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Biomedical subjects

D Shapiro

Publications and source records attributed to D Shapiro.

At least 55 records · Page 3Linked to original sources
PubMed1997

Reduction in drug requirements for hypertension by means of a cognitive-behavioral intervention.

The purpose of the present study was to test the effectiveness of a cognitive-behavioral intervention as an adjunctive treatment of hypertension. To qualify for the study, subjects had to have an unmedicated clinic diastolic blood pressure > or = 95 mm Hg. After qualification, minimal drug requirements were established using a diuretic and a beta-blocker to control blood pressure at < or = 90 mm Hg. Subjects were then randomized into a 6-week cognitive-behavioral intervention or a measurements-only control group. After the treatment phase, medication levels were reduced in all subjects by means of a systematic stepdown procedure. Subjects were followed for 1 year after the stepdown was completed. Addition of the cognitive-behavioral intervention was twice as effective as the control procedure in reducing drug requirements. At 12-months follow-up, 73% of the treatment group were at lower levels of medication than at the time of randomization, compared to 35% in the control group. Moreover, 55% of the treatment group remained completely free of medication, compared to 30% of the control group, at the 12-month follow-up. The reductions in medication were associated with maintained controlled levels of clinic, ambulatory, and home blood pressure. The addition of a standardized and inexpensive group-administered cognitive-behavioral intervention to the drug treatment of hypertension is beneficial as an adjunctive treatment in reducing drug requirements for patients with hypertension, thereby reducing the costs and potential side effects of antihypertensive medications.

Adrenergic beta-Antagonists↗
PubMed1997

Daily mood states and ambulatory blood pressure.

In this study, we examined relationships between moods and both ambulatory blood pressure and heart rate in 197 men and women college students. Participants who reported frequently feeling angry during the day had higher levels of blood pressure, especially diastolic pressure during sleep. Reports of sad feelings were positively correlated and reports of pleasant or happy were negatively correlated with diastolic pressure during sleep. Participants scoring high on hostility and anxiety trait measures and low on defensiveness reported negative moods more frequently. Cluster analysis identified different mood profiles. Participants characterized by reports of all negative moods plus anger had high scores on trait hostility and consistently higher levels of blood pressure, particularly diastolic pressure during sleep. Heart rate was not related to mood reports. Hostile and anxious behavioral dispositions may play a role in sleep disturbance and high levels of blood pressure. Positive moods may counter these effects.

Adult↗
PubMed1997

Hostility, testosterone, and vascular reactivity to stress: effects of sex.

This study investigated the association of personality with cardiovascular stress reactivity (CVR) in men and women. Also, the degree to which testosterone and estradiol reactivity were related to personality and CVR measures was examined. Twenty-six men and 44 women completed the Cook-Medley Hostility Scale, the Beck Depression Inventory, and the Spielberger Trait Anxiety Inventory before speech, Stroop, and math stress. Testosterone (men) and estradiol (subset of women) were sampled once after an initial rest period and again after the last stressor. Cardiovascular reactivity, including cardiac output and total peripheral resistance (TPR), was assessed during stressors. For men, testosterone increased significantly with stress, and testosterone reactivity to stressors was significantly correlated with hostility. However, stepwise multiple regression revealed that hostility was the only independent predictor of CVR to speech, math, and Stroop stress in men, accounting for 13%-32% of the variance in TPR. Baseline systolic blood pressure explained 22% of the variance in TPR reactivity to speech preparation. No evidence was obtained to suggest that hostility, depressive mood, or anxiety predicted CVR in women, and estradiol did not show stress-sensitive effects. These data provide evidence that increased vascular reactivity may be one mechanism linking hostility to increased cardiovascular mortality in men and support the notion that hostility may have different implications for CVR in women.

Journal Article↗
PubMed1997

Cerebral laterality, repressive coping, autonomic arousal, and human bonding.

Jim Henry wrote extensively about emotional expressive styles, such as alexithymia which is characterized by reduced awareness of one's own or others' feelings and emotions, and their relation to cerebral hemispheric asymmetries. The repressive coping style is a stable individual characteristic, which is marked by reduced and minimized reports of stress coupled with higher levels of autonomic, somatic, and behavioural responsivity. The apparent dissociation between subjective and physiological response may be associated with a functional disconnection between the two cerebral hemispheres and with greater cerebral lateralization. To test this hypothesis, we reexamined data from a study in which emotional and neutral slides were presented unilaterally to the left and right hemisphere. Exposure duration was 200 ms. Subjects were divided into four different coping styles based on their defensiveness and anxiety scores. Repressive copers were the only group to show a significant cardiac response (heart rate deceleration) to emotional material when it was presented to the right but not to the left hemisphere. These findings and the fact that repressive copers have a high need for social approval support Henry's views about the role of the right hemisphere in affiliation and human bonding.

