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Denis M McCarthy

Publications and source records attributed to Denis M McCarthy.

31 records · Page 2Linked to original sources
PubMed2003

Strategies for reduction and cessation of alcohol use: adolescent preferences.

BACKGROUND: Although the majority of youth and adults resolve alcohol problems without formal treatment, we know little about the strategies used by youth in their efforts to decrease alcohol use. Recent studies have begun to address change efforts that adolescents report being helpful in cutting down or stopping alcohol use. The current study seeks to improve our understanding of adolescent change processes in alcohol use by examining the perceptions of high school students. METHODS: As part of a secondary alcohol intervention study of high school students (ages 12-18; 51% male), 1069 participants completed an anonymous supplemental questionnaire on change strategies for cutting down and stopping alcohol use. Based on content analysis of youth-generated responses, a classification system consisting of nine broad categories was developed (e.g., informal-interpersonal supports, formal aids, alternative activities). Participant responses were independently coded by two raters trained to criterion. Cases with full agreement (n = 934; 96%) were used for data analyses of methods for cutting down drinking, stopping drinking, and strategies recommended for a friend. RESULTS: The five most frequently youth-generated change strategies to alter drinking were environmental exposure management (e.g., avoid drinking situations, 19%); informal interpersonal supports (e.g., talk to a friend, 18%); formal aids (e.g., peer support group, counselor, 17%); behavioral self-management (e.g., limit consumption, 14%); and alternative activities (e.g., recreation, sports, 10%). Whereas informal interpersonal supports were consistently endorsed for all change situations, behavioral self-management strategies were viewed as more useful for reduction of drinking and formal aids more critical for cessation efforts. Some differences were observed in youth-generated strategies for changing their own drinking compared with efforts to help friends, with environmental changes (e.g., reducing exposure to risk situations and people, formal aids) more often considered when changing youth's own behavior, and strategies reflecting a need for personal change (e.g., education) recommended to others. CONCLUSIONS: Our findings support theoretical conceptualizations of alcohol and drug problem resolution that accommodates multiple pathways to recovery. The normative information about specific change strategies generated by youth may further aid in the design of interventions more acceptable for adolescents.

Adolescent↗
PubMed2003

Role of the DPC4 tumor suppressor gene in adenocarcinoma of the ampulla of Vater: analysis of 140 cases.

The K-ras oncogene is activated in approximately 90% of pancreatic adenocarcinomas, and the DPC4 (MADH4/SMAD4) tumor suppressor gene is inactivated in approximately 55% of pancreatic adenocarcinomas. The contributions of these genetic alterations to the development of adenocarcinoma of the ampulla of Vater have not been fully established. One hundred forty surgically resected ampullary adenocarcinomas (76 with associated adenomas with high-grade dysplasia) were immunohistochemically labeled for the DPC4 gene product, and in 85 cases the results were correlated with the status of the K-ras oncogene from previously reported data. The results were correlated with clinical outcome and with other pathologic predictors of prognosis. Complete loss of Dpc4 labeling was identified in 34% (95% confidence interval [CI]: 26%, 43%) of the invasive carcinomas and in none (upper 95% CI: 6%) of the associated adenomas. Focal loss of Dpc4 was seen in three (4%; 95% CI: 1%, 14%) of the areas of high-grade dysplasia. Complete loss of Dpc4 expression was seen in 28/77 intestinal-type tumors, in 17/46 pancreaticobiliary-type tumors, and in 0/10 colloid carcinomas. Activating point mutations in the K-ras gene were identified in 40% of the invasive cancers. There was no correlation between K-ras gene mutations and Dpc4 expression and no correlation between these variables and survival. The overall 5-year survival rate was 38%. Lymph node metastases were associated with shorter survival (P =.03). Loss of Dpc4 expression occurs in approximately one third of invasive ampullary cancers but is not seen in adenomas; thus, loss of Dpc4 expression occurs late in ampullary carcinogenesis. Although ampullary and pancreatic adenocarcinomas share histologic and molecular features, ampullary carcinomas are less likely to show loss of Dpc4 expression or K-ras gene mutations.

Adenocarcinoma↗
PubMed2003

GERD 2003 -- a consensus on the way ahead.

