Treatment History (treatment + history)

Distribution by Scientific Domains

Selected Abstracts

The prevalence of reduced zidovudine susceptibility in zidovudine-naive, antiretroviral-experienced HIV-1-infected patients

HIV MEDICINE, Issue 4 2003
Y Gilleece
Objectives There is increasing in vitro and in vivo evidence that reduced zidovudine (ZDV) susceptibility is generated by the selective pressure conferred by other nucleoside reverse transcriptase inhibitors (NRTIs). However, the degree to which this occurs in clinical practice remains unclear. We assessed phenotypic and genotypic resistance in ZDV-naive patients with virological failure on stavudine (d4T)-containing regimens, with particular reference to potential cross-resistance between d4T and ZDV. Methods Patients were identified from a clinical database. Treatment history was confirmed by case note evaluation and discussion with patients. Genotypic and phenotypic analyses were undertaken by Virco (Virco BVBA, Mechelen, Belgium). Results Sixty-seven drug-experienced, ZDV-naive patients who underwent a resistance test while failing a d4T-containing regimen were identified. Of these patients, 23% had received three or more NRTIs and 42% at least one non-nucleoside reverse transcriptase (RT) inhibitor; 22% had viruses with reduced d4T susceptibility (>1.8-fold resistance), and 25% had viruses with reduced ZDV susceptibility (>4-fold). The most frequently observed RT mutations were identified. A significant correlation was found between susceptibility to d4T and susceptibility to ZDV (r=0.36; P=0.003), and also between virtual resistance to d4T and that to ZDV (r=0.38; P=0.002). Conclusions A significant minority of d4T-treated, ZDV-naive patients were found to have viruses with reduced ZDV susceptibility, with a variable association with classical ZDV resistance mutations. These data suggest that cross-resistance between d4T and ZDV may involve novel constellations of mutations. Correlations between d4T and ZDV susceptibilities and resistances further support cross-resistance between NRTIs. [source]

The characteristics of heroin users entering treatment: findings from the Australian Treatment Outcome Study (ATOS)

Abstract The current study aimed to describe the characteristics (demographics, drug use, mental and physical health) of entrants to treatment for heroin dependence in three treatment modalities; and to compare these characteristics with heroin users not in or seeking treatment. Participants were 825 current heroin users recruited from Sydney, Adelaide and Melbourne: 277 entering methadone/buprenorphine maintenance treatment (MT), 288 entering detoxification (DTX), 180 entering drug-free residential rehabilitation (RR) and 80 not in treatment (NT). Treatment entrants were generally long-term heroin users with previous treatment experience. The majority of the sample (55%) were criminally active in the month preceding interview. Injection-related health problems (74%) and a history of heroin overdose (58%) were commonly reported. There were high degrees of psychiatric co-morbidity, with 49% reporting severe psychological distress, 28% having current major depression, 37% having attempted suicide and 42% having a lifetime history of post-traumatic stress disorder. Personality disorders were also prevalent, with 72% meeting criteria for antisocial personality disorder and 47% screening positive for borderline personality disorder. Striking similarities were noted between the non-treatment and treatment groups in length of heroin use career, drug use and treatment histories. [source]

A Bayesian Semiparametric Survival Model with Longitudinal Markers

BIOMETRICS, Issue 2 2010
Song Zhang
Summary We consider inference for data from a clinical trial of treatments for metastatic prostate cancer. Patients joined the trial with diverse prior treatment histories. The resulting heterogeneous patient population gives rise to challenging statistical inference problems when trying to predict time to progression on different treatment arms. Inference is further complicated by the need to include a longitudinal marker as a covariate. To address these challenges, we develop a semiparametric model for joint inference of longitudinal data and an event time. The proposed approach includes the possibility of cure for some patients. The event time distribution is based on a nonparametric Pólya tree prior. For the longitudinal data we assume a mixed effects model. Incorporating a regression on covariates in a nonparametric event time model in general, and for a Pólya tree model in particular, is a challenging problem. We exploit the fact that the covariate itself is a random variable. We achieve an implementation of the desired regression by factoring the joint model for the event time and the longitudinal outcome into a marginal model for the event time and a regression of the longitudinal outcomes on the event time, i.e., we implicitly model the desired regression by modeling the reverse conditional distribution. [source]

