PubMed Health⌕ Search

Biomedical subjects

G Sullivan

Publications and source records attributed to G Sullivan.

At least 37 records · Page 2Linked to original sources
PubMed1999

Potent and orally bioavailable noncysteine-containing inhibitors of protein farnesyltransferase.

Potent and orally bioavailable nonthiol-containing inhibitors of protein farnesyltransferase are described. Oral bioavailability was achieved by replacement of the pyridyl ether moiety of 1 with a 2-substituted furan ether to give 4. Potency was regained with 2,5-disubstituted furan ethers while maintaining the bioavailability inherent in 4. p-Chlorophenylfuran ether 24 is 0.7 nM in vitro (FTase) and is 32% bioavailable in the mouse, 30% bioavailable in rats, and 21% bioavailable in dogs.

Alkyl and Aryl Transferases↗
PubMed1999

The economic impact of capitated care for high utilizers of public mental health services: the Los Angeles PARTNERS program experience.

Los Angeles PARTNERS, or "people achieving rehabilitation together need empowering respectful support," is a treatment program that uses capitation to shift risk for treatment costs of high utilizers of public mental health services to private community-based treatment organizations. This analysis reveals two important findings from PARTNERS. First, the economic incentives created by capitation contributed to the dis-enrollment of PARTNERS clients; furthermore, factors such as not speaking English or Spanish or having schizophrenia increased the probability of dis-enrollment. Second, analyses of health costs for enrollees in the PARTNERS capitation program suggest that the program did not result in a change in total costs. However, the program increased the use of community-based care and increased treatment costs for clients with lower preprogram costs but decreased costs for the clients with high preprogram costs. These results suggest that future capitation programs for this severely ill population would benefit from using detailed clinical information to determine program eligibility and to set risk-adjusted capitation rates.

Capitation Fee↗
PubMed1999

The role of gender in engaging the dually diagnosed in treatment.

Individuals with both a serious mental illness and substance abuse are particularly difficult to engage in treatment. Given known gender differences in both substance abuse and schizophrenia, we examined the impact of gender on treatment engagement. Qualitative interviews with ten males and eleven females focused on how the client perceived the engagement process, and what obstacles they faced. While both males and females are difficult to engage, the interviews suggest that they experience the process differently and that they face different obstacles. We discuss the implication for service providers.

Adult↗
PubMed1999

Patient, provider, and treatment factors associated with poor-quality care for schizophrenia.

Interventions are needed to improve the quality of care for schizophrenia. However, in designing these interventions it would be helpful to understand better which patients are at highest risk for poor-quality care and why care for this disorder is often of poor quality. We study the extent to which patient and treatment factors are associated with poor-quality care in 224 patients randomly sampled from two mental health clinics. Quality of medication management is evaluated using an established method based on national treatment recommendations. Multivariate regression is used to study the effect of patient and treatment factors on treatment quality, controlling for provider. Risk for poor-quality care was greater for patients who were more severely ill, older, and less compliant with treatment recommendations. There were trends toward poor management of symptoms in men and substance abusers, and poor management of side effects in Black patients. Provision of poor-quality care was associated with failure to document symptoms and side effects in the medical record. Interventions to improve care for schizophrenia should attend to the need for accurate clinical assessment and strategies for managing challenging clinical situations.

Adolescent↗
PubMed1999

Utilization of mental health and substance abuse services among homeless adults in Los Angeles.

OBJECTIVES: Even though psychiatric disorders are disproportionately present among the homeless, little is known about the extent to which homeless people receive treatment for those problems or the factors that are associated with receiving treatment. This article examines utilization and predictors of mental health and substance abuse treatment among a community-based probability sample of homeless adults. METHODS: The data analyzed here were collected through face-to-face interviews with 1,563 homeless individuals. Bivariate analyses examined differences between homeless men and women in (1) the prevalence of major mental illnesses and substance dependence and (2) utilization of inpatient and outpatient treatment services for those with specific diagnoses. Logistic regression analyses identified predictors of mental health treatment among those with chronic mental illness and substance abuse treatment among those with recent substance dependence. RESULTS: Two-thirds of these homeless adults met criteria for chronic substance dependence, whereas 22% met criteria for chronic mental illness, with substantial overlap between those two disorders: 77% of those with chronic mental illness were also chronic substance abusers. Only one-fifth of each of those two groups reported receiving treatment for those disorders within the last 60 days. Mental health service utilization was predicted largely by factors related to need (eg, diagnosis, acknowledgment of a mental health problem), whereas substance abuse service utilization was predicted by myriad additional factors, reflecting, in part, critical differences in the organization and financing of these systems of care. CONCLUSIONS: More attention must be directed at how to better deliver appropriate mental health and substance abuse services to homeless adults.

Adolescent↗
PubMed1999

HIV and people with serious mental illness: the public sector's role in reducing HIV risk and improving care.