Gastroesophageal reflux disease (GERD) has in recent times become an important public health issue owing to the considerable health care resources utilized in its management, its deleterious effect on quality of life and the increasing prevalence of a relatively rare complication of reflux disease - esophageal adenocarcinoma. We review here the major current challenges in the field of reflux disease and its complications, and provide some approaches that may be useful in management. The issues to be faced include the very limited comprehension of the reasons behind the increasing prevalence of the disease, difficulties in correlating symptoms with objective data of pathological gastroesophageal reflux and the relatively unsophisticated tools we are employing to investigate the underlying pathophysiology. It is certain that the lack of well-defined and characterized methodologies to compare the effects of therapy require the development of more effective questionnaire-type analytic tools. In regard to treatment, there is little doubt that the widely prescribed proton pump inhibitors have dose-equivalent efficacy and are the most highly effective agents capable of suppressing acid, controlling many of the symptoms of GERD and healing erosions. Nevertheless, many patients continue to experience symptoms on withdrawal or at night. Pharmacological agents that can effectively increase lower esophageal sphincter pressure or promote motility are as yet unavailable. Although the introduction of laparoscopic techniques has resulted in a modest revival in surgical intervention using a variety of 'wrap-type' operations, the indications are few and the procedure is associated with a significant morbidity and even mortality especially if the expertise of the surgeon is an issue. Endoscopic techniques of regulating reflux are at this time experimental and not applicable to the general population. Intestinal metaplasia in the lower esophagus is probably very common. Whether and how to, first, screen for, and then, perform surveillance in Barrett's esophagus remains highly problematic and contentious.

Barrett Esophagus↗
PubMed2003

Influence of language abilities and alcohol expectancies on the persistence of heavy drinking in youth.

OBJECTIVE: It has been suggested that neuropsychological functioning and cognitive factors influence substance use and treatment outcomes in youth. This study examined a model in which language skills moderate the extent to which expectancies about the positive effects of alcohol predict the persistence of alcohol involvement in youth over an 8-year period. METHOD: Participants were substance use disordered adolescents recruited from inpatient alcohol and drug treatment centers (N = 139). Exclusion criteria included major head trauma, neurological illness and psychiatric disorders. Participants were administered neuropsychological tests, expectancy questionnaires and substance involvement interviews that spanned an 8-year period from ages 16 to 24 on average. Substance involvement was assessed by self-report, collateral reports and urine toxicology screens. RESULTS: Using latent class growth analysis of alcohol use over 8 years, participants were classified as abstainers, infrequent users, worse with time or frequent users. Language x Expectancy interactions were significant at all time points (p range .05 to .0001, effect size eta2 range 0.03 to 0.20). This interaction significantly predicted 8-year alcohol dependence symptoms over and above effects accounted for by covariates or main effects (F = 2.98, 5/100 df, p < .05; R2delta = 4%, beta = 0.21, p <.05). CONCLUSIONS: For youths with above average language skills, positivealcohol expectancies predicted alcohol use frequency and dependence symptoms in the 8 years following treatment; expectancies were less related to outcomes for youths with poorer language scores. Results suggest that verbal skills may magnify the relationship between alcohol expectancies and drinking behavior.

Adolescent↗
PubMed2003

Pulmonary embolization of bovine collagen.

A bovine collagen matrix is sometimes used as a delivery medium during direct intratumoral injection of a chemotherapeutic agent. The bovine collagen enhances the dose and duration of local drug delivery and limits systemic toxicity. Although this strategy is advocated as a means of easy and effective delivery of chemotherapeutic drugs, the associated risks are not well defined. We report the case of a 71-year-old man with hepatocellular carcinoma who underwent weekly intratumoral injections of cisplatin in a bovine collagen matrix. During the third injection, he suddenly and unexpectedly underwent cardiac arrest and died. An autopsy disclosed diffuse occlusion of the pulmonary microcirculation by bovine collagen. The collagen emboli were associated with an inflammatory infiltrate typical of bovine collagen-induced hypersensitivity. This case identifies a fatal complication of intratumoral chemotherapy injections using a bovine collagen matrix, which does not appear to have been previously reported. This case underscores the valuable role of the traditional autopsy examination as a means of identifying possible complications of novel oncologic strategies, which are being rapidly developed and implemented.

Aged↗
PubMed2002

Similarities and differences between Caucasian and African American college women on eating and dieting expectancies, bulimic symptoms, dietary restraint, and disinhibition.

