were observed, except greater DASS,anxiety and longer sleep duration were measured at baseline among the mirtazapine group. Discussion and Conclusions. Results suggest that mirtazapine does not facilitate retention or recruitment in out-patient methamphetamine withdrawal treatment, although recruitment may have been insufficient to identify a significant treatment effect. The potential role of narrative therapy for methamphetamine dependent patients deserves further exploration. [source]

The development and validation of the Indigenous Risk Impact Screen (IRIS): a 13-item screening instrument for alcohol and drug and mental health risk

DRUG AND ALCOHOL REVIEW, Issue 2 2007
CARLA M. SCHLESINGER
Abstract The study aimed to assess the psychometric properties of the Indigenous Risk Impact Screen (IRIS) as a screening instrument for determining (i) the presence of alcohol and drug and mental health risk in Indigenous adult Australians and (ii) the cut-off scores that discriminate most effectively between the presence and absence of risk. A cross-sectional survey was used in clinical and non-clinical Indigenous and non-Indigenous services across Queensland Australia. A total of 175 Aboriginal and Torres Strait Islander people from urban, rural, regional and remote locations in Queensland took part in the study. Measures included the Indigenous Risk Impact Screen (IRIS), the Severity of Dependence Scale (SDS), the Alcohol Use Disorders Identification Test (AUDIT) and the Leeds Dependence Questionnaire (LDQ). Additional Mental Health measures included the Depression Anxiety and Stress Scale (DASS-21) and the Self-Report Questionnaire (SRQ). Principle axis factoring analysis of the IRIS revealed two factors corresponding with (i) alcohol and drug and (ii) mental health. The IRIS alcohol and drug and mental health subscales demonstrated good convergent validity with other well-established screening instruments and both subscales showed high internal consistency. A receiver operating characteristics (ROC) curve analysis was used to generate cut-offs for the two subscales and t-tests validated the utility of these cut-offs for determining risky levels of drinking. The study validated statistically the utility of the IRIS as a screen for alcohol and drug and mental health risk. The instrument is therefore recommended as a brief screening instrument for Aboriginal and Torres Strait Islander people. [source]

Validation of the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): report of results from the Australian site

DRUG AND ALCOHOL REVIEW, Issue 3 2005
DAVID A. L. NEWCOMBE
Abstract The concurrent, construct, discriminative and predictive validity of the World Health Organization's Alcohol Substance Involvement Screening Test (ASSIST) were examined in an Australian sample. One hundred and fifty participants, recruited from drug treatment (n = 50) and primary health care (PHC) settings (n = 100), were administered a battery of instruments at baseline and a modified battery at 3 months. Measures included the ASSIST; the Addiction Severity Index-Lite (ASI-Lite); the Severity of Dependence Scale (SDS); the MINI International Neuropsychiatric Interview (MINI-Plus); the Rating of Injection Site Condition (RISC); the Drug Abuse Screening Test (DAST); the Alcohol Use Disorders Identification Test (AUDIT); the Revised Fagerstrom Tolerance Questionnaire (RTQ); and the Maudsely Addiction Profile (MAP). Concurrent validity was demonstrated by significant correlations between ASSIST scores and scores from the ASI-lite, SDS, AUDIT and DAST; and significantly greater ASSIST scores for those with diagnoses of abuse or dependence. Construct validity was established by significant correlations between ASSIST scores and measures of risk factors for the development of drug and alcohol problems. Participants diagnosed with attention deficit/hyperactivity disorder or antisocial personality disorder had significantly higher ASSIST scores than those not diagnosed as such. Discriminative validity was established by the capacity of the ASSIST to discriminate between substance use, abuse and dependence. ROC analysis was able to establish cut-off scores for an Australian sample, with suitable specificities and sensitivities for most substances. Predictive validity was demonstrated by similarity in ASSIST scores obtained at baseline and at follow-up. The findings demonstrated that the ASSIST is a valid screening test for psychoactive substance use in individuals who use a number of substances and have varying degrees of substance use. [source]

Combined counseling and bupropion therapy for smoking cessation: identification of outcome predictors