Gender differences in jail inmates' symptoms of mental illness, treatment history and treatment seeking,

Amy L. Drapalski
Background,Rates of mental illness among prisoners are substantial, but little is known about the unique mental health needs of women in jail, those under pre-trial custodial remand or serving short sentences. Aims,To compare male and female jail inmates along a wide range of symptoms of mental illness using identical assessment methods, and to examine gender differences in treatment seeking before and during incarceration. Methods,Soon after incarceration in a county jail, 360 male and 154 female pre-trial and post-trial inmates completed the Personality Assessment Inventory, a wide-ranging measure of psychiatric symptoms. Treatment seeking information was taken from official jail records. Results,Women were more likely to report clinically significant symptoms of anxiety, borderline personality features, somatic concerns and trauma-related symptoms; however, trauma-related symptoms and borderline features were also common among male inmates. Although both men and women reported high rates of drug-related problems, alcohol-related problems were twice as prevalent among male inmates. Female inmates were more likely to seek and be enrolled in jail-based treatment; there were no differences in reported help seeking prior to incarceration. Conclusions,Female jail inmates are especially in need of mental health services. Effective interventions for post-traumatic stress disorder and borderline personality disorder are needed in jail settings for both male and female inmates during incarceration and upon release. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Injecting and non-injecting cocaine use in Sydney, Australia: physical and psychological morbidity

Abstract This study aimed to examine the physical and psychological harms of cocaine use and investigate the role of injecting versus non-injecting routes of administration in the severity of such harms. Two hundred and twelve cocaine users from inner-city and southwestern Sydney were administered a structured interview containing sections on demographics, drug treatment history, drug use history, cocaine use patterns, cocaine dependence and physical and psychological problems associated with cocaine use. Serious physical and psychological symptoms were prevalent among both injecting and non-injecting cocaine users. The prevalence and extent of symptoms was greater among injecting cocaine users, however route of administration did not prove to be a significant independent predictor of harm when other factors, such as frequency of use and level of dependence, were taken into account. While the level of physical and psychological harm was greater among cocaine injectors, it would appear that factors engendered by injecting, such as more frequent use and higher levels of dependence, result in higher levels of harm, rather than the route of administration per se. Physical and psychological problems were also reported among infrequent users, suggesting that cocaine can cause harm irrespective of frequency or method of use. Harm reduction initiatives should be targeted towards all cocaine users, not just those who seek treatment for dependence or present with acute medical complications. [source]

Opioid agonist pharmacotherapy in New South Wales from 1985 to 2006: patient characteristics and patterns and predictors of treatment retention

ADDICTION, Issue 8 2009
Lucy Burns
ABSTRACT Aims The aims of this study were to: examine the number and characteristics of patients entering and re-entering opioid replacement treatment between 1985 and 2006, to examine select demographic and treatment correlates of leaving treatment between 1985 and 2000, and to compare retention rates in methadone and buprenorphine maintenance treatment from 2001 to 2006. Design A retrospective cohort study using register data from the Pharmaceutical Drugs of Addiction System. Setting Opioid substitution treatment in New South Wales (NSW), Australia. Participants A total of n = 42 690 individuals prescribed opioid replacement treatment between 1985 and 2006 in NSW. Measurements Client characteristics over time, retention in days in first treatment episode, number of episodes of treatment and proportion switching medication. Findings Overall, younger individuals were significantly more likely to leave their first treatment episode than older individuals. In 2001,06, after controlling for age, sex and first administration point, the hazard of leaving treatment was 1.9 times for those on buprenorphine relative to those on methadone. Retention in treatment varied somewhat across historical time, with those entering during 1995,2000 more likely to leave at an earlier stage than those who entered before that time. Conclusions Retention in treatment appears to fluctuate in inverse proportion to the availability of heroin. Individuals in contemporary treatment are older users with a lengthy treatment history. This study has provided population-level evidence to suggest that retention in methadone and buprenorphine differ in routine clinical practice. Future work might investigate ways in which patient adherence and retention may be improved. [source]