OBJECTIVE: To clarify race differences in eating disorder risk factors and symptoms, by comparing Caucasian and African American samples on the factor structures, intercorrelations, and mean levels of endorsement on a set of risk and symptom measures. METHOD: A sample of 300 Caucasian and 200 African American undergraduates completed measures of eating and thinness/dieting expectancies, the Three-Factor Eating Questionnaire (TFEQ), and the BULIT. RESULTS: The factor structures of each measure were invariant across race. Intercorrelations among the measures generally did not differ across race. On the three expectancy measures predictive of symptomatology, two of three scales of the TFEQ, and the BULIT, African American women had lower mean scores than Caucasian women. Socioeconomic status did not account for the results: in this sample, it was unrelated to race and correlated with only 1 of 20 measures. DISCUSSION: The factor-based meaning of these measures appears to be consistent across race. The measures correlate similarly across race, suggesting that the risk process may be similar for both races, but African American women endorsed significantly fewer risk factors and fewer symptoms.

Adult↗
PubMed2002

Negative affect combines with smoking outcome expectancies to predict smoking behavior over time.

The present study examined whether the tendency to experience negative affective states combines with smoking outcome expectancies to predict smoking behavior over time. Participants were 121 young adults and resource people recruited from 3 alcohol and drug treatment programs and through community advertisements. Each participant completed 3 interviews over a 4-year period. Results indicated that dispositional negative affect and positive smoking expectancies were significantly correlated with smoking behavior both within and across time. Expectations of positive and negative reinforcement partially mediated negative affect's relation with smoking across time. Positive expectancies did not function as a moderator of negative affect's relation with smoking behavior. These results represent an important step in incorporating smoking outcome expectancies into multivariate models of smoking risk.

Adolescent↗
PubMed2002

Educational and occupational attainment and drinking behavior: an expectancy model in young adulthood.

AIMS: The socio-economic status (SES) variables of education level and occupational functioning have been found to be correlated negatively with alcohol use. The present study examined prospectively the relationship between these functioning measures, alcohol expectancies and alcohol involvement. We propose that expectancies function as a mediator of the relationship between educational/occupational attainment and drinking behavior. We hypothesized that changes in young adult functioning are linked to changes in social context and/or the availability of non-alcohol reinforcers, which in turn affect the reinforcement expected from alcohol. PARTICIPANTS AND DESIGN: Participants were 172 young adults from an ongoing longitudinal study of long-term clinical course of adolescent substance use treatment. Data from 6- and 8-year follow-ups were used in the present analyses. The treated sample (n=100) was recruited from in-patient substance abuse treatment programs for adolescents. A community sample (n=72) was matched on family history of substance abuse and SES at intake. FINDINGS: A cross-lag panel analysis indicated that education had a unique longitudinal relationship with expectancy for both the treated and community sample, over and above previous alcohol use and expectancy. Occupational variables did not have a longitudinal relationship with alcohol use and expectancy for either sample. Expectancies mediated the education/drinking relationship for the treated sample only. CONCLUSIONS: These results suggest one means through which changes in functioning may alter alcohol involvement over time: alteration of the reinforcement expected from alcohol.

Adult↗
PubMed2002

Reliability, stability, and factor structure of the Bulimia Test-Revised and Eating Disorder Inventory-2 scales in adolescence.

The Eating Disorder Inventory-2 (EDI-2) and Bulimia Test-Revised (BULIT-R) have demonstrated strong reliability and validity in college students and adults. Although used in adolescent samples, little is known about the psychometric properties of these measures for adolescents. The reliability, factor structure, and mean levels of five EDI-2 scales and the BULIT-R were evaluated over 3 years. Data were collected yearly from two samples of adolescent females, one recruited from three public middle schools (n = 239, mean baseline age = 12.8) and one from two public high schools (n = 119, mean baseline age = 15.9). Results provide strong evidence for the reliability and stability of these measures. Mean levels of both measures appeared remarkably consistent over the 3 years. These results provide evidence of good psychometric performance for these scales in adolescence. The lack of change in these measures raises questions about the developmental trajectory of these variables through adolescence.

Adolescent↗
PubMed2002

K-ras, p53, and DPC4 (MAD4) alterations in fine-needle aspirates of the pancreas: a molecular panel correlates with and supplements cytologic diagnosis.