DRUG DEVELOPMENT RESEARCH, Issue 3 2006
Maria Caterina Grassi
Abstract Because some smoking-induced pathologies improve upon discontinuation, strategies have been developed to help smokers quit. The aim of this study was to measure the rate of smokers still abstinent one year after one cycle of a six-week group counseling given alone or in combination with a seven-week period of daily administration of bupropion. We also evaluated the predictor validity of nicotine dependence intensity at enrollment, administering both the Fageström Tolerance Questionnaire (FTQ) and the Severity of Dependence Scale (SDS). Visual Analogue Scale (VAS), to measure the intensity of "smoke craving," was also administered. Two hundred twenty-nine subjects trying to quit smoking were enrolled. Bupropion therapy was accepted by 110 subjects, but only 50 completed the 7-week cycle of therapy. Abstinence rates at one year were 68.0 and 56.6%, respectively, in the group that used bupropion for the scheduled 7 weeks and in the group that discontinued bupropion, and 35.3% in the group with counseling therapy alone. SDS (but not FTQ) scores at enrollment, VAS values for craving at the end of the program, and bupropion therapy were the variables selected by Linear Discriminant Analysis to assign subjects to the Smoker or Non-smoker group, with a global correctness of 70.9%. In conclusion, the efficacy of bupropion largely depends upon its interaction with psychological factors, such as the level of nicotine dependence, craving for nicotine, and the subject's commitment to quit smoking. Drug Dev. Res. 67:271,279, 2006. © 2006 Wiley-Liss, Inc. [source]

Elongation Index as a New Index Determining the Severity of Left Ventricular Systolic Dysfunction and Mitral Regurgitation in Patients with Congestive Heart Failure

ECHOCARDIOGRAPHY, Issue 7 2005
Mehmet Yokusoglu M.D.
The shape of the left ventricle is an important echocardiographic feature of left ventricular dysfunction. Progression of the mitral regurgitation and consequent left ventricular remodeling is unpredictable in heart failure. Elongation index is an index of left ventricular sphericity. The surface area of the elongated ventricle is larger than that of a spherical one. The objective of this study was to assess the relation between elongation index and the degree of mitral regurgitation along with noninvasive indices of left ventricular function. Thirty-two patients (21 male, 11 female, mean age: 57 ± 6 yrs) with congestive heart failure and mitral regurgitation were included. Patients were stratified into three groups according to vena contracta width as having mild (n = 11), moderate (n = 11) and severe mitral regurgitation (n = 10). The elongation index (EI) was considered as equal to {[(left ventricular internal area-measured) , (theoretical area of the sphere with measured left ventricular volume)]/(theoretical area of the sphere with measured left ventricular volume)}. Ejection fractions by the modified Simpson rule, dP/dt and sphericity index (SI) were also recorded. The relationship between (EI), ejection fraction, dP/dt and SI reached modest statistical significance (p < 0.05). When the EI and SI were compared, the correlation was also significant (p < 0.01). The areas under the receiver operator curve of EI and SI for discriminating dP/dt < 1000 mm Hg/s were 0.833 and 0.733, respectively. In conclusion, the elongation, which defines the shape of the left ventricle, might be related to the systolic function of the left ventricle and the degree of the mitral regurgitation. Further studies are needed to demonstrate its use in other clinical entities. [source]

The cost-effectiveness of antidepressants for smoking cessation in chronic obstructive pulmonary disease (COPD) patients

ADDICTION, Issue 12 2009
Constant P. Van Schayck
ABSTRACT Objectives In healthy smokers, antidepressants can double the odds of cessation. Because of its four times lower costs and comparable efficacy in healthy smokers, nortriptyline appears to be favourable compared to bupropion. We assessed which of both drugs was most effective and cost-effective in stopping smoking after 1 year compared with placebo among smokers at risk or with existing chronic obstructive pulmonary disease (COPD). Methods A total of 255 participants, aged 30,70 years, received smoking cessation counselling and were assigned bupropion, nortriptyline or placebo randomly for 12 weeks. Prolonged abstinence from smoking was defined as a participant's report of no cigarettes from week 4 to week 52, validated by urinary cotinine. Costs were calculated using a societal perspective and uncertainty was assessed using the bootstrap method. Results The prolonged abstinence rate was 20.9% with bupropion, 20.0% with nortriptyline and 13.5% with placebo. The differences between bupropion and placebo [relative risk (RR) = 1.6; 95% confidence interval (CI) 0.8,3.0] and between nortriptyline and placebo (RR = 1.5; 95% CI 0.8,2.9) were not significant. Severity of airway obstruction did not influence abstinence significantly. Societal costs were ,1368 (2.5th,97.5th percentile 193,5260) with bupropion, ,1906 (2.5th,97.5th 120,17 761) with nortriptyline and ,1212 (2.5th,97.5th 96,6602) with placebo. Were society willing to pay more than ,2000 for a quitter, bupropion was most likely to be cost-effective. Conclusions Bupropion and nortriptyline seem to be equally effective, but bupropion appears to be more cost-effective when compared to placebo and nortriptyline. This impression holds using only health care costs. As the cost-effectiveness analyses concern some uncertainties, the results should be interpreted with care and future studies are needed to replicate the findings. [source]