OBJECTIVE: The paper discusses issues related to the detection, prevention of transmission, and treatment of human immunodeficiency virus (HIV) infection among persons with serious mental illness and suggests ways public mental health systems can address these issues. METHODS: MEDLINE was searched from 1980 through 1998, and all pertinent references were reviewed. RESULTS: Persons with severe mental illness are at greatly increased risk of HIV infection due to increased likelihood of high-risk sexual behaviors and injection drug use. The formidable barriers to detection and effective treatment of HIV that exist in this population can be attributed to the unique characteristics of this population, lack of knowledge and expertise among mental and physical health care providers, and fragmented mental and physical health care systems. CONCLUSIONS: In the last five years, treatments for HIV that are far more efficacious than earlier treatments have become available, making it more important for HIV infection be detected and treated among persons with serious mental illness. Public mental health systems need to implement active prevention policies and practices, educate both mental health and physical health care providers about key treatment issues, and develop effective linkages between mental and physical health care providers and systems.

Disease Susceptibility↗
PubMed1999

Political opportunism and the harassment of homosexuals in Florida, 1952-1965.

This paper examines activities by the state against homosexuals in Florida between 1952 and 1965. At the beginning of this period most of this activity took the form of police raids on gay bars, beaches and other gathering places. By the mid-1950s, however, the state government had established an investigations committee which concentrated on what the legislature saw as the "homosexual problem." The committee was particularly concerned with homosexual school teachers and faculty members in land grant universities in Florida, and attempted to purge state institutions of homosexual employees. This activity followed a similar campaign against homosexuals by the federal government and the article examines this in order to provide background for the Florida campaign. The ideology about homosexuals which was propagated by these campaigns is examined, as are the effects of the campaigns on homosexuals, and their response. Concern about the "homosexual menace" gradually abated and these discriminatory campaigns subsided. The article examines the social and political context of these campaigns and speculates on causes for the rise and demise of these campaigns. Principal among these appear to be political expediency by leaders of campaigns to extend political power by attacking a weak and defenseless target group, and a desire by conservatives to re-establish traditional values.

Faculty↗
PubMed1998

Potent and selective non-cysteine-containing inhibitors of protein farnesyltransferase.

Potent and selective non-thiol-containing inhibitors of protein farnesyltransferase are described. FTI-276 (1) was transformed into pyridyl ether analogue 19. The potency of pyridyl ether 19 was improved by modification of the biphenyl core to that of an o-tolyl substituted biphenyl core to give 29. In addition to 0.4 nM in vitro potency, 29 displayed 350 nM potency in whole cells as the parent carboxylic acid. The o-tolyl biphenyl core dramatically and unexpectedly enhanced the potency of other compounds as exemplified by 46, 47, 48, and 49.

3T3 Cells↗
PubMed1998

Measuring the quality of outpatient treatment for schizophrenia.

BACKGROUND: Consumers and policy makers are increasingly interested in measuring treatment quality. We developed a standardized approach to measuring the quality of outpatient care for schizophrenia and used it to evaluate routine care. METHODS: We randomly sampled 224 patients in treatment for schizophrenia at 2 public mental health clinics. Appropriate medication management was defined according to criteria derived from national treatment recommendations, and focused on recent management of symptoms and side effects. Adequate psychosocial care was defined as the recent provision of case management or family management to patients for whom it is indicated. Care was evaluated using patient interviews and medical records abstractions. RESULTS: Although patients at the 2 clinics had similar illnesses, the treatment they received was quite different. In total, 84 (38%) of patients received poor-quality medication management, and 117 (52%) had inadequate psychosocial care. Clinics differed in the proportion of patients receiving poor-quality medication management not attributable to patient factors (28% vs 16%). The clinic with better-quality medication management provided case management to fewer severely ill patients (48% vs 81%). More than half of the cases of poor care would not have been detected if we had used only medical records data. CONCLUSIONS: At these clinics, many schizophrenic patients were receiving poor-quality care and most poor care was likely due to factors that can be modified. One approach to improving care begins by developing systems that monitor quality. These systems may require improved medical records and patient-reported symptoms and side effects.

Adult↗
PubMed1998

The effect of provider characteristics on case management activities.

The authors investigated the impact of provider characteristics on the performance of clinical case managers. Case managers in a large California county were interviewed using a structured instrument that assessed service linkage, assertive outreach, and family management. Findings indicate that assertive outreach was done more often by more experienced case managers, and less often by those with larger caseloads. Belief in the efficacy of an activity was associated with doing it much more frequently.

Adult↗
PubMed1998

Implementing publicly funded risk contracts with community mental health organizations.

The study analyzed the experience of the Los Angeles County Department of Mental Health with implementation of new contractual arrangements for services for patients with severe mental illness. The arrangements shifted the financial risk for treatment to community organizations and paid a fixed annual rate per enrolled patient without further adjustment for severity of illness. Patients were assigned to the program based on high prior treatment costs. The new contractual approach enhanced programs' flexibility and accountability and increased their emphasis on principles of psychosocial rehabilitation. Challenges in implementation included disenrollment of the majority of assigned patients by the community organizations at risk for high treatment costs. Prior treatment costs for continuing cases, while high, were lower than those for disenrolled cases. Existing information systems provided limited clinical and cost data, making it difficult to monitor providers' performance. Risk contracting required substantial clinical, fiscal, and management changes at community organizations and the mental health authority. The analysis suggests that mental health authorities that are planning to institute risk contracts need to balance fiscal incentives with performance guarantees and to pay particular attention to information systems requirements and to the severity of patients' illness. Although risk contracts present challenges, they can lead to improvements in service delivery that persist beyond the implementation phase.