Between January 1997 and February 2000, 101 fine-needle pancreatic aspirates were obtained. After a cytologic diagnosis was made, possible molecular alterations were determined on the 94 aspirates with adequate tissue using a molecular panel (K-ras, p53, and DPC4 [MAD4] genes). The 94 aspirates were categorized as follows: diagnostic of adenocarcinoma, 48 (51%); atypical (suggestive of but not diagnostic of adenocarcinoma), 19 (20%); negative for adenocarcinoma, 25 (2 7%); diagnostic of a neoplasm other than adenocarcinoma, 2 (2%). Clinical follow-up revealed that 3 patients (12%) with negative cytologic diagnoses and 12 patients (63%) with atypical cytologic diagnoses had adenocarcinoma. Of 63 with a final diagnosis of adenocarcinoma, 42 (67%) had an alteration in at least 1 of the genes analyzed. In contrast, only 2 (6%) of 31 patients without adenocarcinoma had an alteration in 1 gene on the panel. Overall, the molecular analyses supported the diagnosis of adenocarcinoma in 6 (32%) of 19 aspirates originally diagnosed as atypical by cytology alone. A molecular panel that includes the K-ras, p53, and DPC4 (MAD4) genes correlates with and can supplement traditional cytologic diagnosis of pancreatic fine-needle aspirates.

Adenocarcinoma↗
PubMed2002

Ulcers, Helicobacter pylori infection, platelets and gastrointestinal complications of non-steroidal anti-inflammatory drugs: what are the connections?

The term "gastropathy", and discussion surrounding the adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs) on the gastrointestinal (GI) tract, suggests that most of the complications arise from injury to the gastric mucosa, resulting in gastric ulcers that develop complications. The commonest GI complication is bleeding, which results principally from thrombocytopathy or impaired platelet function in the presence of various underlying GI conditions, including but not confined to antecedent peptic ulcer disease, and in some cases ulcers caused by NSAIDs. In unselected cases, bleeding as a result of aspirin or NSAID may occur early in the course of treatment, much of it predictable from a careful history, taken to identify well-defined risk factors, including previous peptic ulcer disease, GI bleeding, or concomitant treatment with steroids, anticoagulants, or anti-platelet drugs. Only in the presence of such risk factors is NSAID use likely to be associated with a serious GI complication. Although GI complications are common in such cases, attributability of the event solely to NSAIDs is low. Attributability of the complication to the drug is highest when NSAID use is the sole risk factor: the estimated incidence of complications in this setting is only about 10% of all NSAID-associated GI complications. In estimating the likely outcome of therapy, the risk factors identifiable from the history in each case before treatment are more important than the choice of NSAID. Independently analysed, the VIGOR and CLASS trials showed that use of rofecoxib or celecoxib caused fewer clinical ulcers and bleeding, but much of the bleeding observed did not arise from ulcers or from sites proximal to the ligament of Treitz. This suggests that the main value of these drugs is the absence of thrombocytopathy: their safety is substantially reduced by concomitant treatment with low doses of aspirin. This paper analyses the separate roles of COX 2-selective agents, H. pylori eradication, and concomitant aspirin prophylaxis or treatment with acid-suppressant drugs.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMedDate not supplied

Impact of cotherapy with some proton pump inhibitors on medical claims among HMO patients already using other common drugs also cleared by cytochrome P450.

Adverse drug event (ADE) rates resulting from coadministration of proton pump inhibitors (PPIs) and other drugs with potential for interaction with PPIs (DPIs) are unknown. This retrospective study assesses the occurrence of such ADEs and their potential impact on medical care costs by reviewing integrated medical and pharmacy claims. Managed care patients receiving one or more DPIs were identified. Within this sample, those who were also prescribed omeprazole or lansoprazole (DPI + PPI) were included. A second cohort (DPI alone) was created, matching for age, gender, and DPI use. Rates of ADEs were followed for 6 months after entry. Among PPI users, 58% used one or more DPIs, whereas 7% of DPI subjects used a PPI. Among claims arising from ADEs occurring in more than 1% of patients, 14 occurred in the DPI + PPI group and 2 occurred in the DPI-alone cohort, respectively, a highly significant difference. Crude odds ratios for the risks of specific ADEs were significantly increased for cotherapy with a PPI and warfarin, clarithromycin, corticosteroids, carbamazepine, nifedipine, or diclofenac. After adjustment, the first three associations remained significant. Coprescription of a PPI with potentially interacting drugs was common in practice and associated with significantly increased claims for medical care.

2-Pyridinylmethylsulfinylbenzimidazoles↗