Biomedical subjects
Publications and source records attributed to A Broderick.
A painful dystonia of rapid onset and associated parkinsonian features is described in a girl aged 14 years. The condition is refractory to treatment and has led to severe neurological disability. Her father had presented with a similar picture.
Intensity of symptoms including mood and psychomotor activity has been shown to vary according to the time of the day in a group of depressed patients. This pattern represents one diagnostic criterion for the melancholic type of depression. The variation of intensity is experienced by the patient and can be observed as a behavioral symptom. However, the relation of circadian alterations in psychomotor activity and depressed mood remains unclear. Therefore, spontaneous motor activity and experienced intensity of symptoms were measured in 21 depressed patients who showed daily variations of subjective symptoms. Patients felt significantly less active, awake, and more depressed in the morning compared to the evening. However, corresponding activity levels, which were measured by actigraphy, appeared significantly higher in the morning compared to the evening. Increased motor activity could represent the observable behavioral equivalent of self-experienced psychomotor retardation and depressed mood.
Spontaneous motor activity measured by actigraphy and subjectively experienced intensity of symptoms were investigated in 16 unipolar depressed inpatients with melancholic features. Patients felt significantly less active, awake, and more depressed in the morning compared to the evening. However, morning activity levels appeared significantly higher compared to evening levels. Diurnal variations of symptoms were reflected by actigraphically measured motor activity, which was negatively correlated with subjectively experienced symptom intensity. Increased motor activity may represent an observable, psychobiological, behavioral equivalent of self-experienced depressive symptoms in major depression with melancholic features.
Compliance of nCPAP therapy was investigated in many studies. In our study we were interested in the influence of early subjective reactions as predictive factors of nCPAP compliance. We present the first 14 patients treated with nCPAP for 4 months. Preliminary results show a significant correlation between positive early subjective statements and acceptance of nCPAP therapy after 4 months. Our data indicates that the early subjective assessment of treatment may be considered as a possible predictive factor of nCPAP compliance.
To further assess the clinical significance of asbestos-induced pleural fibrosis, we performed cardiopulmonary exercise testing in 90 subjects who were exposed to asbestos. Of the 82 subjects without an abnormal resperate exercise, 35 had normal pleura, 33 had circumscribed pleural plaques, and 14 had diffuse pleural thickening. Interstitial fibrosis (International Labor Organization [ILO]. > or = 1/10) was present in 14 of 35 subjects with normal pleura, 13 of 33 subjects with circumscribed pleural plaques, and 2 of 14 subjects with diffuse pleural thickening. Although pleural fibrosis did not appear to be related to impaired respiratory function with exercise in our entire cohort, this finding was confounded by a higher proportion of interstitial fibrosis in subjects with normal pleura. In fact, among study subjects without asbestosis, significant decreases in gas exchange (higher VD/VT and increased alveolar-arterial oxygen pressure difference) were observed at maximal exercise among subjects with pleural fibrosis. Interestingly, neither a higher respiratory rate nor a lower VT/FVC ratio was observed among those with pleural fibrosis, suggesting that the mechanical effects of pleural fibrosis on the chest wall do not explain the increased VD/VT. Using multivariate analyses to control for potential confounders, regression models showed that pleural plaques (p = 0.04) and diffuse pleural thickening (p = 0.03) were independently associated with significant increases in dead space ventilation (VD/VT) with maximal exercise. These findings indicate that asbestos-induced pleural fibrosis is independently associated with decrements in gas exchange with maximal exercise and suggest that interstitial lung disease, not detected on the routine chest x-ray film, may be responsible for this abnormal response to exercise.
The highly diverse Asian and Pacific Island population in the United States doubled in size from 1980 to 1990 and is now the nation's fastest-growing minority group. This article describes the Asian and Pacific Island elderly population and its ethnic diversity, geographic location, gender ratios, income and poverty, health status, service utilization, and cultural values and beliefs. Also presented are the specific challenges for social workers in practice settings in designing and providing culturally relevant services and programs. A number of suggestions for social work education to meet the needs of this growing aging population are offered, including the development of an ethnogerontological and multicultural social work curriculum and the critical need for data on this population.