Drinking patterns, dependency and life-time drinking history in alcohol-related liver disease

ADDICTION, Issue 4 2009
Jennifer Hatton
ABSTRACT Aims To examine the hypothesis that increases in UK liver deaths are a result of episodic or binge drinking as opposed to regular harmful drinking. Design A prospective survey of consecutive in-patients and out-patients. Setting The liver unit of a teaching hospital in the South of England. Participants A total of 234 consecutive in-patients and out-patients between October 2007 and March 2008. Measurements Face-to-face interviews, Alcohol Use Disorders Identification Test, 7-day drinking diary, Severity of Alcohol Dependence Questionnaire, Lifetime Drinking History and liver assessment. Findings Of the 234 subjects, 106 had alcohol as a major contributing factor (alcoholic liver disease: ALD), 80 of whom had evidence of cirrhosis or progressive fibrosis. Of these subjects, 57 (71%) drank on a daily basis; only 10 subjects (13%) drank on fewer than 4 days of the week,of these, five had stopped drinking recently and four had cut down. In ALD patients two life-time drinking patterns accounted for 82% of subjects, increasing from youth (51%), and a variable drinking pattern (31%). ALD patients had significantly more drinking days and units/drinking day than non-ALD patients from the age of 20 years onwards. Conclusions Increases in UK liver deaths are a result of daily or near-daily heavy drinking, not episodic or binge drinking, and this regular drinking pattern is often discernable at an early age. [source]

Validation of the alcohol, smoking and substance involvement screening test (ASSIST)

ADDICTION, Issue 6 2008
Rachel Humeniuk
ABSTRACT Aim The concurrent, construct and discriminative validity of the World Health Organization's Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were examined in a multi-site international study. Participants One thousand and 47 participants, recruited from drug treatment (n = 350) and primary health care (PHC) settings (n = 697), were administered a battery of instruments. Measurements Measures included the ASSIST; the Addiction Severity Index-Lite (ASI-Lite); the Severity of Dependence Scale (SDS); the MINI International Neuropsychiatric Interview (MINI-Plus); the Rating of Injection Site Condition (RISC); the Drug Abuse Screening Test (DAST); the Alcohol Use Disorders Identification Test (AUDIT); the Revised Fagerstrom Tolerance Questionnaire (RTQ); and the Maudsley Addiction Profile (MAP). Findings Concurrent validity was demonstrated by significant correlations between ASSIST scores and scores from the ASI-Lite (r = 0.76,0.88), SDS (r = 0.59), AUDIT (r = 0.82) and RTQ (r = 0.78); and significantly greater ASSIST scores for those with MINI-Plus diagnoses of abuse or dependence (P < 0.001). Construct validity was established by significant correlations between ASSIST scores and measures of risk factors for the development of drug and alcohol problems (r = 0.48,0.76). Discriminative validity was established by the capacity of the ASSIST to discriminate between substance use, abuse and dependence. Receiver operating characteristic (ROC) analysis was used to establish cut-off scores with suitable specificities (50,96%) and sensitivities (54,97%) for most substances. Conclusions The findings demonstrated that the ASSIST is a valid screening test for identifying psychoactive substance use in individuals who use a number of substances and have varying degrees of substance use. [source]

Quantitative EEG Asymmetry Correlates with Clinical Severity in Unilateral Sturge-Weber Syndrome

