Biomedical subjects

G McAvay

Publications and source records attributed to G McAvay.

14 recordsLinked to original sources

PubMed2000

Psychiatric disorders and impairment in the children of opiate addicts: prevalances and distribution by ethnicity.

This study examined rates of psychiatric disorders and impairment in 283 children, aged 6 to 17, of 69 Caucasian, 45 African-American, and 47 Hispanic-American methadone maintenance patients. Children were evaluated by direct and/or parental interview with the K-SADS-E. Final DSM-III-R diagnoses and Global Assessment Scale (C-GAS) were assigned by best estimate. Substantial lifetime prevalences of mood (21%), anxiety (24%) and disruptive disorders (30%), school problems (37%), and global impairment (C-GAS < 61) (25%) were observed in the children of opiate-dependent patients. There were few differences between ethnic groups. Effects of proband gender and major depression and their interactions with ethnicity on risk for childhood psychopathology were also examined. The results suggest children of patients in treatment for opiate dependence from diverse ethnic groups are at risk for psychopathology. Programs for early detection and intervention should be devised and evaluated.

Adolescent↗

PubMed1999

Risk/protective factors among addicted mothers' offspring: a replication study.

There are few systematic studies of the school-aged offspring of drug-dependent patients, although this information is useful for planning evidence-based prevention programs. We have completed such a study, which we compare to a similar study independently conducted in 1998. In both studies, both the parent and offspring were assessed blindly and independently by direct diagnostic interviews, and parental assessment of offspring was also obtained. The similarity in design and methods between studies provided an opportunity for replication by reanalysis of data. The major findings are a replication in two independently conducted studies of school-aged offspring of opiate- and/or cocaine-addicted mothers of the high rates of any psychiatric disorder (60% in both studies), major depression (20%, 26%), oppositional defiant disorder (ODD) (18%, 23%), conduct disorder (17%, 9%), attention-deficit/hyperactivity disorder (ADHD) (13%, 8%), and substance abuse (5%, 10%) among offspring. Both studies also found high rates of comorbid alcohol abuse, depression, and multiple drugs of abuse in the mothers. We conclude that efforts to replicate findings by analyses of independently conducted studies are an inexpensive way to test the sturdiness of findings that can provide the empirical basis for preventive efforts. Clinically, the data in both studies suggest that both drug dependence and associated psychopathology should be assessed and treated in opiate addicts with young offspring, and the offspring should be monitored for the development of conduct and mood disorders and substance use.

Adolescent↗

PubMed1999

Self-efficacy beliefs and perceived declines in functional ability: MacArthur studies of successful aging.

Longitudinal data from a cohort of older men and women, aged 70-79, were used to test the hypothesis that stronger self-efficacy beliefs would protect against onset of perceived functional disabilities over a 2.5-year follow-up, independent of underlying physical ability. Standard self-report scales were used to assess perceived functional disabilities, ranging from mild performance difficulties (measured by a 5-item scale based on items by Nagi) to more severe disabilities (measured by the 7-item Katz Activities of Daily Living Scale [ADL]). Performance-based measurements of strength, balance, and gait provide more objective assessments of physical abilities. Self-efficacy beliefs were measured in terms of beliefs relating to managing interpersonal relationships and beliefs relating to managing more instrumental daily activities. Gender-specific multiple regression models revealed that weaker instrumental self-efficacy beliefs predicted declines in reported functional status as measured by the Nagi performance scale among both men and women, independent of standard sociodemographic, health status, and health behaviors. Among men, instrumental efficacy beliefs were also negatively related to reports of onset of Katz ADL. Self-efficacy beliefs were unrelated to measured changes in actual physical performance abilities for both men and women. These findings suggest that self-efficacy beliefs have significant impacts on perceptions of functional disability, independent of actual underlying physical abilities. Through such influences on perceptions of disability, self-efficacy beliefs may importantly affect lifestyles and quality of life at older ages.

Activities of Daily Living↗

PubMed1999

Variation in the impact of social network characteristics on physical functioning in elderly persons: MacArthur Studies of Successful Aging.

