PubMed HealthSearch

Biomedical subjects

A Spiro

Publications and source records attributed to A Spiro.

18 recordsLinked to original sources

Supporting parents who wish to breastfeed twins.

Parents expecting twins need special support from health visitors to prepare them for the changes to their lives. A sound knowledge of the mechanics of breastfeeding and an empathetic understanding of their hopes and fears will prepare them for the months ahead, writes Alison Spiro. Health visitors may also be able to mobilise statutory and voluntary resources in the community to provide extra practical or emotional help.

Adaptation, Psychological

Thymic peptides, stress, and depressive symptoms in older men: a comparison of different statistical techniques for small samples.

Thymic peptides play an important role in aging and immune regulation, but little is known about their relationship to psychosocial factors. One thymic fraction, thymosin-alpha 1 (TSN-alpha 1) may be of particular interest given its hypothesized role in the differentiation of immature T cells into functional, mature T cells. We examined the relationships among stress, psychological symptoms, and TSN-alpha 1 levels in two conditions; before and after a glucose challenge test. The sample consisted of 18 men, aged 48-80, participants in the Normative Aging Study. While none of the correlations reached significance in the baseline condition, life events and depressive symptoms were significantly correlated with TSN-alpha 1 in the postchallenge condition (r's = .57, and .62, respectively). Hierarchical regression analyses with cross-product interaction terms suggested that individuals who were high in both life events and depression showed the highest levels of postchallenge TSN-alpha 1, with the psychosocial variables accounting for 65% of the variance. Given the small sample size, we replicated these analyses using jackknife and bootstrap techniques, which generally confirmed these findings. Thus, these preliminary results suggest that psychosocial factors may be related to abnormal TSN-alpha 1 responses to a challenge.

Aged

Personality and aging: a study of the MMPI-2 among older men.

We examined whether separate norms for older men are necessary for the revised Minnesota Multiphasic Personality Inventory (MMPI-2). Scores from 1,459 men in the Normative Aging Study (NAS) (age: M = 61.27, SD = 8.37) were contrasted with those from 1,138 men from the MMPI Restandardization Study (age: M = 41.71, SD = 15.32). Results showed that scores on the MMPI-2 validity, clinical, and content scales for the NAS men were highly similar to those from the MMPI-2 Restandardization sample. There were also few differences between the two groups at the item level. Within-sample analyses revealed some differences between age groups. However, the magnitudes of these differences were small and may represent the single or combined effects of cohort factors and age-related changes in physical health status rather than age-related changes in psychopathology per se. We concluded that special, age-related norms for the MMPI-2 are not needed for older men.

Adolescent

Longitudinal findings from the Normative Aging Study: II. Do emotionality and extraversion predict symptom change?

We investigated the relationship between the personality traits of emotionality and extraversion and symptom-reporting, both cross-sectionally and longitudinally. The sample consisted of 1,034 men, initially screened for good health, who completed both the 16PF and at least two CMIs, (M = 5, range = 2-8) over an average period of 17 years (range = 2-25). Using a two-stage growth model, we obtained a predicted baseline and slope for each man for self-reported physical and psychological symptoms. Correlations revealed that emotionality was positively related to the numbers of both physical and psychological symptoms reported at baseline, while extraversion was negatively related. However, regression analyses including age and both personality variables indicated that only emotionality was associated with level of symptom-reporting. Longitudinal analyses revealed that emotionality was unrelated to physical symptom slopes and only weakly related to psychological slopes. We interpret these results as showing that, while personality and symptom-reporting are related cross-sectionally, personality does not predict changes in symptom reporting.

Adult

Does emotionality predict stress? Findings from the normative aging study.

Investigated whether emotionality, assessed in 1975, predicted the reporting of both objective stress (life events) and subjective stress (hassles) 10 years later, and how emotionality affected the relation between both objective and subjective stress and mental health. The sample consisted of 1,159 older men, participants in the Normative Aging Study. Path analysis revealed that the reporting of stress was confounded with personality: Individuals higher in emotionality reported both more life events and more hassles. Furthermore, individuals higher in emotionality exhibited slightly higher levels of symptoms under stress than did individuals lower in emotionality. Nonetheless, both stress measures contributed independent variance to the prediction of psychological symptoms, even controlling for prior levels of emotionality. Implications for the assessment of stress are discussed.

Adaptation, Psychological

Longitudinal findings from the normative aging study: 1. Does mental health change with age?