Adaptation, Psychological↗
PubMed1996

Clinical trials.

Explore the source record for details and available documents.

Clinical Trials as Topic↗
PubMed1996

Fertility decline in Kinshasa.

This paper examines key socio-economic changes over the past 40 years in the lives of women in Kinshasa, Zaire, and how those changes relate to observed fertility behaviour. Data from surveys carried out in 1955, 1975, and 1990 are used to highlight the remarkable shift that has taken place in the educational attainment of women: in the 1950s the vast majority of adult women had no formal education, while by 1990 the median woman had been to secondary school. This dramatic shift was accompanied by several related changes, including delays in age at marriage and increased participation in the labour market. Total fertility, which was estimated at 7.5 in the 1950s and had not changed much by 1975, appears to have fallen more recently, by about 1.5 children or more. This decline in fertility appears to be closely linked to the improvements in secondary schooling for women in Kinshasa.

Democratic Republic of the Congo↗
PubMed1996

Craniofacial injuries resulting from taxicab accidents in New York City.

Taxicab accidents are a common occurrence in New York City. This review was undertaken to characterize the nature of craniofacial injuries that result from taxicab accidents. Data were collected on 16 patients who required admission to trauma or plastic and reconstructive surgery services, after sustaining craniofacial injury as a result of a taxicab accident. Front-end deceleration collisions were the most common mechanism of injury. Fifty-six percent of the patients were thrown against the bulletproof, Plexiglas driver safety divider and sustained an injury most commonly to the anterior midface. Both bony and soft-tissue injuries were common in the entire group. Complex facial fractures were sustained by 56% of patients, with nasal-septal fractures most common, followed by naso-ethmoid-orbital, anterior frontal, anterior maxillary, and Le Fort I and II fractures. Only 1 patient in the group was wearing a seat belt and that patient was a driver. Given the high incidence of craniofacial injury, appropriate safety standards for taxicabs must be initiated, including the reevaluation of the utility of the safety divider and mandatory seat belt use for rear-seat passengers.

Accidents, Traffic↗
PubMed1996

Blood pressure publication guidelines. Society for Psychophysical Research.

Blood pressure is one of the most commonly recorded functions in physiology and medicine, and it has become a major variable in recent psychophysiological and behavioral medicine research. Many methods have been developed for the measurement of blood pressure in clinical, laboratory, and natural settings. The broad objectives of this report are to summarize the most critical methodological issues in the measurement of blood pressure and to present principles and recommendations for the evaluation of blood pressure methods and findings in published studies.

Blood Pressure↗
PubMed1996

The role of the right hemisphere in the physiological and cognitive components of emotional processing.

Right hemisphere specialization for emotional processing was investigated using behavioral and psychophysiological methods. Fifty undergraduates were shown slides depicting negative emotional and neutral scenes briefly lateralized to the right or left cerebral hemispheres and asked to categorize each as emotional or neutral. Pulse volume and heart rate (HR) measured physiological processing and reaction time measured cognitive processing. The largest vasoconstriction responses and HR deceleration were obtained for emotional items in the right hemisphere. However, reaction time failed to show right hemisphere superiority in perceptual/cognitive processing, demonstrating instead slowest responses to emotional stimuli presented to the right hemisphere together with evidence for left hemisphere competence. Selective right hemispheric activation in autonomic responses, combined with the lack of right hemisphere specialization in the cognitive task, suggests that the physiological response system rather than the perceptual/cognitive system is the locus of the right hemisphere superiority for emotion.

Adult↗
PubMed1996

Who is dentally anxious? Concordance between measures of dental anxiety.

Studies of the prevalence of dental anxiety in general population samples have produced estimates which range from a low of 2.6% to a high of 20.4%. It is not clear whether these reflect real differences among populations or whether they are the result of the use of different measures and different cut-off points. We undertook a large scale mail survey of dental anxiety in a random sample of the adult population living in Metropolitan Toronto designed to assess the performance of and agreement between three measures. These were Corah's DAS, the single item used by Milgrom and colleagues in Seattle and the ten-point fear scale used by Gatchel. These measures and their published cut-off points produced prevalence estimates of 10.9%, 23.4% and 8.2% respectively. While there was a significant association between scores on pairs of measures the agreement between them was far from perfect. Kappa values ranged from 0.37 to 0.56, indicating only fair to moderate agreement beyond chance. There was evidence to indicate that the dentally anxious subjects identified by each measure differed according to certain behavioural and other characteristics. The results of the study suggest the need to revisit the issue of measurement in studies of dental anxiety.