Drug use and perceived treatment need among newly sentenced prisoners in England and Wales

ADDICTION, Issue 2 2009
Duncan Stewart
ABSTRACT Aims To investigate pre-custody levels of drug use among newly sentenced prisoners and factors associated with perceived drug treatment need. Design, setting and participants A sample of 1457 prisoners was recruited to a general purpose longitudinal survey of convicted prisoners starting a new sentence. Measurements Data were collected by structured interviews on reception to prison. Measures were taken of illicit drug use, drug treatment history, current treatment needs, psychological health and a range of social problems. Findings Life-time use of heroin, crack cocaine, cocaine powder, amphetamines or cannabis was reported by 79% of prisoners. Cannabis was the drug reported most commonly, but approximately a third had used heroin or crack cocaine during the year before custody. Nearly half of recent drug users reported wanting help or support with a drug problem during their sentence. Dependence on heroin and cocaine, previous drug treatment, employment, accommodation and psychological health problems were all associated positively with perceived treatment need. Conclusions The prevalence of pre-custody drug use among this sample of newly sentenced prisoners was high. Because treatment need was associated with a range of drug, health and social factors, assessment and referral to appropriate interventions should occur as soon as possible on reception. Treatment should be coordinated with other services and support. [source]

Cessation of periodontal care during pregnancy: effect on infant birthweight

Philippe P. Hujoel
The goal of this study was to assess whether interruption of care for chronic periodontitis during pregnancy increased the risk of low-birthweight infants. A population-based case-control study was designed with 793 cases (infants <,2,500 g) and a random sample of 3,172 controls (infants ,,2,500 g). Generalized estimating equation models were used to relate periodontal treatment history to low birthweight risk and to common risk factors. The results indicate that periodontal care utilization was associated with a 2.35-fold increased odds of self-reported smoking during pregnancy (95% confidence interval: 1.48,3.71), a 2.19-fold increased odds for diabetes (95% confidence interval: 1.21,3.98), a 3.90-fold increased odds for black race (95% confidence interval: 2.31,6.61), and higher maternal age. After adjustment for these factors, interruption of periodontal care during pregnancy did not lead to an increased risk for a low-birthweight infant when compared to women with no history of periodontal care (odds ratio, 0.96; 95% confidence interval, 0.60,1.52). In conclusion, women receiving periodontal care had genetic and environmental characteristics, such as smoking, diabetes and race, that were associated with an increased risk for low-birthweight infants. Periodontal care patterns, in and of themselves, were unrelated to low-birthweight risk. [source]

Treatment of chronic hepatitis C in patients with haemophilia: a review of the literature

HAEMOPHILIA, Issue 5 2006
Summary., Chronic hepatitis C is a major cause of morbidity and mortality in haemophilia patients. In contrast to studies in the general population, the studies of antiviral therapy in haemophilia patients are limited and often include small numbers of patients. A review of the literature was performed to assess the efficacy of interferon (IFN)-based therapy for patients with haemophilia chronically infected with hepatitis C virus (HCV). Studies were identified by electronic searches (Medline, Embase) and hand searches in references of key articles. Data of the included studies were pooled, and responses to therapy were stratified according to treatment regimen, HIV co-infection status, and treatment history. The main outcome was a sustained virological response (SVR) defined as absence of HCV RNA both at the end of treatment and 24-week post-treatment. Thirty-five studies were identified that included 1151 patients. After pooling the data of included patients, the SVR in HIV-negative treatment naïve patients was 22% for IFN monotherapy, 43% for IFN and ribavirin, and 57% for pegylated IFN and ribavirin, respectively. Re-treatment with IFN and ribavirin of those who failed to respond to previous IFN monotherapy was successful in 33%. In HCV/HIV-coinfected patients, response to IFN monotherapy was 8% and to IFN combined with ribavirin 39%. Responses to IFN-based therapy in patients with haemophilia have been improved over time and are nowadays approximately 50,60%. However, data on haemophilic HCV/HIV-coinfected patients and in patients who failed to respond to previous therapy are limited and future studies in these specific patient population are necessary. [source]

