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Biomedical subjects

B L Martz

Publications and source records attributed to B L Martz.

At least 19 recordsLinked to original sources

A model for predicting depression in elderly tenants of public housing.

To assess the prevalence of and risk factors for depression in an older population, the Multilevel Assessment Instrument (MAI) and the Center for Epidemiological Studies Depression Scale (CES-D) were administered to 176 elderly residents of a public housing apartment building in Indianapolis. The 41 patients diagnosed by the CES-D as depressed had significantly lower scores on MAI measures of psychological adjustment, cognitive function, and physical health compared with the nondepressed respondents and were more likely to have had episodes of anxiety and depression in the year before the study. Four variables--respondents' overall physical health as measured by the MAI, days spent sick in bed during the past year, living alone, and educational level--explained some of the variance between the CES-D scores of the depressed and nondepressed patients. A model for predicting current levels of depressive symptomatology based on scores on each of these four variables distinguished the depressed from the nondepressed tenants more than 80 percent of the time.

Aged

The effects of positive and negative life changes on the self-reported health status of elderly adults.

We examined the effects of (a) positive and negative life changes and (b) social support upon the self-reported health status of 187 elderly public housing tenants. Our interview included the Multilevel Assessment Instrument, from which we derived physical health and social support scores, and an evaluation of change in 14 areas. Experiencing change correlated inversely, although weakly, with health (R2 = .05); however, negative changes were more predictive of health status than were total changes (R2 = .25). In multivariate analyses, persons who were older and experienced more positive and less negative changes during the preceding year reported better health (R2 = .30). Social support had neither a direct nor interactive effect (with life change) upon health. We conclude that studies on life changes should separate positive from negative events. Also, more research on the measurement of social support for elderly adults is needed.

Age Factors

Medication use by ambulatory elderly. An in-home survey.

The elderly residents of an urban subsidized apartment building were interviewed in their apartments to determine a comprehensive medication profile. The interviews were conducted by doctor of pharmacy candidates, and 155 residents (81.2%) participated. Compliance was similar to rates previously reported (49.3%), and adverse drug reactions were common (29.1%). Other findings included: compliance did not decrease with advancing age; most elderly individuals could open child-resistant containers (83.4%), read standard container labels (79.7%), and identify teaspoon (97.3%) and tablespoon (88.5%) quantities; inability to open easy-open (flip-off) containers decreased compliance (P = .03); men were more compliant than women (68.4 v 42.4%, P = .006) but were taking fewer medications (3.3 per male v 5.0 per female); only 12.6% of respondents thought they were taking too much medication but when they did compliance diminished (P = .003); medications were infrequently shared (5.6% of respondents reported sharing); and only 6.4% of respondents reported medication expense as a concern.

Adult

Factors contributing to medication noncompliance in elderly public housing tenants.

A study examined the extent and correlates of noncompliance in 155 predominantly elderly public housing tenants. Data were gathered through in-home interviews; only data from tenants taking prescribed medications on a regularly scheduled basis (n = 140) were analyzed. Noncompliance was significantly (p less than 0.05) associated with taking more than five prescribed medications, an inability to read prescription and auxiliary labels, and difficulty opening flip-off type medication container lids. The results indicate that attempts to reduce the total number of prescription drug products used in these elderly residents by carefully scrutinizing the need for each prescription drug may enhance compliance. Pharmacists could assist in the detection of elderly patients at risk for medication noncompliance (five or more total prescription medications) by assessing the patients' ability to read labels on prescription containers for all new drug additions and refills, and by having them try to open a flip-off container lid.

Aged

Self-rated health as a predictor of hospital admission and nursing home placement in elderly public housing tenants.

We assessed the validity of self-rated health in a one-year prospective study of 155 elderly public housing tenants. Compared to studies of elderly community residents, tenants had poorer self-rated health, and higher hospital admission and nursing home placement rates. Poor self-rated health was a risk factor for both outcomes. We conclude that self-rated health may be useful in identifying persons at increased risk for hospital admission and nursing home placement.

Aged

Safety and effectiveness of probucol as a cholesterol lowering agent.

Monitored clinical studies conducted in 1133 patients, involving 3928 patient years of experience with probucol, have shown that it is an effective cholesterol lowering agent and is well tolerated during long term administration (some patients treated for as long as nine years). The incidence of morbidity and mortality in patients treated with probucol is in the expected range. Although a possibly protective action is suggestive against certain endpoints, the lack of long term parallel placebo groups does not allow for a statistical contrast of the results. Therefore, it is preferable to limit conclusions to observing that no excess of cardiac deaths, sudden deaths or cardiac morbidity occurred in probucol treated men with or without ischemic heart disease compared with men not receiving probucol.

Adult

[A long-term (9 years) clinical study of the safety and efficacy of probucol, and an analysis of morbidity and mortality rates (author's transl)].

The lowering effect of probucol on plasma cholesterol was confirmed in 1 133 patients. The study covered 9 years and approximately 4 000 patient-years. The daily dosage of probucol was 1 g divided into two 500 mg doses. On average, plasma cholesterol values decreased from 300 mg/dl to about 240 mg/dl. There was no tendency to escape. The study also included measurements of plasma probucol in patients under long-term treatment. The drug was generally well tolerated; the only complaints were episodes of loose stools or diarrhea which did not usually oblige to interrupt treatment. The morbidity and mortality rates in these 1 133 patients were compared with those of two major epidemiological surveys: the Coronary Drug Project and the WHO studies. Statistical analysis was impossible, as our long-term trial did not include patients under placebo. However, no unexpected overall excess of mortality was observed with long-term probucol treatment; there was no increase in morbidity, nor in sudden deaths or deaths from coronary disease. These findings apply equally to patients with or without a history of coronary disease prior to their entry into the trial.

Adult

Comparative plasma concentrations of quinidine following administration of one intramuscular and three oral formulations to 13 human subjects.

A GLC method, based on flame-ionization detection, was developed for the assay of methotrimeprazine and its sulfoxide in plasma. For a 6-ml aliquot, the sensitivity was 2-3 ng/ml for the unchanged drug and 4-5 ng/ml for the sulfoxide. The coefficient of variation, calculated from duplicate analyses of plasma samples, was 8-15% for concentrations between 10 and 100 ng/ml. Patients treated with orally administered methotrimeprazine had higher plasma levels of the sulfoxide than of unmetabolized drug. The method also was applied to the analysis of promazine and chlorpromazine in patient plasma.

Administration, Oral

Panel 2: phase II investigations.

At the end of Phase II, a decision must be made as to whether or not the drug should be developed as a therapeutic agent. Such a decision may be based on many criteria in addition to the scientific data derived from the Phase II study. At this point, expert judgment is needed. One should like to assume that if the decision is made to proceed with the increasingly expensive and laborious process of further development, the drug will, barring some completely unforeseen misadventure, ultimately find its way into clinical therapeutics. Phase II studies, therefore, are the most crucial stage in the course of drug development. Planning of these studies requires great care and investigators of the highest caliber should be used for their conduct. The escalating costs of new drug development are resulting in an undesirable imbalance of efforts in the direction of studies characterized more by easily defined end points than by therapeutic needs. Industry, academia, and the FDA must all be concerned with facilitationg studies in areas of most-needed therapeutic advances.

Clinical Trials as Topic