Adolescent↗
PubMed1996

Character and psychotherapy.

Psychoanalytic theory of psychopathology began as a theory of particular pathogenic agents in the form of repressed memories or drive-generated fantasies. It has developed in the direction of a theory of the mind's organization; that is, a theory of character pathology. A characterological understanding of psychopathology enlarges therapeutic attention beyond the patient's verbal references and toward the patient himself in the "here and now."

Character↗
PubMed1996

Efficacy and Tolerability of Low-dose Simvastatin and Niacin, Alone and in Combination, in Patients With Combined Hyperlipidemia: A Prospective Trial.

BACKGROUND: Combination lipid-lowering therapy may be desirable in patients with elevated low-density lipoprotein cholesterol, high triglycerides, and low high-density lipoprotein cholesterol. This study was conducted to determine the lipid-lowering efficacy of the combination of low-dose simvastatin and niacin in patients with combined hyperlipidemia and low high-density lipoprotein cholesterol. METHODS AND RESULTS: In this multicenter, prospective, randomized trial, 180 patients with hypercholesterolemia and hypertriglyceridemia and/or low high-density lipoprotein cholesterol were randomized to combination simvastatin (10 mg/day) and niacin (0.75 g/day) or to either drug alone for 9 weeks. The dose of niacin was doubled (from 0.75 g/day to 1.5 g/day) in both the combination and niacin arms for the remaining 8 weeks. The combination of simvastatin, 10 mg/day, and niacin, 1.5 g/day, reduced total, low-density lipoprotein, and very low-density lipoprotein cholesterol and triglycerides by 24%, 29%, 45%, and 31%, respectively, while increasing high-density lipoprotein cholesterol by 31%. The addition of niacin to simvastatin did not enhance the low-density lipoprotein cholesterol by 31%. The addition of niacin to simvastatin did not enhance the low-density lipoprotein cholesterol-lowering effect of simvastatin; however, the combination was more effective than either monotherapy at raising high-density lipoprotein cholesterol and lowering very low-density lipoprotein cholesterol (P <.05). More patients discontinued treatment because of an adverse event in the niacin (P <.03) and combination groups (P =.06) than the simvastatin group. CONCLUSIONS: Treatment of patients with combined hyperlipidemia and/or low high-density lipoprotein with combination low-dose simvastatin and niacin resulted in large reductions in total, low-density lipoprotein, and very low-density lipoprotein cholesterol and increases in HDL cholesterol. Although the combination was well tolerated in the current trial, its safety needs to be evaluated in larger trials of longer duration.

Journal Article↗
PubMed1996

Size-dependent neural integration between genetically different colonies of a marine bryozoan

Although the formation of genetic chimeras is rare in the animal kingdom, it has long been known that colonial marine invertebrates fuse under natural conditions, forming genetic chimeras. I report here an example of selective, partial fusion. When small colonies of the encrusting marine bryozoan Membranipora membranacea grow into contact, they usually become behaviorally coordinated: if one colony is disturbed, both colonies will simultaneously retract their feeding structures (lophophores). As a first step towards understanding the fitness consequences of this type of apparent fusion, I examine its mechanistic basis. Using assays of zooid behavior, electrophysiological recordings and 14C-labeled metabolites, I demonstrate that physiological integration between M. membranacea colonies is both partial and temporary. Specifically, this study demonstrates (1) that behavioral coordination is the result of neural integration between colonies, (2) that coordinated colony pairs do not exchange metabolites, and (3) that neural integration is a temporary phenomenon that is terminated as colonies grow larger. Additionally, I show that only those zooids at the middle of the intercolony border mediate neural integration. Partial physiological integration between M. membranacea colonies could be a highly specific interaction that increases the potential benefits of fusion (i.e. neural integration) while minimizing the potential costs (i.e. resource parasitism).

Journal Article↗
PubMed1996

Negative dental experiences and their relationship to dental anxiety.