EPILEPSIA, Issue 1 2007
Laura A. Hatfield
Summary:,Purpose: Sturge-Weber syndrome (SWS) is a neurocutaneous disorder with vascular malformations of the skin, brain, and eye. SWS results in ischemic brain injury, seizures, and neurologic deficits. We hypothesized that a decrease in quantitative EEG (qEEG) power, on the affected side, correlates with clinical severity in subjects with SWS. Methods: Fourteen subjects had 16-channel scalp EEG recordings. Data were analyzed using fast Fourier transform and calculation of power asymmetry. Blinded investigators assigned scores for clinical neurological status and qualitative assessment of MRI and EEG asymmetry. Results: The majority of subjects demonstrated lower total power on the affected side, usually involving all four frequency bands (delta, theta, alpha, and beta). qEEG asymmetry correlated strongly with neurologic clinical severity scores and MRI asymmetry scores. qEEG data generally agreed with the MRI evidence of regional brain involvement. In MRI-qEEG comparisons that did not agree, decreased power on qEEG in a brain region not affected on MRI was more likely to occur in subjects with more severe neurologic deficits. Conclusions: qEEG provides an objective measure of EEG asymmetry that correlates with clinical status and brain asymmetry seen on MRI. These findings support the conclusion that qEEG reflects the degree and extent of brain involvement and dysfunction in SWS. qEEG may potentially be a useful tool for early diagnosis and monitoring of disease progression in SWS. qEEG may prove useful, in severely affected individuals with SWS, for determining regions of brain dysfunction. [source]

The Influence of Comorbid Depression on Seizure Severity

EPILEPSIA, Issue 12 2003
Joyce A. Cramer
Summary:,Purpose: To determine the relation between depressive symptoms and seizure severity among people with epilepsy. Methods: A postal questionnaire was used to survey a nationwide community sample about seizures and depression. The Seizure Severity Questionnaire (SSQ) assessed the severity and bothersomeness of seizure components. The Centers for Epidemiological Studies-Depression scale categorized levels of depression. Results: Respondents categorized as having current severe (SEV, n = 166), mild,moderate (MOD, n = 74), or no depression (NO, n = 443) differed significantly in SSQ scores (all p < 0.0001). People with SEV or MOD reported significantly worse problems than did those with NO depression for overall seizure recovery (mean, 5.3, 4.9, 4.5, respectively); overall severity (5.0, 4.5, 4.2); and overall seizure bother (5.3, 4.8, 4.4) (all p < 0.005). Cognitive, emotional, and physical aspects of seizure recovery also were rated worse among people with SEV than with NO depression (all p < 0.05). Symptoms of depression were significantly correlated with higher levels of all components of generalized tonic,clonic seizure severity (r = 0.33,0.48; all p < 0.0001), and partial seizures (r = 0.31,0.38; all p < 0.01). Conclusions: Clinically depressed people with epilepsy reported higher levels of perceived severity and bother from seizures, as well as greater problems with overall seizure recovery than did nondepressed people experiencing similar types of seizures. The pervasive influence of depressive symptoms on reports of seizure activity suggests that people with epilepsy should be screened for depression. These data highlight the importance of detecting and treating depression among people with epilepsy. [source]

Changes in Quality of Life in Epilepsy: How Large Must They Be to Be Real?

EPILEPSIA, Issue 1 2001
Samuel Wiebe
Summary: ,Purpose: The study goal was to assess the magnitude of change in generic and epilepsy-specific health-related quality-of-life (HRQOL) instruments needed to exclude chance or error at various levels of certainty in patients with medically refractory epilepsy. Methods: Forty patients with temporal lobe epilepsy and clearly defined criteria of clinical stability received HRQOL measurements twice, 3 months apart, using the Quality of Life in Epilepsy Inventory-89 and -31 (QOLIE-89 and QOLIE-31), Liverpool Impact of Epilepsy, adverse drug events, seizure severity scales, and the Generic Health Utilities Index (HUI-III). Standard error of measurement and test-retest reliability were obtained for all scales and for QOLIE-89 subscales. Using the Reliable Change Index described by Jacobson and Truax, we assessed the magnitude of change required by HRQOL instruments to be 90 and 95% certain that real change has occurred, as opposed to change due to chance or measurement error. Results: Clinical features, point estimates and distribution of HRQOL measures, and test-retest reliability (all > 0.70) were similar to those previously reported. Score changes of ±13 points in QOLIE-89, ±15 in QOLIE-31, ±6.3 in Liverpool seizure severity,ictal, ±11 in Liverpool adverse drug events, ±0.25 in HUI-III, and ±9.5 in impact of epilepsy exclude chance or measurement error with 90% certainty. These correspond, respectively, to 13, 15, 17, 18, 25, and 32% of the potential range of change of each instrument. Conclusions: Threshold values for real change varied considerably among HRQOL tools but were relatively small for QOLIE-89, QOLIE-31, Liverpool Seizure Severity, and adverse drug events. In some instruments, even relatively large changes cannot rule out chance or measurement error. The relation between the Reliable Change Index and other measures of change and its distinction from measures of minimum clinically important change are discussed. [source]