Adolescent↗
PubMed1997

Functional and receptor binding characterization of recombinant murine macrophage inflammatory protein 2: sequence analysis and mutagenesis identify receptor binding epitopes.

Murine macrophage inflammatory protein-2 (MIP-2), a member of the alpha-chemokine family, is one of several proteins secreted by cells in response to lipopolysaccharide. Many of the alpha-chemokines, such as interleukin-8, gro-alpha/MGSA, and neutrophil activating peptide-2 (NAP-2), are associated with neutrophil activation and chemotaxis. We describe the expression, purification, and characterization of murine MIP-2 from Pichia pastoris. Circular dichroism spectroscopy reveals that MIP-2 exhibits a highly ordered secondary structure consistent with the alpha/beta structures of other chemokines. Recombinant MIP-2 is chemotactic for human and murine neutrophils and up-regulates cell surface expression of Mac-1. MIP-2 binds to human and murine neutrophils with dissociation constants of 6.4 nM and 2.9 nM, respectively. We further characterize the binding of MIP-2 to the human types A and B IL-8 receptors and the murine homologue of the IL-8 receptor. MIP-2 displays low-affinity binding to the type A IL-8 receptor (Kd > 120 nM) and high-affinity binding to the type B IL-8 receptor (Kd 5.7 nM) and the murine receptor (Kd 6.8 nM). The three-dimensional structure of IL-8 and sequence analysis of six chemokines (IL-8, gro-alpha, NAP-2, ENA-78, KC, and MIP-2) that display high-affinity binding to the IL-8 type B receptor are used to identify an extended N-terminal surface that interacts with this receptor. Two mutants of MIP-2 establish that this region is also involved in binding and activating the murine homologue of the IL-8 receptor. Differences in the sequence between IL-8 and related chemokines identify a unique hydrophobic/aromatic region surrounded by charged residues that is likely to impart specificity to IL-8 for binding to the type A receptor.

Amino Acid Sequence↗
PubMed1997

Behaviors as risk factors for rehospitalization: implications for predicting and preventing admissions among the seriously mentally ill.

This case-control study investigated the extent to which aberrant behaviors, in contrast to more traditional clinical factors (such as symptoms and alcohol abuse), place individuals with schizophrenia at increased risk for rehospitalization. One hundred and one recidivists (cases) were matched to 101 non-recidivists (controls) on gender, race, and time since index hospitalization. Key informants, usually family members, were interviewed to assess behaviors during a 2-week period. After controlling for possible confounding variables, we found that each aberrant behavior increased the risk for rehospitalization, but highly disruptive or dangerous behaviors (such as threatening others, acting very bizarrely, or attempting suicide) conveyed a markedly high degree of risk (adjusted odds ratio = 83.9). It is possible that service providers may be able to avert the fiscal and emotional cost of hospitalization by collaborating more closely with family members to identify these behaviors and intervene before hospitalization becomes unavoidable.

Adult↗
PubMed1997

Medication compliance among the seriously mentally ill in a public mental health system.

Medication non-compliance, a pervasive problem among persons with serious, chronic mental illness, has been linked to increased inpatient resources use in public mental health systems. The objective of this analysis was to determine which factors are associated with medication compliance in this population so that more appropriate screening and intervention programs can be designed. Using knowledge gained from clinical research on compliance in schizophrenia and research testing the Health Belief Model as a conceptual framework in studying compliance behavior, we conducted a secondary analysis of data collected in the Mississippi public mental health system in 1988. The study subjects were schizophrenic patients (n = 202), the majority of whom were low-income, African-American males. Data sources included structured interviews with patients and family members, as well as state hospital and community mental health clinic administrative records. Receipt of consistent outpatient mental health treatment and belief that one had a mental illness were significantly associated with higher levels of medication compliance in this population of seriously mentally ill patients. Our results suggest that screening programs to identify those at highest risk for non-compliance in this population might be more productive if they included a review of inpatient and outpatient mental health service utilization patterns, in addition to formal assessment of patients' attitudes and beliefs about their illness. This study illustrates an approach to examining predictors of a policy-relevant health behavior in a minority population within a public mental health system.

Adult↗
PubMed1997

Eating attitudes and the irritable bowel syndrome.

A series of 48 new patients with irritable bowel syndrome (IBS) were asked to complete an Eating Attitudes Test. The same test was given to a series of 32 patients attending an Eating Disorder clinic, a series of 31 patients attending a gastroenterology outpatient clinic with a diagnosis of inflammatory bowel disease (IBD), and to a group of 28 'normal' controls. The results showed that there was no significant difference between the IBD group and control groups for EAT score. The EAT score for the group with eating disorders was significantly higher than for all other groups. The EAT score for the IBS group was greater than those for the IBD and control group (p = 0.05) when all four groups were compared using analysis of variance and the Least Significant Difference test.

Attitude↗