OBJECTIVES: Social support and social networks have been shown to exert significant effects on health and functioning among elderly persons. Although theorists have speculated that the strength of these effects may differ as a function of sociodemographic characteristics and prior health status, few studies have directly tested the moderating effects of these variables. METHODS: Longitudinal data from the MacArthur Study of Successful Aging were used to examine the effects of structural and functional social support on changes in physical functioning over a 7-year period, measured by the Nagi scale, in a sample of initially high-functioning men and women aged 70 to 79 years. Multiple regression analyses were used to test the main effects of social support and social network variables, as well as their interactions with gender, income, and baseline physical performance. RESULTS: After controlling for potential confounding effects, respondents with more social ties showed less functional decline. The beneficial effects of social ties were stronger for respondents who were male or had lower levels of baseline physical performance. DISCUSSION: The effects of social support and social networks may vary according to the individual's gender and baseline physical capabilities. Studies of functional decline among elderly persons should not ignore this population variation in the effects of social networks.

Activities of Daily Living↗

PubMed1999

Physical health problems in depressed and nondepressed children and adolescents of parents with opiate dependence.

The increased risk of physical health problems in adult depressed patients has been shown in numerous studies. A recent study of the offspring of depressed parents found similar associations. The purpose of this study is to examine the strength and specificity of the association between depression and physical health problems in children and adolescents whose parents are dependent upon opiates. The sample consisted of offspring ages 6-17 (mean age 11 years) of opiate addicts who had a history of major depressive disorder (MDD; n = 28); other mood disorders (n = 31); no history of mood disorders but other psychiatric disorders (n = 92); or no history of psychiatric disorder (n = 127). Detailed psychiatric assessment and medical history of the offspring by direct interview with the offspring and an informant were obtained blind to parental diagnosis. After controlling for possible confounders, there was an increased risk of dermatological disorders, headache, other neurological/neuromuscular disorders, bronchitis, other respiratory disorders and hospitalizations for nonsurgical procedures in offspring with MDD, as compared to nonpsychiatrically ill controls. The offspring with other mood disorders had a slightly elevated risk. Major depression in children and adolescents whose parents are dependent on opiates is associated with increased risk of physical health problems. This finding is consistent with other reports and the timing of the physical health problems requires further study.

Adolescent↗

PubMed1998

Psychopathology in children of parents with opiate dependence and/or major depression.

OBJECTIVE: To evaluate psychiatric disorders and impairment in school-age and adolescent children of opiate-dependent patients. METHOD: One hundred fourteen children, aged 6 to 17 years, of 69 white methadone maintenance patients with (n = 30) and without (n = 39) major depression were evaluated for DSM-III-R diagnoses by the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic version and best estimate, and by measures of functioning (Children's Global Assessment Scale, Social Adjustment Inventory for Children and Adolescents, WISC, Peabody Picture Vocabulary Test), and compared with children of historical controls without substance abuse history. RESULTS: Sons of opiate addicts with major depression were at increased risk for conduct disorder and global, social, and intellectual impairment compared with sons of opiate addicts without major depression and/or sons of controls with neither drug dependence nor depression. Sons of opiate addicts without major depression differed little from controls. Daughters of opiate addicts did not differ from controls in rates of disorders but had poorer social adjustment and nonverbal intelligence. CONCLUSIONS: Children of opiate-dependent patients, particularly sons of addicts with depression, may be at risk for a developmental path toward antisocial personality and poor social and intellectual functioning. Treatment settings such as methadone maintenance might afford an opportunity for primary and secondary prevention, both through early detection of childhood disorders and treatment of parental drug dependence and psychopathology.

Adolescent↗

PubMed1996

Does multiple risk factor reduction explain the reduction in fall rate in the Yale FICSIT Trial? Frailty and Injuries Cooperative Studies of Intervention Techniques.

In a recent study of fall prevention in 301 community-living older persons (the Yale FICSIT Trial, 1990-1993), participants in the multifactorial targeted intervention (TI) group experienced significantly fewer falls than participants in the social visit (SV) control group. In the present paper, the authors explore the relation between changes in the studied risk factors and the occurrence of falling. In comparison with SV participants, TI participants showed significantly greater improvements in postural blood pressure change (p = 0.01), step length (p = 0.004), use of > or = 4 medications (p = 0.003), and unsafe tub and toilet transfers (p = 0.05), while change in balance was of borderline significance (p = 0.08). Reduction in the occurrence of falling, in turn, was at least marginally associated with improvements in balance, postural blood pressure change, step length, lower extremity strength/range of motion, and transfers. When participants were divided into tertiles based on a composite risk factor change score, a significantly higher percentage of TI participants (42%) than SV participants (22%) were in the greatest risk factor reduction tertile. Among TI participants, there was a progressively lower fall rate per person per year in the tertiles with the least, intermediate, and greatest risk reduction (0.832, 0.624, and 0.260), respectively. A similar but weaker relation between risk factor reduction and fall rate was seen in the SV group. When compared within tertiles, essentially adjusting for the amount of risk factor reduction, the fall rates among TI and SV participants in the greatest risk factor reduction tertile were identical (0.260 falls per person per year), and the rates in the least reduction tertile were similar (0.832 vs. 1.040 falls per person per year); this suggests that risk factor reduction at least partially mediated the treatment effect. These results support the feasibility of implementing and analyzing the effectiveness of a multiple risk factor reduction strategy in the aged.