To further define the relationship between asbestos-induced pleural fibrosis and restrictive lung function, we investigated the pleural determinants of respiratory symptoms and restrictive physiology in 1,211 sheet metal workers. We evaluated the relationship between specific components of pleural fibrosis (costophrenic angle involvement, diaphragmatic plaques, width and length of pleural fibrosis, pleural calcification, and the type of fibrosis-circumscribed plaque or diffuse pleural thickening) and both forced vital capacity and respiratory symptoms. We found that costophrenic angle involvement, the width and length of pleural fibrosis, and the presence of either circumscribed plaque or diffuse pleural thickening were each significantly associated with a lower FVC. No consistent relationship was observed between FVC and either diaphragmatic plaques or pleural calcification. However, since the pleural abnormalities were highly collinear, none of these abnormalities alone or in combination predicted the reduction in FVC significantly better than a model that included circumscribed plaques and diffuse pleural thickening. We also investigated the relationship of each component of pleural fibrosis with cough, dyspnea, and chest pain. After controlling for appropriate confounders, a trend toward significance was observed between increased width and length of fibrosis and dyspnea with exertion. Otherwise, these pleural abnormalities were not consistently related to any of the three respiratory symptoms. Our results indicate that although pleural plaques and diffuse pleural thickening and their components are independently associated with a lower FVC, these components of pleural fibrosis do not substantially improve the previously defined relationship between FVC and both circumscribed plaques and diffuse pleural thickening. In addition, a trend toward significance was observed between the width and length of the pleural abnormality and dyspnea while hurrying.
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To estimate the accuracy of routine hospital-wide surveillance for nosocomial infection, the authors performed a validation study at the University of Iowa Hospitals and Clinics, a 900-bed tertiary care institution, by daily concurrent surveys of all patients' charts. The study extended over a 10-month period from January to October 1987. The sensitivity and specificity of the reported data were 80.7% (95% confidence interval (CI) 72.2-89.2) and 97.5% (95% CI 96.4-98.5), respectively. The predictive values of positive or negative reports of an infection were 75.3% (95% CI 66.3-84.2) and 98.1% (95% CI 97.3-99.1), respectively. In a separate analysis, the data entry system was reviewed for eight descriptive variables among all patients with infections (n = 443) identified over a 2-month period. The data entry was found to be 94-99% accurate. To improve the efficiency of current surveillance, the authors used data gathered during the study to develop a computer model for the identification of patients with a high probability of having a nosocomial infection. The use of stepwise logistic regression identified five variables which independently predicted infection: age of the patient (years), days of antibiotics, days of hospitalization, and the number of days on which urine and/or wound cultures were obtained. Optimal sensitivity and specificity (81.6% and 72.5%, respectively) were found when the model examined patients with an 8% or higher a priori probability of infection; this figure corresponded to a review of 33% of the patients' charts. Increasing the a priori probability would progressively increase specificity and reduce both sensitivity and the number of charts needed for review. If it is prospectively validated, the model may provide a more efficient mechanism by which to conduct hospital-wide surveillance.
Gait analysis using Code-3 provides information which allows individual gait to be characterised with little interference to the patient. It is an ideal method for analysing gait in patients with cerebral palsy. Because of the ease with which this information is now available using Coda-3, gait analysis can now be performed on all ambulant patients in whom surgery is contemplated.
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Subjectively experienced sleep patterns often differ from observed sleeping behavior in insomniacs. Sleep patterns have been evaluated by measurements of motor activity in healthy subjects and insomniacs, but results may depend on the insomnia subtype. Sleep disturbances are frequent complaints in depression, but the influence of psychopathology on activity measurements remains elusive. Therefore, the relationship between reported sleep complaints and motor activity was studied in patients with major depression. Severity of depression was documented in depressed inpatients by observer-(HAMD) and self-rated scales (DACL, SHAPS-D). Self-reports of sleep were obtained by Pittsburgh Sleep Quality Index (PSQI) and daily sleep logs (DSL). Motor activity was continuously recorded over 72 h by actigraphy. 'Good' sleepers showed less motor activity during the night compared to 'poor' sleepers (p<0.01). Patients with high HAMD scores (> or = 18) showed greater nocturnal motor activity and less sleep quality compared to patients with low HAMD scores (p<0.01). When controlling for age and severity of depression, partial correlation was found to be significant between perceived daily sleep quality and nocturnal motor activity (r = -0.63, p<0.01). There was a significant effect of nocturnal motor activity as a covariate on disturbances of subjective sleep quality and severity of depression as the main effect (p<0.01). In depressed patients, nocturnal motor activity seems to be an indicator of experienced sleep disturbances. The results warrant further controlled studies to evaluate the role of psychological factors for objective measurements and subjective perception of sleep patterns.
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