Assessment of Adverse Events Associated With Triptans,Methods of Assessment Influence the Results

HEADACHE, Issue 10 2004
Fred D. Sheftell MD
Background.,A recent study conducted in triptan-naïve migraine patients showed that tolerability was the second most important attribute of an acute treatment. However, the proportion of patients reporting side effects after any acute treatment may vary with regard to the method of assessment. Objectives.,To contrast two methods of assessing adverse events (prompted and unprompted) in those with headache using triptans. Methods.,This study was conducted in two sites, a headache center in the United States, and a neurology office focusing on headache in Italy. We prospectively surveyed 415 adults with headache, who had been using the same triptan for at least 3 months. Participants were asked about their headache and treatment history. Subjects then completed a standardized questionnaire, assessing adverse events in two different ways. First, subjects were asked if they had any adverse events when using the triptan. After returning the first part of the questionnaire, subjects received a second form, where 49 possible adverse events were listed. We contrasted and correlated both sets of answers. Results.,Most patients (U.S. = 74.9%, Italy = 65.5%) reported no side effects in the unprompted questionnaire. However, most of them (U.S. = 62.9%, Italy = 54.1%) reported at least one side effect in the prompted questionnaire. Most patients that reported side effects in the unprompted questionnaire said they had just one adverse event, while most reported two or more side effects in the prompted questionnaire. Both in the unprompted and in the prompted questionnaires, most side effects were rated as mild or moderate. Interestingly, 31 (7.5%) subjects (pooling data from both sites together) graded their adverse events as severe in the prompted questionnaire, but had not self-reported them. Conclusions.,(1) When assessing adverse events, the method of data collection may dramatically influence the results. (2) From those subjects who did not self-report adverse events after using a triptan, most of them will report positively if presented with a list of side effects. [source]

Retrospective database analysis on the effectiveness of typical and atypical antipsychotic drugs in an outpatient clinic setting

Cengiz Akkaya
Abstract Objective To report the outcomes of a retrospective database analysis to compare the effectiveness of atypical and typical antipsychotic drugs. Methods Medical records of patients admitted to the psychiatry outpatient clinic between January 1998 and October 2005 were retrospectively reviewed. Data obtained from patient records were noted on a special form assessing four aspects of the treatment history: socio-demographic features, disease characteristics, initial treatment at the time of admission, and course of treatment. Patient groups (typical/atypical and Risperidone/Haloperidol/Olanzapine) were compared for time to all-cause medication discontinuation and rate of discontinuation. Results There was no statistically significant difference in the duration of treatment between patients using atypical (n,=,150) and typical (n,=,124) antipsychotics. The duration of treatment was significantly longer in patients on Haloperidol (n,=,91) compared with those on Risperidone (n,=,63). Rates of discontinuation over 18 months were 59.3% for patients on atypical antipsychotics and 57.3% for those on typical antipsychotics, and 68.3% for patients on Risperidone, 51.6% for patients on Haloperidol and 54.3% for patients on Olanzapine. Conclusion Despite our hypothesis patients with chronic schizophrenia discontinued their atypical and typical antipsychotics, at a high rate with no significant difference indicating substantial limitations in the effectiveness of these drugs. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Outcome of secondary root canal treatment: a systematic review of the literature