Accidental Falls↗

PubMed1996

Self-efficacy beliefs and change in cognitive performance: MacArthur Studies of Successful Aging.

Data from a cohort of relatively high functioning, older men and women were used to test the hypothesis that stronger self-efficacy beliefs predict better maintenance of cognitive performance. Structural equation modeling revealed that stronger baseline instrumental efficacy beliefs predicted better verbal memory performance at follow-up among men but not among women, controlling for baseline verbal memory score and sociodemographic and health status characteristics. For both men and women there were no significant associations between either type of self-efficacy beliefs and measures of nonverbal memory, abstraction, or spatial ability. Consistent with previous research showing relationship between baseline cognitive performance and change in self-efficacy beliefs, better abstraction ability was also predictive of increase in instrumental efficacy beliefs among the men.

Age Factors↗

PubMed1996

The cost-effectiveness of a multifactorial targeted prevention program for falls among community elderly persons.

OBJECTIVES: Falls and fall injuries are common-potentially preventable-causes of morbidity, functional decline, and increased health-care use among elderly persons. The current analyses, performed on data obtained as part of a randomized controlled trial conducted within a health maintenance organization, describe the costs of a multifactorial, targeted prevention program for falls, present total net health-care costs, estimate the cost per fall prevented, and describe acute fall-related health-care costs. METHODS: The 301 participants were at least 70 years of age and possessed at least one of eight targeted risk factors for falling. The 153 participants randomized to the targeted intervention (TI) group received a combination of medication adjustment, behavioral recommendations, and exercises as determined by their baseline assessment. The 148 participants randomized to the usual care (UC) group received a series of home visits by a social work student. RESULTS: The mean intervention cost per TI participant was $925 (range $588 to $1,346). Total mean health-care costs were approximately $2,000 less in the TI than UC group, whereas median costs were approximately $1,100 higher in the TI than UC group. The TI strategy was unequivocally cost effective when mean costs were used because the intervention was associated with both lowered total health-care costs and fewer total and medical care falls. In sensitivity analyses, the cost-effectiveness of the TI strategy appeared robust to widely differing assumptions about total health-care costs (25th to 75th percentile of the actual distribution) and intervention costs (minimum to maximum costs). In subgroup analyses, the TI strategy showed its strongest effect among individuals at high risk of falling, defined as possession of at least four of the eight targeted risk factors. CONCLUSIONS: Consideration should be given toward incorporating and reimbursing the cost of fall-prevention programs within the usual health care of community-living elderly persons, particularly for those persons at high risk for falling.

Accidental Falls↗

PubMed1994

A multifactorial intervention to reduce the risk of falling among elderly people living in the community.

BACKGROUND: Since falling is associated with serious morbidity among elderly people, we investigated whether the risk of falling could be reduced by modifying known risk factors. METHODS: We studied 301 men and women living in the community who were at least 70 years of age and who had at least one of the following risk factors for falling: postural hypotension; use of sedatives; use of at least four prescription medications; and impairment in arm or leg strength or range of motion, balance, ability to move safely from bed to chair or to the bathtub or toilet (transfer skills), or gait. These subjects were given either a combination of adjustment in their medications, behavioral instructions, and exercise programs aimed at modifying their risk factors (intervention group, 153 subjects) or usual health care plus social visits (control group, 148 subjects). RESULTS: During one year of follow-up, 35 percent of the intervention group fell, as compared with 47 percent of the control group (P = 0.04). The adjusted incidence-rate ratio for falling in the intervention group as compared with the control group was 0.69 (95 percent confidence interval, 0.52 to 0.90). Among the subjects who had a particular risk factor at base line, a smaller percentage of those in the intervention group than of those in the control group still had the risk factor at the time of reassessment, as follows: at least four prescription medications, 63 percent versus 86 percent, P = 0.009; balance impairment, 21 percent versus 46 percent, P = 0.001; impairment in toilet-transfer skills, 49 percent versus 65 percent, P = 0.05; and gait impairment, 45 percent versus 62 percent, P = 0.07. CONCLUSIONS: The multiple-risk-factor intervention strategy resulted in a significant reduction in the risk of falling among elderly persons in the community. In addition, the proportion of persons who had the targeted risk factors for falling was reduced in the intervention group, as compared with the control group. Thus, risk-factor modification may partially explain the reduction in the risk of falling.