Although negative dental experiences are often cited as the major factor in the development of dental anxiety, very few studies have provided data on their prevalence. The studies that are available used limited samples from which it is not possible to generalise, or confined their enquiries to painful experiences only. In this paper data are provided on negative dental experiences and their relationship to dental anxiety obtained from a large, random sample of the general population. Just over three-quarters reported what are termed as direct negative experiences; 71 per cent had had experiences that were painful, 23 per cent experiences that were frightening and 9 per cent experiences that were embarrassing. Such experiences were not confined to childhood. For 23 per cent, the first experience of this kind happened during adolescence and for 40 per cent in adulthood. The relationship between these experiences and dental anxiety was strong. Subjects reporting all three types of experience were 22.4 times at risk of being dentally anxious than subjects reporting none of them. The data suggested that the nature of these unpleasant experiences was more important than the age at which they occurred in predicting dental anxiety. One third of dentally anxious subjects reported a negative response experience in the form of feeling faint, fainting or having a panic attack while at the dentist. Further research using more appropriate methods is needed to clarify the role of dental experiences in the genesis of dental anxiety.

Adolescent↗
PubMed1995

Concordant loss of imprinting of the human insulin-like growth factor II gene promoters in cancer.

The human insulin-like growth factor II (IGFII) gene has been shown to be imprinted for the promoters P2, P3, and P4 but not for the promoter P1 in liver and chondrocytes. Loss of imprinting of the IGFII gene has been found in a variety of human tumors including rhabdomyosarcoma and lung cancer. In this report, we determined whether loss of imprinting in tumors displays a promoter-specific pattern. We examined allelic expression of all four IGFII promoters in rhabdomyosarcoma, lung cancer, and normal skeletal muscle. We demonstrate that the imprinting of all IGFII promoters is relaxed in rhabdomyosarcoma and lung cancer. These data suggest that loss of imprinting of IGFII gene promoters may be regulated coordinately by a common mechanism in these tumors. Unexpectedly, we also found that P1, in addition to P2, P3, and P4 is monoallelically expressed in three informative adult skeletal muscle tissues. This indicates that imprinting of the IGFII promoter P1 occurs in a tissue-specific manner.

Adult↗
PubMed1995

Ambulatory monitoring of panic patients during regular activity: a preliminary report.

Ten patients with panic disorder and 10 matched control subjects were compared as to their blood pressure and heart rate during regular daily activity. Physiological responses were monitored by ambulatory recorder, and subjective reports of mood were collected. Data were analyzed controlling for activity and stress level of the subjects. Diastolic blood pressure emerged as a possible discriminatory factor between the groups. A trend for higher heart rate occurred in the panic group. In behavioral terms, panic patients tended to avoid anxiety-provoking situations, resulting in anxiety ratings comparable to those of the control group. Thus, recorded physiological differences between the groups may reflect heightened baseline autonomic activity in panic patients.

Activities of Daily Living↗
PubMed1995

Long-term efficacy and tolerability of simvastatin in a large cohort of elderly hypercholesterolemic patients.

The long-term efficacy and tolerability of simvastatin, a 3-hydroxy-3-methylglutaryl-co-enzyme A (HMG-CoA) reductase inhibitor, was assessed during a 24-month follow-up period in 168 elderly hypercholesterolemic patients. After completing a 4 week double blind dose ranging study with simvastatin, 47 males and 122 females over 62 years of age with type II hyperlipidemia, a total cholesterol level above 6.5 mmol/l and clinically manifest cardiovascular disease were included in this extended study. A total of 159 patients completed the 12-month follow-up period and 141 patients were monitored over the full 24 months. All patients were started on 10 mg simvastatin once daily and the dosage was increased until the target levels of low density lipoprotein (LDL) cholesterol between 2.3 mmol/l (90 mg/dl) and 3.6 mmol/l (140 mg/dl) were reached. Fifty percent of patients reached the targeted LDL cholesterol goal of < 3.6 mmol/l (140 mg/dl) during the study. At study completion, 65 patients (39%) were taking 40 mg simvastatin per day, 56 patients (33%) 20 mg, 42 patients (25%) 10 mg and 5 patients (3%) only used 5 mg per day. Sixteen patients (9%) received concomitant lipid lowering therapy. Over 2 years, the mean decrease in LDL cholesterol ranged from 36% to 38%, the median decrease in triglycerides was 12% to 19% and the mean increase in high density lipoprotein (HDL) cholesterol ranged from 9% to 10%, respectively. Seven patients discontinued simvastatin because of adverse clinical or laboratory events, but only in two (1.1%) was this considered to be drug-related. Side-effects were mild and most frequently gastrointestinal in nature. Mean changes in asparate aminotransferase (AST) were not significantly different from zero and mean changes in alanine aminotransferase (ALT) and creatine phosphokinase (CPK) showed a small increase. We conclude that simvastatin is an efficacious and well-tolerated treatment for hypercholesterolemia in elderly individuals for extended periods.

Aged↗