Longitudinal changes in self-reported symptoms were investigated using the Cornell Medical Index (CMI) in a sample of 2,041 men. The average man completed 5 CMIs (range = 2-8) over 17 (range = 2-25) years. Using a two-stage growth model, we first regressed symptoms against time on study for each man. The average slope of physical symptoms showed a moderate increase over time, but the average slope of psychological symptoms showed little change. Next, individual differences in change were examined using age at entry as an explanatory variable. Age accounted for 50% of the variance in physical symptoms at entry and 7% of the variance in slopes, but explained neither baseline level nor change in psychological symptoms. Rather, a U-shaped curve described the relation between age and psychological symptom change. These results, in concert with a developmental perspective, may help reconcile conflicting findings on aging and mental health.

Adult

Utilization management in the small group insurance market.

Small businesses are the most rapidly growing segment of the economy, providing one half of all jobs in the United States. The health insurance industry must address issues which are unique to this market. The health insurance product for small businesses must have simple administration for the owners and easy access to quality medical care for the employees. Small businesses have been adversely affected by the high cost of health care. Numerous studies have shown that a major factor contributing to the high cost of health care is inappropriate and unnecessary utilization of health care. Until recently, techniques of utilization management have been difficult to adapt to the small group market. The Celtic Life Insurance Company has been using a managed care fee for service arrangement for the past three years. Celtic has been able to tailor a program for small businesses and maintain complete administrative coordination, instead of contracting with a private utilization review company. Our program maintains freedom of choice of providers and easy access to health care, without limiting access to specialists. Cost containment features have assisted insureds in selecting appropriate health care, in the appropriate setting while not interfering with the doctor-patient relationship.

Economic Competition

Cumulative and reversible effects of lifetime smoking on simple tests of lung function in adults.

Data from a random sample of 8,191 men and women from 6 U.S. cities are used to fit a model describing the effects of cumulative and current cigarette smoking on pulmonary function. The data show that smokers suffer an irreversible loss of FVC and FEV1, which is described by a linear function of their cumulative cigarette smoking as measured in pack-years. For a typical male 173 cm tall, the estimated loss of FEV1 is 7.4 ml for each pack-year smoked. For a typical woman, 161 cm tall, the estimated effect is 4.4 ml per pack-year. Current cigarette smoking adds an acute deficit over and above the cumulative effect of lifetime smoking. For any lifetime pack-years, exsmokers have higher levels of FEV1, 123 ml for a typical man, 107 ml for a typical woman, than do current smokers of a pack per day (p less than 0.001). A man who starts smoking one pack of cigarettes per day at 25 yr of age would at age 60, after 35 pack-years of exposure, have an expected FEV1 equal to that of a man 69.4 yr of age who had never smoked. If he stopped smoking at 60 yr of age, his expected level would increase to that of a 66.5-yr-old never-smoker. This model therefore estimates how much lung function is irreversibly lost by smoking, estimates how much could be regained with cessation of smoking, and predicts the future loss of lung function in both cases.

Adult

Respiratory muscle dysfunction in hereditary motor sensory neuropathy, type I.

Pulmonary function tests were performed on ten patients who were shown to have hereditary motor sensory neuropathy, type I. Mean values for spirometry, static lung volumes, and diffusion capacity were all greater than 80% of the predicted normal values for the group. In contrast, both inspiratory and expiratory muscle testing showed substantial reductions in function for the group. These abnormalities have not previously been reported, and they may be important in the management of these patients and in patients with other neuromuscular diseases.

Adolescent

Explaining discrepancies between longitudinal and cross-sectional models.

Data from longitudinal studies may be analyzed both cross-sectionally and longitudinally. Discrepancies between estimates obtained from these analyses pose questions about the validity of cross-sectional estimates of change. In some cases these discrepancies are the result of period effects, cohort effects, or selective dropout. In others, they are the result of incomplete modeling of the process and are spurious rather than substantive. In this report, we show that when the true relation between a dependent variable and age is non-linear (e.g. quadratic), but is modeled as linear, the estimated age effect will be a function of the age distribution. In a continuous-time idealization, if the age distribution is Gaussian, the estimated age effects agree. If the age distribution is symmetric and the non-linearity is quadratic, cross-sectional and longitudinal results agree. Otherwise they do not. We illustrate these points by analysis of the relation between aging and pulmonary function in middle and old age using data from a large, prospective, longitudinal study.

Adult

Some biophysical properties of the erythrocyte membrane in Duchenne muscular dystrophy.

