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Biomedical subjects

A M Jacobson

Publications and source records attributed to A M Jacobson.

66 records · Page 4Linked to original sources
PubMedDate not supplied

The association of lifetime psychiatric illness and increased retinopathy in patients with type I diabetes mellitus.

Forty-nine patients with Type I diabetes mellitus were assessed to examine the relationship between lifetime prevalence of psychiatric illness and retinopathy severity. The subjects with a history of psychiatric illness had significantly worse retinopathy than the subjects without psychiatric illness. Eighty-nine percent of the subjects with severe nonproliferative retinopathy or proliferative retinopathy had a history of psychiatric illness, predominantly affective illness. In addition, the subjects with a history of psychiatric illness had significantly higher current glycohemoglobin levels than those with no psychiatric history. This study's findings suggest that psychiatric illness may be a risk factor for development of retinopathy in Type I diabetic patients.

Adaptation, Psychological↗
PubMedDate not supplied

Psychologic stress and glycemic control: a comparison of patients with and without proliferative diabetic retinopathy.

Using a case/control design, patients with (cases) and without (controls) proliferative diabetic retinopathy were compared using three psychosocial measures: life events, psychiatric symptomatology, and ego development. Cases reported significantly more symptoms. They also demonstrated a modest and significant correlation of negative life events with HgbA1c that was not shown in the controls. When the relationship of life events with glycemic control was explored in cases of varying durations of proliferative retinopathy, we found that the association between negative life events and HgbA1c was accounted for by the cases with a recent onset of retinopathy. Patients in this recent group showed a trend towards more negative life events that decreased with longer duration of proliferative retinopathy. This study suggests that the onset of proliferative retinopathy portends a life crisis during which metabolic control is sensitive to additional life stress and that this association is not found among patients whose illness is more stable.

Adult↗
PubMedDate not supplied

Psychosocial correlates of mild visual loss.

Studies of the psychosocial aspects of visual impairment have emphasized the effects of blindness, giving relatively little attention to the effects of mild or partial visual impairment. Consequently, we know little about when in the course of visual loss significant psychosocial dysfunction develops. To address this question, we assessed psychosocial functioning at three times over eight months in 31 adults with proliferative diabetic retinopathy and mild to moderate visual impairment in at least one eye. Examination of the correlations between visual and psychosocial measures revealed strong and significant correlations between visual acuity and adjustment (range of r = -0.45 to -0.68), between visual acuity and psychological symptoms (range of r = -0.39 to -0.50), and between visual acuity and emotion-focused coping (range of r = -0.38 to -0.53). The strength of these correlations and their occurrence in three independent measures of psychosocial functioning suggest a clinically meaningful relationship between visual and psychosocial functioning in the range of mild to moderate visual impairment. Psychosocial dysfunction related to visual impairment develops long before blindness. Further prospective research on the psychosocial aspects of partial visual impairment will clarify this relationship and may help justify early intervention with rehabilitation in the visually impaired who do not qualify for services for the blind.

Adaptation, Psychological↗
PubMedDate not supplied

Family environment and glycemic control: a four-year prospective study of children and adolescents with insulin-dependent diabetes mellitus.

An onset cohort of children and adolescents with insulin-dependent diabetes mellitus (IDDM) and their parents were studied. Aspects of family environment were evaluated at study inception, and their influence on the initial level of, and change in, glycemic control over 4 years was examined. Family measures of expressiveness, cohesiveness, and conflict were linked to differences in the longitudinal pattern of glycemic control. In particular, the encouragement to act openly and express feelings directly (expressiveness) seemed to ameliorate deterioration of glycemic control over time in both boys and girls. Boys were especially sensitive to variations in family cohesiveness and conflict; those from more cohesive and less conflicted families showed less deterioration in glycemic control. This study demonstrated the important influence of family psychosocial factors present at diabetes onset on glycemic control in children and adolescents over the first 4 years of IDDM.

Adaptation, Psychological↗
PubMedDate not supplied

Psychosocial aspects of diabetic retinopathy.

Diabetic retinopathy, particularly in the more advanced stages, poses many difficult psychosocial problems and demands major adjustments by the patient. Our review of this literature has identified specific problems relevant to patient care, future research, and public policy. For example, proliferative retinopathy often leads to at least partial visual impairment, psychiatric symptoms, and difficulties with glycemic control. Partial visual impairment appears to cause as much psychosocial disruption as severe blindness. This suggests that most rehabilitation programs that serve the legally blind may come too late in the course of this illness. This review emphasizes the paucity of past research on psychosocial aspects of diabetic retinopathy and raises some questions for future research.

Activities of Daily Living↗
PubMedDate not supplied

Psychological adjustment of children with recently diagnosed diabetes mellitus.

Children with recent onset of insulin-dependent diabetes mellitus (IDDM) were compared with a sample of children with a recent acute medical problem. No differences were found in terms of self-esteem, locus of control, behavioral symptoms, or social functioning. A separate assessment of adjustment to diabetes was strongly correlated with each of these general personality, behavioral symptom, and social functioning measures. Sociodemographic factors such as age, gender, and social class did not predict the level of adjustment to diabetes. This study suggests that onset of diabetes does not necessarily lead to major disruptions of psychological adaptation. It also affirms the view that early adjustment to diabetes is embedded in a context of overall personality development and adaptation.

Acute Disease↗
PubMedDate not supplied

Uses of ambulatory health/mental health utilization data in organized health care settings.

A follow-up assessing uses of findings from NIMH-supported research on health and mental health services utilization in organized health care settings revealed a range of applications across the study sites. The research, conducted primarily for national policy purposes, had an impact on study sites in the following areas: clinician perceptions and attitudes about mental health services provided; program directions; fiscal policy; and further related research. Research team composition and dissemination of study findings are discussed in relation to the applications made.

Attitude of Health Personnel↗
PubMedDate not supplied

Factors relating to the use of mental health services in a neighborhood health center.

Six-month utilization data are presented for the mental health unit of a comprehensive neighborhood health center. Almost 5% of the 16,877 people in Charlestown, Mass., used these services at a rate of 48.7 per 1,000 residents. Nearly all the residents of this Boston neighborhood were white; the median family income was $8,828 annually; and 14% of the families received public assistance. Age, sex, marital status, census tract of residence, and diagnostic factors were quantitatively related to the use of services. Those 0-17 years represented 39.6% of the total caseload and had a utilization rate of 57.0 per 1,000. Boys and women were the biggest users of service, and married adults constituted 47.7% of the adults using the service. About 55% of the patients paid through Medicaid. During the study period 999 diagnoses were recorded for 822 separate patients, or 1.2 diagnoses per patient. Findings from the center's caseload are compared with utilization data for other mental health services and available national data. The study data demonstrate that the health center's goals of providing accessible, family-oriented, comprehensive mental health services that are targeted particularly to the lower socioeconomic groups in the community were largely accomplished.

Adolescent↗