Quantitative Assessment of Seizure Severity for Clinical Trials: A Review of Approaches to Seizure Components

EPILEPSIA, Issue 1 2001
Joyce A. Cramer
Summary: Quantitative assessment of seizure severity has been approached using a variety of systems. This review describes currently available methods and possible new approaches to seizure assessment for clinical trials. A review of the literature on methods of seizure assessments resulted in tabulation of the seizure rating scales known as VA, Chalfont-National Hospital, Liverpool, Hague, and the Occupational Hazard Scale. Seizures have been evaluated by simply counting all events, counting events by type, by clinician ratings, patient ratings, and combinations. Each of the scales has advantages and disadvantages. Most scales share core components: seizure frequency, seizure type, seizure duration, postictal events, postictal duration, automatisms, seizure clusters, known patterns, warnings, tongue biting, incontinence, injuries, and functional impairment. This review revealed a partial consensus about aspects of seizures that are important markers for severity. However, usefulness of the existing scales is limited by lack of data on responsiveness. New approaches are needed to assess changes in seizure severity as a result of an intervention in a clinical trial. [source]

Intralesional bovine papillomavirus DNA loads reflect severity of equine sarcoid disease

EQUINE VETERINARY JOURNAL, Issue 4 2010
R. HARALAMBUS
Summary Reasons for performing study: Sarcoids are nonmetastasising, yet locally aggressive skin tumours that constitute the most frequent neoplasm in equids. Infection by bovine papillomaviruses types 1 and 2 (BPV-1, BPV-2) has been recognised as major causative factor in sarcoid pathogenesis, but a possible correlation of intralesional virus load with disease severity has not been established thus far. Hypothesis: Given the pathogenic role of BPV-1 and BPV-2 in sarcoid disease, we suggest that intralesional viral DNA concentration may reflect the degree of affection. Methods: Severity of disease was addressed by recording the tumour growth kinetics, lesion number and tumour type for 37 sarcoid-bearing horses and one donkey. Viral load was estimated via quantitative real-time PCR (qPCR) of the E2, E5, L1 and L2 genes from the BPV-1/-2 genome for one randomly selected lesion per horse and correlated with disease severity. Results: Quantitative PCR against E2 identified viral DNA concentrations ranging from 0,556 copies/tumour cell. Of 16 horses affected by quiescent, slowly growing single tumours or multiple mild-type lesions, 15 showed a viral load up to 1.4 copies per cell. In stark contrast, all equids (22/22) bearing rapidly growing and/or multiple aggressive sarcoids had a viral load between 3 and 569 copies per cell. Consistent results were obtained with qPCR against E5, L1 and L2. Conclusions: While tumours of the same clinical type carried variable virus load, confirming that viral titre does not determine clinical appearance, we identified a highly significant correlation between intralesional viral load and disease severity. Potential relevance: The rapid determination of BPV viral load will give a reliable marker for disease severity and may also be considered when establishing a therapeutic strategy. [source]

Prevalence and impact of pain in diabetic neuropathy

EUROPEAN DIABETES NURSING, Issue 2 2009
M Geerts M
Abstract Background: Diabetic neuropathy (DNP) is a serious and common complication of diabetes mellitus, with a prevalence of around 30-50%. Aims: To describe the prevalence, severity and medical treatment of painful DNP (PDNP) experienced by patients treated in secondary care; to determine quality of life (QoL) impact and the relationship between severity of pain and severity of DNP. Methods: Cross-sectional, two-phase survey. First, a pain interview was conducted by telephone (219 DNP patients), which covered types of pain, location and duration. Secondly, 50 patients were visited at home. Patients completed the Brief Pain Inventory, the Short Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale. Results: Prevalence of PDNP was 57.5%. Average and worst pain scores were 5.3 ± 2.1 and 6.4 ± 2.2, respectively (0-10 scale, 10 = worst pain imaginable). In 70% of patients, average pain was severe (score ,5). Substantial interference by pain (score ,4) was found in walking ability, sleep and normal activities. PDNP patients had a decreased QoL for all SF-36 domains (p,0.01) except for health change. Moreover, symptoms of anxiety (36%) and depression (34%) were reported frequently. Medical treatment was prescribed in 46% of patients, in whom treatment was ineffective in 39%. Physical functioning scores were lower in patients with severe versus moderate DNP (p,0.01). Conclusions: The prevalence of severe PDNP was high. Severity of DNP was not related to pain severity. PDNP was associated with loss of QoL and with symptoms of anxiety and depression. A considerable proportion of patients did not have medical treatment and, if treatment was given, its impact was disappointing. Medical treatment of PDNP was unsatisfactory and clearly needs to be improved. Copyright © 2009 FEND [source]