Y.-L. Ng
Abstract Aims, (i) To investigate the effects of study characteristics on the reported success rates of secondary root canal treatment (2°RCT or root canal retreatment); and (ii) to investigate the effects of clinical factors on the success of 2°RCT. Methodology, Longitudinal human clinical studies investigating outcome of 2°RCT which were published upto the end of 2006 were identified electronically (MEDLINE and Cochrane database 1966,2006 Dec, week 4). Four journals (Dental Traumatology, International Endodontic Journal, Journal of Endodontics, Oral Surgery Oral Medicine Oral Pathology Endodontics Radiology), bibliographies of all relevant papers and review articles were hand-searched. Two reviewers (Y-LN, KG) independently assessed and selected the studies based on specified inclusion criteria and extracted the data onto a pre-designed proforma, independently. The criteria were: (i) Clinical studies on 2°RCT; (ii) Stratified analyses available for 2°RCT where 1°RCT data included; (iii) Sample size given and larger than 10; (iv) At least 6-month post-operative review; (v) Success based on clinical and/or radiographic criteria (strict = absence of apical radiolucency; loose = reduction in size of radiolucency); and (vi) Overall success rate given or could be calculated from the raw data. Three strands of evidence or analyses were used to triangulate a consensus view. The reported findings from individual studies, including those excluded for quantitative analysis, were utilized for the intuitive synthesis which constituted the first strand of evidence. Secondly, the pooled weighted success rates by each study characteristic and potential prognostic factor were estimated using the random effect model. Thirdly, the effects of study characteristics and prognostic factors (expressed as odds ratios) on success rates were estimated using fixed and random effects meta-analysis with DerSimonean and Laird's methods. Meta-regression models were used to explore potential sources of statistical heterogeneity. Study characteristics considered in the meta-regression analyses were: decade of publication, study-specific criteria for success (radiographic, combined radiographic & clinical), unit of outcome measure (tooth, root), duration after treatment when assessing success (,at least 4 years' or ,<4 years'), geographic location of the study (North American, Scandinavian, other countries), and qualification of the operator (undergraduate students, postgraduate students, general dental practitioners, specialist or mixed group). Results, Of the 40 papers identified, 17 studies published between 1961 and 2005 were included; none were published in 2006. The majority of studies were retrospective (n = 12) and only five prospective. The pooled weighted success rate of 2°RCT judged by complete healing was 76.7% (95% CI 73.6%, 89.6%) and by incomplete healing, 77.2% (95% CI 61.1%, 88.1%). The success rates by ,decade of publication' and ,geographic location of study' were not significantly different at the 5% level. Eighteen clinical factors had been investigated in various combinations in previous studies. The most frequently and thoroughly investigated were ,periapical status' (n = 13), ,size of lesion' (n = 7), and ,apical extent of RF' (n = 5) which were found to be significant prognostic factors. The effect of different aspects of primary treatment history and re-treatment procedures has been poorly tested. Conclusions, The pooled estimated success rate of secondary root canal treatment was 77%. The presence of pre-operative periapical lesion, apical extent of root filling and quality of coronal restoration proved significant prognostic factors with concurrence between all three strands of evidence whilst the effects of 1°RCT history and 2°RCT protocol have been poorly investigated. [source]

Soluble syndecan-1 (sCD138) as a prognostic factor independent of mutation status in patients with chronic lymphocytic leukemia

