Biomedical subjects

D Jarjoura

Publications and source records attributed to D Jarjoura.

9 recordsLinked to original sources

PubMed1992

Recognition of depression by internal medicine residents.

We studied the ability of internal medicine residents to recognize depressive symptoms in a population of lower socio-economic primary care patients. Four hundred twenty patients completed the short form of the Beck Depression Inventory (BDI). Simultaneously, the resident caring for the patient estimated the degree of depression for each patient. One-fourth of the patients scored at or above the moderately depressed level on the BDI and the residents rated 23 percent of their patients as at least moderately depressed. However, the accuracy of the residents' assessment of his or her individual patient was poor (correlation = 0.42, sensitivity = 0.46, specificity = 0.84). Patients with a prior history of psychiatric disorder scored higher on the BDI and were given higher ratings of depression. No other pre-existing medical condition was significantly associated with a higher or lower BDI score. The amount of alcohol consumed and the amount smoked, were both associated with higher BDI scores. Residents varied in their sensitivity to their patients' BDI scores. Some showed high agreement with BDI scores, others low. There were no specific resident characteristics (e.g. year of training, resident gender) that could explain this variability. Patients with a history of depression were given lower resident ratings compared to other patients and patients with a history of depression were given lower resident ratings than predicted by their BDI scores. Residents' ability to accurately diagnose and treat depression in the underprivileged primary care patient can be facilitated by the institution of depression screening in the ambulatory clinic.

Adolescent↗

PubMed1992

Searching for a pattern: repeat suicide attempts.

1. Although there is a large population of unsuccessful suicide attempts and the same patients are often admitted repeatedly, little investigation has been done to understand this group. 2. Prescription drugs were almost always used in overdose attempts. There was no indication that physicians successfully intervened in preventing abuse of prescribed medication among patients with a history of overdose suicide attempt. 3. Most people choose a method for suicide and repeatedly use the same method (physical versus overdose). The majority of repeat attempts occurred among young people, and alcohol use was especially high when physical methods were used. Identification of these trends could lead to effective intervention.

Alcohol Drinking↗

PubMed1991

Elapsed time from symptom onset and acute myocardial infarction in a community hospital.

STUDY OBJECTIVE: Previous reports have emphasized that thrombolytic therapy for acute myocardial infarction should be initiated within three or four hours of symptom onset to obtain the best clinical outcomes. However, our clinical impression was that late arrivers, who often do not receive thrombolytic therapy, have a good short-term prognosis. Therefore, we investigated the relationships among the elapsed time from symptom onset, thrombolytic therapy, and short-term prognosis in acute myocardial infarction patients. The research hypothesis was that late arrivers have a better in-hospital prognosis because they have less severe disease that may involve spontaneous thrombolysis. DESIGN: Observational cohort study based on reviewing medical records and emergency department service logs. SETTING: 500-bed teaching hospital with medical school affiliation in northeastern Ohio. TYPE OF PARTICIPANTS: Four hundred consecutive patients with acute infarction confirmed by chest pain and positive ECGs or elevated cardiac enzymes. MEASUREMENTS AND MAIN RESULTS: Patients arriving early (elapsed time less than or equal to 1.5 hours) were more likely to be in Killip class III or IV (P = .04) or to have hypotension (P = .0004); and they experienced twofold increased odds of ventricular tachycardia (P = .007), cardiac arrest (P = .03), or death (P = .01). Patients arriving late (elapsed time greater than 3.5 hours) were more likely to have a history of angina (P = .002) and had a better short-term prognosis. CONCLUSIONS: Time of ED arrival after onset of acute myocardial infarction symptoms distinguishes two patient groups that differ in their risk of in-hospital complications. Late arrivers have better short-term prognoses and less (acutely) severe disease, and may have less need for thrombolytic therapy because of possible spontaneous thrombolysis. Patients with prior angina may need education on seeking care if their symptoms change.

Aged↗

PubMed1990

Variation in heart disease mortality across census tracts as a function of overdispersion and social class mixture.

Variation in heart disease (HD) mortality rates across census tracts is greater than expected given binomial error and available explanatory variables. We extended an extra-binomial variation model for rates standardized by the direct method. The overdispersion parameter accounted for 36 per cent of the observed variation in standardized rates. Ignoring overdispersion resulted in a change in an estimate of the effect of social class on HD mortality and substantial underestimation of the error of the estimates of such effects. Ecologic regression on the proportional mixture of social classes within tracts provided an appealing approach to the problem of estimating fixed effects with aggregated data.

Adolescent↗

PubMed1990

Modeling heart disease mortality with census tract rates and social class mixtures.