Inasmuch as prior authors have suggested a 'generalized membrane defect' in patients with Duchenne muscular dystrophy, this study was undertaken to examine some biophysical properties of the erythrocytes in affected individuals. Using the micropipette technique we investigated the rheological properties of erythrocytes from 11 Duchenne muscular dystrophy patients (boys 3-14 years old) and 5 carriers (mothers 20-42 years old). The mean elastic modulus and membrane viscosity of the patient's erythrocytes were not significantly different from those of a group of 8 unaffected age-matched boys. The carrier group did not differ significantly from the adult control group in any of the rheological parameters. A significant increase in the number of stomatocytes was observed in the patient group, and a similar trend (not statistically significant) was observed in the carrier group. The membrane lipid fluidity of erythrocytes from patients, carriers, and normal controls was assessed with three different probes by fluorescence depolarization, and no significant differences were found. Our results indicate that there is a progressive elevation of the membrane elastic modulus with increasing age of the patients: the younger patients have a lower elastic modulus than their age-matched controls, while the older patients have a higher elastic modulus than their age-matched controls.

Adolescent

The fate of transposed immature muscle and its clinical application.

Transposition of muscles with their intact neurovascular bundles is a well-accepted procedure in the adult with a predictable outcome. The fate of transposed immature muscle, however, has not been studied. For this reason, muscles were transposed in three 6-week-old puppies and harvested when the puppies were 6 months old. The developing normal and transposed muscles were studied using serial biopsies, electromyography, and histochemical methods, and the growth in bulk was assessed by serial radiography and measurements of length, breadth, height, and weight of the muscles at death. As judged by these criteria, the transposed muscle developed normally. A patient with prune-belly syndrome, treated by muscle transpositions from thigh to abdomen with satisfactory results, is also described.

Aging

Distribution of forced expiratory volume in one second and forced vital capacity in healthy, white, adult never-smokers in six U.S. cities.

As part of a longitudinal study of the respiratory health effects of air pollution, we measured the lung function of 2,454 white adults 25 to 74 yr of age who had never smoked and who reported no respiratory symptoms. These measurements were analyzed to develop a simple model for the cross-sectional dependence of pulmonary function on height, sex, and age. Both forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) can be effectively standardized for body size by dividing each pulmonary function measurement by the square of the standing height (HT2). The age-specific distribution of these standardized measurements is approximately Gaussian, with variance that is independent of age. Plots of FEV1/HT2 and FVC/HT2 against age showed a nonlinear relationship consistent with an increase in the rate of pulmonary function loss with age. On the basis of these graphic analyses, both pulmonary function measurements were fitted to a four-parameter normative model including sex and linear and quadratic terms in age as dependent variables. This model gave predictions that were very close to those from more complicated models currently in use. Predicted percentile levels were calculated for each sex and age, and shown to describe the observations well. The estimated annual change in height-standardized lung function based on the cross-sectional model was compared with the observed change between the first and second examinations of these adults 3 yr later. The observed changes were close to predicted values, except for subjects younger than 35 yr of age at their first examination. The observed change was larger for men than for women. Such simple longitudinal comparisons are subject to selection bias. In this study, subjects in the lowest quartile of FEV1/HT2 for their age and sex at the first examination had a lower probability of providing a lung function measurement 3 yr later.

Adult

Effects of passive smoking on health of children.

Analysis of data on the effects of passive smoking obtained in preadolescent children from the Harvard Six-Cities Study demonstrates an exposure-response relationship between the number of smokers in the household and the reporting rates for doctor-diagnosed respiratory illness before age 2, history of bronchitis, wheeze most days and nights apart from colds, and a composite of symptoms defined as the lower respiratory index. Similarly, when only the amount currently smoked by the mother was used, the data indicated a relatively uniform increase in each of the reported diseases and symptoms. FEV1 was lower in children with smoking mothers compared to children of nonsmoking mothers. Rate of increases in FEV1 after adjusting for normal growth was significantly smaller in children of smoking mothers and was related also to amount smoked. Notably the effect on level of FVC was not seen and this finding, consistent in several studies, remains unexplained. Although children of smoking mothers were shorter on the average than children of nonsmoking mothers, no on-going passive smoking effect on height growth can be ascertained. All these differences are small and their medical significance remains to be defined.

Body Height

Sensory neuropathy with onion-bulb formation. Report of a case with onset in infancy.

A 27-month-old girl suffered from severe sensory neuropathy with minimal motor dysfunction. The CSF protein level was increased and nerve conduction was severely impaired. Sural nerve biopsy specimen showed increased endoneurial connective tissue. An onion-bulb pattern with concentric interdigitations of Schwann cell cytoplasmic processes and redunbant basal laminae were prominent features under electron microscopy. Degress of myelination in individual fiber was far less than expected. Although the clinical manifestations of onion-bulb neuropathy with onset in infancy have been reported to resemble infantile progressive spinal muscular atrophy, the present case demonstrates that the condition can also appear as severe sensory ataxia.

Ataxia