Summary Syndecan-1 (sCD138) is a transmembrane heparan sulfate-bearing proteoglycan expressed in epithelial cells as well as hematopoietic cells that demonstrate plasmacytoid differentiation. Higher levels of sCD138 correlate with poor outcome in myeloma. We examined the association of circulating sCD138 levels in plasma with clinical behavior in 104 patients with chronic lymphocytic leukemia. sCD138 levels were significantly higher in patients (median, 52.8 ng/ml; range, 13.4,252.7 ng/ml) than in healthy control subjects (median, 19.86; range, 14.49,33.14 ng/ml) (P < 0.01). Elevated sCD138 (>median, 52.8 ng/ml) was associated with significantly shorter survival (P = 0.0004); this association was independent of IgVH mutation status, ,2-microglobulin (,2-M) level, and treatment history. Patients with mutated IgVH but high sCD138 levels (>52.8 ng/ml) had significantly shorter survival than those with mutated IgVH and lower levels of sCD138. Similarly, patients with unmutated IgVH but high sCD138 levels had significantly shorter survival than those with lower sCD138 levels and unmutated IgVH (P = 0.007). In a multivariate Cox regression model, only Rai stage, ,2-M, and sCD138 remained predictors of survival. These data suggest that sCD138 when combined with ,2-M and Rai stage, may replace the need for testing IgVH mutation status. [source]

Why do primary care doctors diagnose depression when diagnostic criteria are not met?

Michael Höfler
Abstract This study examines predictors of false positive depression diagnoses by primary care doctors in a sample of primary care attendees, taking the patients' diagnostic status from a self-report measure (Depression Screening Questionnaire, DSQ) as a yardstick against which to measure doctors' correct and false positive recognition rates. In a nationwide study, primary care patients aged 15,99 in 633 doctors' offices completed a self-report packet that included the DSQ, a questionnaire that assesses depression symptoms on a three-point scale to provide diagnoses of depression according to the criteria of DSM-IV and ICD-10. Doctors completed an evaluation form for each patient seen, reporting the patient's depression status, clinical severity, and treatment choices. Predictor analyses are based on 16,909 patient-doctor records. Covariates examined included depression symptoms, the total DSQ score, number and persistence of depression items endorsed, patient's prior treatment, history of depression, age and gender. According to the DSQ, 11.3% of patients received a diagnosis of ICD-10 depression, 58.9% of which were correctly identified by the doctor as definite threshold, and 26.2% as definite subthreshold cases. However, an additional 11.7% of patients not meeting the minimum DSQ threshold were rated by their doctors as definitely having depression (the false positive rate). Specific DSQ depression items endorsed, a higher DSQ total score, more two-week depression symptoms endorsed, female gender, higher age, and patient's prior treatment were all associated with an elevated rate of false positive diagnoses. The probability of false positive diagnoses was shown to be affected more by doctors ignoring the ,duration of symptoms' criterion than by doctors not following the ,number of symptoms' criterion for an ICD or DSM diagnosis of depression. A model selection procedure revealed that it is sufficient to regress the ,false positive diagnoses' on the DSQ-total score, symptoms of depressed mood, loss of interest, and suicidal ideation; higher age; and patient's prior treatment. Further, the total DSQ score was less important in prediction if there was a prior treatment. The predictive value of this model was quite good, with area under the ROC-curve = 0.86. When primary care doctors use depression screening instruments they are oversensitive to the diagnosis of depression. This is due to not strictly obeying the two weeks duration required by the diagnostic criteria of ICD-10 and DSM-IV. False positive rates are further increased in particular by the doctor's knowledge of a patient's prior treatment history as well as the presence of a few specific depression symptoms. Copyright © 2000 Whurr Publishers Ltd. [source]