Eating disturbance and severe personality disorder: outcome of specialist treatment for severe personality disorder

EUROPEAN EATING DISORDERS REVIEW, Issue 2 2006
Fiona Warren
Abstract Objective To assess the outcome for patients receiving specialist democratic therapeutic community treatment for personality disorder (PD) when they also have eating disturbance. Method Prospective, naturalistic study. Personality psychopathology and disturbed eating attitudes of 135 male and female referrals to tertiary treatment for PD were assessed at referral. Seventy-five referrals were admitted for treatment and 60 were not. Participants were reassessed at 1-year follow-up. Results There was a significant effect of treatment on dieting but not other aspects of eating disturbance. However, patients with eating disturbance were not more likely than those without to terminate treatment early or to have poorer outcome in terms of their personality pathology. Severity of baseline personality pathology did not predict treatment response. Conclusion Clients with comorbidity should be considered for treatment of the personality disorder prior to treatment for the eating disorder. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association. [source]

Complement activation by both classical and alternative pathways is critical for the effector phase of arthritis

EUROPEAN JOURNAL OF IMMUNOLOGY, Issue 4 2004
Albert Hietala
Abstract To analyze the role of the classical and alternative pathways of complement activation in the effector phase of arthritis, we have induced arthritis in C3- and factor,B (FB)-deficient (C3,/, and FB,/,) DBA/1J mice using well-defined monoclonal IgG2b and IgG2a antibodies to type,II collagen. In control DBA/1J mice, severe swelling of the joints, destruction of cartilage and erosion of bone developed very rapidly with a 100% incidence and a peak on days,7,10. Although 75% of C3,/, mice developed arthritis, the clinical severity was very mild and the onset was delayed. Severity of arthritis in FB,/, mice ranked intermediate in comparison with C3,/, and control mice with an incidence of 100%. Immunohistochemical analysis of the inflamed joints demonstrated substantial reduction in macrophage and neutrophilic leukocyte infiltration in both C3,/, and FB,/, mice, thereby confirming the clinical findings. We conclude that both the classical and the alternative pathways of complement activation are involved in the effector phase of arthritis. [source]

Parents and Practitioners Are Poor Judges of Young Children's Pain Severity

ACADEMIC EMERGENCY MEDICINE, Issue 6 2002
Adam J. Singer MD
Objective: Visual analog pain scales are reliable measures in older children and adults; however, pain studies that include young children often rely on parental or practitioner assessments for measuring pain severity. The authors correlated patient, parental, and practitioner pain assessments for young children with acute pain. Methods: This was a prospective, descriptive study of a convenience sample of 63 emergency department patients aged 4-7 years, with acute pain resulting from acute illness or painful invasive procedures. A trained research assistant administered a structured pain survey containing demographic and historical features to all parents/guardians. Children assessed their pain severity using a validated ordinal scale that uses five different faces with varying degrees of frowning (severe pain) or smiling (no pain). Each face was converted to a numeric value from 0 (no pain) to 4 (severe pain). Parents and practitioners independently assessed their child's pain using a validated 100-mm visual analog scale (VAS) marked "most pain" at the high end. Pairwise correlations between child, parent, and practitioner pain assessments were performed using Spearman's or Pearson's test as appropriate. The association between categorical data was assessed using ,2 tests. Results: Sixty-three children ranging in age from 4 to 7 were included. Mean age (±SD) was 5.7 (±1.1); 42% were female. Fifty-seven successfully completed the face scale. The distribution of the children's scores was 0-17%, 1-9%, 2-30%, 3-14%, and 4-30%. Mean parental and practitioner scores (±SD) on the VAS were 61 (±26) mm and 37 (±26) mm, respectively (maximal = 100 mm). Correlation between child and parent scores was 0.47 (p < 0.001). Correlation between child and practitioner scores was 0.08 (p = 0.54). Correlation between parent and practitioner scores was 0.04 (p = 0.001). Conclusions: There is poor agreement between pain ratings by children, parents, and practitioners. It is unclear which assessment best approximates the true degree of pain the child is experiencing. [source]