The relationship between social class and 1980 heart disease (HD) mortality in eight urban U.S. counties was examined by regressing age and sex adjusted census tract specific HD rates (N = 1211) on tract social class characteristics. The regression model indicated that lower middle class residents experienced a HD mortality rate 1.9 (95% CI = 1.3, 2.8) times the rate in the upper middle/middle class, while the working poor experienced a HD rate 4.4 (95% CI = 3.5, 5.7) times the rate in the referent class. Similar class effects were seen for both black and nonblack residents. The crude race effect (1.3 with 95% CI = 1.2, 1.4) was explainable by the concentration of blacks in the lower classes. The methods illustrate the ecologic regression of mixtures of mortality rates on mixtures of exposure in the presence of random tract effects which eliminates some of the problems associated with small denominators or zero rates in some tracts.

Coronary Disease↗

PubMed1990

Cardiomyocyte aging and hypertrophy: atrial and ventricular changes in normal and myopathic Syrian hamsters.

Cardiac eccentric hypertrophy is associated with complex architectural and metabolic alterations. Atrial and ventricular myocyte diameters in cardiomyopathic (Bio 14.6) and age-matched control (F1b) Syrian hamsters were compared and histopathology was examined by electron microscopy. The mean diameter of ventricular myocyte diameters increased with age in both F1b and Bio 14.6 hamsters. Significantly greater hypertrophy was noted in the Bio 14.6 left ventricle myocytes than the F1b. Histo- and cytopathologic findings included amitotic myocardial divisions and focal myocyte necrosis in Bio hearts. Sarcomere length appeared to be similar across age and strain; however, wider sarcomeres were found in conjunction with wider diameters of myopathic left ventricle myocytes. Moreover, F1b hamsters' atrial myocytes maintained a static diameter, while those of the Bio 14.6 showed hypertrophy even preceding ventricular changes. These findings indicated that the cardiomyopathic heart is characterized by a continued fiber hypertrophy despite cardiac decompensation. Other histopathological findings included amitotic myocardial divisions, focal necrosis and sarcoplasmic widening of Z-lines. In addition, vascular smooth muscles of Bio 14.6 demonstrated vacuolization.

Aging↗

PubMed1989

Risk of imbalance in elderly people with impaired hearing or vision.

We evaluated the effect of impaired hearing and vision on balance in a sample of 977 elderly people residing in the community. Of the sample, 21% reported balance problems, 27% vision problems, and 30% hearing problems. The increased relative risk for balance problems was 1.7 for each 10-year age increment. Women were 1.7 times more likely to report balance problems than were men. The relative risk of imbalance with impaired vision decreased with age from 2.8 in those aged 65-69 years to 1.0 in those over 85 years. There was no age-hearing interaction, the relative risk for impaired hearing is 1.6. It appears that impaired vision and hearing are important risk factors for imbalance and perhaps falls and injury.

Accidental Falls↗

PubMed1989

Weight gain in supervised and take-home feeding programmes in Chad.

The rehabilitative effects of a supplementary feeding programme for Chadian children are reported. Both feeding centre-based and take-home premix strategies for the delivery of an 821 kcal/day porridge supplement were employed. A total of 641 malnourished children no more than 80 per cent median reference weight for height from two nomad reinstallation camps were enrolled in a supervised feeding programme. In a third camp, 133 children were enrolled in a take-home feeding programme. The mean length-of-stay in the programmes was 59 days. A regression model was developed to permit analysis of anthropometric data obtained from follow-up measures varying in number and distribution across time. The model estimates indicate that the supervised group had an average weight gain 60 days after enrollment of 1013 g, while the take-home group had an average 60-day gain of 951 g. The 62 g difference in the two strategies is not significantly greater than zero (P = 0.56).

Chad↗

PubMedDate not supplied

Dialysis leg cramps. Efficacy of quinine versus vitamin E.

A controlled randomized double-blind study was done to determine the frequency and severity of leg cramps in 40 patients on dialysis with a history of leg cramps. All patients entered a 2 month placebo washout and were randomized into a 2 month double-dummy phase of quinine 325 mg at bedtime versus vitamin E 400 IU at bedtime. Of the 29 patients completing the study, 16 received quinine and 13 vitamin E. During placebo washout, the vitamin E group had a mean of 10.4 leg cramps per month, and the quinine group had a mean of 10.9. The vitamin E and quinine groups had a 1 month reduction in leg cramps to 3.3 and 3.6, respectively (p < 0.0005 for both groups combined); this was sustained at 2 months. A severity of pain index showed a statistically significant decrease for both groups. The 95% confidence interval for the difference between the number of leg cramps after vitamin E versus quinine treatment (95% confidence interval, -3.8, +3.2) suggests similar efficacy. Quinine and vitamin E were effective treatments for leg cramps in these patients. Considering the potential toxicity of quinine, vitamin E is recommended as the initial treatment of choice for patients on dialysis with leg cramps.

Adult↗