Behaviour guidance in dental treatment of patients with autism spectrum disorder

Background., Autism spectrum disorder (ASD) is a neurodevelopmental disorder categorized into autism, pervasive developmental disorder , not otherwise specified (PDD-NOS) and Asperger syndrome. Aims., To identify factors associated with the behaviour of patients with ASD in a dental setting, use of general anaesthesia (GA), and protective stabilization. Design., The dental charts of 395 patients with ASD patients and 386 unaffected patients were reviewed. The following data were analysed: ASD diagnosis, age, gender, residence, seizure disorder, additional diagnosis (mental retardation, cerebral palsy, self-injurious behaviour or pica), medications, caries prevalence and severity, dental treatment history, behaviour, and behaviour guidance technique(s) used. Results., Within both groups, younger patients were more uncooperative. ASD patients with autism were more uncooperative than patients with PDD-NOS; patients with an additional diagnosis were also more uncooperative. ASD patients with higher caries severity, who were uncooperative or female, were more likely to require GA. Use of protective stabilization was associated with lower caries severity, presence of seizure disorder, uncooperative behaviour, male gender, or residency in a group home/institution. Conclusions., Autism spectrum disorder patients with autism, younger age and an additional diagnosis were more uncooperative. Factors associated with the use of GA and protective stabilization in patients with ASD were also identified. [source]

Determining socio-demographic predictors of treatment dropout: results in a therapeutic community

José J. López-Goñi
This article presents a study of a number of socio-demographic factors that predict treatment dropout from a residential substance use disorder programme in Spain (Proyecto Hombre Therapeutic Community). A sample of 430 patients (173 who completed treatment and 257 who dropped out of treatment) was assessed at entry to the therapeutic community programme in order to collect information on socio-demographic characteristics of the participants. According to the results obtained, factors that predicted treatment dropout included younger age, male gender and previous treatment history in the Proyecto Hombre therapeutic community. Patients with these characteristics were at significantly greater risk of dropping out of treatment. The implications of these results for further research and clinical practice are commented upon. [source]

Ceria in catalysis: From automotive applications to the water,gas shift reaction

AICHE JOURNAL, Issue 5 2010
Raymond J. Gorte
Abstract Ceria is a crucial component of automotive catalysts, where its ability to be reduced and re-oxidized provides oxygen storage capacity. Because of these redox properties, ceria can greatly enhance catalytic activities for a number of important reactions when it is used as a support for transition metals. For reactions that use steam as an oxidant (e.g., the water,gas-shift reaction and steam reforming of hydrocarbons), rates for ceria-supported metals can be several orders of magnitude higher than that for ceria or the transition metal alone. Because the redox properties of ceria are strongly dependent on treatment history and the presence of additives, there are significant opportunities for modifying catalysts based on ceria to further improve their performance. This article will review some of the contributions from my laboratory on understanding and using ceria in these applications. © 2010 American Institute of Chemical Engineers AIChE J, 2010 [source]

Personality disorder scale predictors of depression stability over time as a partial function of mental health history

Alan R. King
The high comorbidity of personality disturbance and psychiatric symptomatology has been well established. Diagnostic and Statistical Manual-IV (DSM-IV) personality disorder symptom clusters often represent aberrant, intense and labile emotional reactions to stressors. The role of personality disorder traits on the variability of depression symptoms as expressed over time, however, has gained relatively little research attention. The presence and number of personality disorder diagnoses have been associated with earlier depression onset and less favourable treatment outcomes suggesting that this form of mood disturbance may be more durable over time when associated with Axis II features. The present study examined Beck Depression Inventory (BDI) temporal stability as a function of Millon Clinical Multiaxial Inventory (MCMI-II) personality disorder base rate scores among 406 college students with and without reported histories of significant mental health concerns. Instability of BDI scores across time was shown to be predicted (r = 0.15) by selected personality disorderscale dimensions (antisocial, self-defeating, borderline and total number of MCMI-II personality disorder elevations). BDI reliability did drop significantly among participants reporting a mental health treatment history and multiple personality disorder elevations. Gender differences were not found in the strength of these bivariate correlations. Women generated smaller BDI absolute differences than men. While BDI test,retest reliability was only linked modestly to personality disorder attributes in this college sample, further study may be warranted to evaluate similar relationships within a clinical sample. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Electrophysiological correlates of response inhibition in children and adolescents with ADHD: Influence of gender, age, and previous treatment history