Accidental Falls↗

PubMed1992

Determinants of change in perceived health in a longitudinal study of older adults.

To determine the factors that are predictive of a negative decline in perceived health in a longitudinal study of 251 men and women aged 62 and older, we developed a "synthetic" cohort of individuals who experienced a decline in perceived health between two time points and a control cohort of those who did not. The longitudinal design of the study made it possible to evaluate the effects of "baseline" predictors, gathered prior to the time interval during which the reported change in perceived health occurred, in addition to measures assessed at the two time points between which the change in health was reported. Hierarchical logistic regression models were used to examine the effect of demographic, psychosocial, and illness measures on change in perceived health. These analyses revealed that increases in new illnesses, increased physician visits, and worsening of preexisting conditions (in subjects who had higher feelings of self-efficacy) were all associated with a decline in perceived health, after controlling for the effects of baseline illnesses and medication use. After accounting for these effects of changes in objective illness indicators, we found that changed psychosocial factors also predicted a decline in perceived health. Lower life satisfaction and higher depression at baseline were predictive of a later decline in perceived health. In addition, data collected at the third consecutive time point were evaluated to assess determinants of a sustained vs transient decline in perceived health. A sustained decline in perceived health was associated with increased depression and decreased self-efficacy.

Aged↗

PubMed1988

Interindividual and intraindividual variation in repeated measures of 24-hour dietary recall in the elderly.

While several studies have examined the validity of the 24-hour recall as a method for assessment of dietary intake in older people, none has examined the components of variability of dietary data obtained from the 24-hour recalls of older adults. The ability to detect differences in group means, and estimates of correlation and regression coefficients, are all reduced when intraindividual (within-subject) variability in a measure is large in comparison to interindividual (between-subject) variability. The present study considered the components of variance of four 24-hour diet recalls taken bimonthly, for 220 adults whose mean age was 72 years. Two components of variability were estimated for 23 nutritional variables: an interindividual (between-subjects) variance component and an intraindividual (within-subjects) variance component. The ratio of intraindividual to interindividual variance differed substantially as a function of the nutritional parameter being assessed. Methods are presented for determining the number of dietary recalls needed to keep the attenuation of correlation and regression coefficients within a specified level. Power calculations for the test of equal means in two independent groups are also presented.

Aged↗

PubMed1988

A longitudinal study of depressed mood and sleep disturbances in elderly adults.

Previous studies have suggested that depression might be more strongly related to sleep disturbances in older than in younger individuals. However, few of these studies have simultaneously considered variables other than depression that have been demonstrated to influence the sleep of elderly persons, and none has examined the relationship between depression and sleep longitudinally. The present study examined the association between frequency of depressed mood, using the Depression Adjective Checklist (DACL), and self-reports of four sleep problems over a 3-year period in a sample of community-residing elderly persons. Results showed that frequency of depressed affect was related positively to sleep disturbance, even when subjects' age, gender, and health status were considered simultaneously. Early morning awakening was the sleep symptom that most consistently related to depressed mood over the course of the study. Poor health and female gender showed positive but less consistent relationships to the sleep complaints than depressed affect. Research on biological mechanisms underlying the disturbed sleep of elderly depressed individuals is discussed.

Age Factors↗

PubMed1987

The abnormally large frontal sinus. I. A practical method for its determination based upon an analysis of 100 normal patients.

One hundred normal Caldwell view radiographs were examined on patients who had no signs or symptoms referable to the frontal sinuses. Magnification factors were determined for Caldwell views obtained on a dedicated head unit and as part of a skull series. The areas of the frontal sinuses were actually measured with a Zeiss Videoplan 2 computer and corrected for magnification. The area variation in this normal population was determined. Four linear measurements were individually correlated with these areas. Two of these lines had excellent correlation with the sinus area and if either of these lines exceeds a calculated value, the sinus area exceeds the 99th percentile of the normal population and can be considered abnormally enlarged. This technique provides a rapid, easy, and reliable method for assessing abnormally enlarged frontal sinus areas.

Frontal Sinus↗