Mario Liotti
Abstract Deficits in response inhibition may be at the core of the cognitive syndrome in ADHD. Here, inhibitory control mechanisms were studied in 36 ADHD-combined type and 30 healthy children by exploring the event-related brain activity during the Stop Signal task. The influence of age, gender, and previous treatment history was evaluated. The ADHD group showed reduced N200 wave amplitudes. For successful inhibitions, the N200 reduction was greatest over right inferior frontal scalp, and only the control group showed a success-related enhancement of such right frontal N200. Source analysis identified a source of the N200 group effect in right dorsolateral prefrontal cortex. Finally, a late positive wave to failed inhibitions was selectively reduced only in treatment-naïve ADHD children, suggesting that chronic stimulants may normalize late conscious error recognition. Both effects were independent of gender and age. [source]

Comprehensive review of conventional and non-conventional methods of management of recurrent vulvovaginal candidiasis

Abstract Recurrent vulvovaginal candidiasis (VVC) is a condition what causes women a great deal of discomfort, inconvenience, and sometimes has psychological sequelae.1 This condition is notoriously difficult to manage. Conventional management is generally favoured by medical practitioners. Some practitioners prefer not to offer other options because of significant possible side-effects and the lack of research supporting alternative treatments. There are many studies and much available information surrounding uncomplicated VVC, including two systematic reviews.2,3 In the area of recurrent VVC however, quality conclusive studies are scarce, and recurrent VVC is featured infrequently in randomised controlled trials (RCTs). Systematic reviews that strongly support a particular pharmacological method of conventional management of recurrent VVC over another are absent from medical literature. Recommendations are largely formed on the basis of scanty RCTs and expert opinion. There is even less conclusive evidence in the area of alternative therapies; yet despite this, anecdotally many practitioners (both alternative and mainstream) continue to advocate certain treatments in the absence of any reliable cure that can be confidently prescribed. As the use of methods other than mainstream medicine becomes more widespread, it is important to be aware of both conventional and non-conventional management of recurrent vulvovaginal candidiasis. Practitioners need to ascertain their patient's preference and treatment history. It is difficult to find comprehensive literature assessing both approaches. Giving women the most up-to-date and relevant information, and different management options, is essential in allowing them to make informed decisions. This review critically assesses both mainstream and less conventional approaches in the management of recurrent VVC. [source]

Subclinical late cardiac toxicity in childhood cancer survivors

CANCER, Issue 8 2008
Impact on self-reported health
Abstract BACKGROUND The authors analyzed how self-reported health and self-reported modified New York Heart Association (NYHA) cardiac function scores were related to cardiac systolic function, cardiac risk factors, and cancer treatment history in childhood cancer survivors who reported no symptoms of cardiac disease. METHODS Long-term survivors of pediatric cancer who were treated between 1971 and 1995 (current ages, 16,39.7 years) underwent noninvasive clinical and laboratory cardiac risk evaluation and responded to selected subscales of the Medical Outcomes Study 36-item Short Form Health Survey. Results were compared with survivor history of anthracycline therapy alone or with radiotherapy (n = 127 patients; mean, 10 years after diagnosis) versus no anthracycline therapy (n = 32 patients; mean, 11 years after diagnosis). RESULTS Sex, current age, highest school grade completed, race, age at diagnosis, diagnostic group, years off therapy, fractional shortening (FS), heart rate, and smoking status were found to be independently predictive of self-reported health. Interaction between female sex and higher low-density lipoprotein values and between diagnosis and abnormal FS variably predicted low reported vitality and low reported modified New York Heart Association (NYHA) scores. Echocardiographic findings, cardiac risk factors, and treatment history explained 13% to 28% of the variance in perceived health and self-reported modified NYHA scores. CONCLUSIONS Systolic function and cardiac risk factors were linked to lower self-reported health and NYHA scores even in the absence of clinically evident cardiotoxicity. Cancer 2008. ©2008 American Cancer Society. [source]