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Biomedical subjects

J Everett

Publications and source records attributed to J Everett.

At least 19 recordsLinked to original sources
PubMed2000

Driving and insulin--consensus, conflict or confusion?

AIMS: All drivers requiring insulin treatment must be able to demonstrate satisfactory diabetic control and recognition of hypoglycaemic symptoms before being allowed to drive a motor vehicle. Clinicians have a duty to discuss fitness to drive with their patients. However, is the advice given consistent and in line with the regulations published by the Driver and Vehicle Licensing Authority (DVLA)? METHODS: Six 'real-life' case scenarios were posted to clinicians (consultant diabetologists, specialist registrars and diabetes specialist nurses) within Wessex, UK. The identical cases were also sent to the DVLA for their comments. RESULTS: Sixty-six doctors (36 consultants) and 70 diabetes specialist nurses were contacted by postal questionnaire of which replies were received from 17 consultants (47%), 17 specialist registrars (57%) and 39 diabetes specialist nurses (56%). Although there was general agreement in cases of hypoglycaemia unawareness, there was disagreement where patients had or were at risk of unstable control albeit for a short time. CONCLUSIONS: Patients treated with insulin may receive conflicting information concerning their ability to drive.

Adolescent↗
PubMed1998

The Morehouse Faculty Development Program: methods and 3-year outcomes.

BACKGROUND AND OBJECTIVES: Faculty development is an established method for increasing the number and effectiveness of faculty in family medicine. However, few published studies focus specifically on the use of faculty development to increase minority representation among faculty. Underrepresented minorities comprise 20% of the nation's population but only 3% of medical school faculty. In the entire nation, only 52 full-time teachers of family medicine are African-Americans. Morehouse School of Medicine has developed an effective model for training large numbers of underrepresented minority physicians to become academic family physicians. From 1993-1996, we trained 23 community-based physicians, three new faculty, six existing faculty, and three full-time fellows as teachers of family medicine. Of 35 participants, 33 were underrepresented minorities. Cultural issues in teaching and communication are an integral part of the curriculum. Seventy-three percent of graduates now teach medical students or residents either full-time or part-time. Further studies are needed to test the replicability of this model in non-minority institutions, as well as to achieve greater cost-effectiveness and improve academic outcomes such as publications and research. Significant faculty diversity is necessary and achievable, if institutions are willing to commit significant resources and network with minority health professionals and institutions.

Black or African American↗
PubMed1997

Distractibility and processing resource deficit in major depression. Evidence for two deficient attentional processing models.

Performance on the Stroop Color-Word Test is impaired in depression, but it is not clear whether this impairment reflects a distractor inhibition disturbance or a reduction of processing resources. In this study, untreated major depressives were evaluated using a modified computerized Stroop Test composed of three tasks: to name the color of XXXXXs, of nonconflicting words, and of conflicting color words. It was hypothesized that, unlike color words, nonconflicting word distractors would disturb the color naming task only in the presence of a primary distractor inhibition disturbance. The slow reaction time (RT) depressives and normal RT depressives, according to their color naming speed without distractors, were contrasted to distinguish depressives with and without clear signs of resource deficit. It was found that interference produced by nonconflicting words was greater in normal RT depressives than in either slow RT depressives or control subjects, while interference caused by color words was dramatically stronger in slow RT depressives than in other groups. Results suggest the existence of two different attentional deficit patterns in clinical depression: some depressives have a distractor inhibition disturbance while others are deficient in processing resources.

Adolescent↗
PubMed1996

Attention deficits in depression: an electrophysiological marker.

EVENT-RELATED POTENTIALS were recorded in young depressed subjects and compared with results from controls. Subjects were required to respond to targets (rare high-frequency sounds) presented to a designated ear, and to ignore targets presented to the non-designated ear as well as standards (frequent low-frequency sounds) presented to either ear. The results confirm those previously obtained with elderly depressed patients, showing the same general profile of electrophysiological and behavioural differences, and in particular a substantial reduction of the N200 amplitude in response to attended targets in depressed subjects. It is suggested that the N200 component could be a marker of depression.

Adult↗
PubMed1996

Attention disturbance in clinical depression. Deficient distractor inhibition or processing resource deficit?

Cognitive impairments in depression have recently been proposed as secondary to more basic attentional disturbances. Studies have shown that performance on the Stroop Color-Word Test is impaired in depressives, but it is not clear whether this impairment reflects a primary distractor inhibition disturbance or a more global cognitive dysfunction, such as a reduction of processing resources. In the present study, unmedicated clinical depressives were evaluated using a computerized Stroop Color-Word Test and the Visuo-Spatial Interference Test, a selective attention task that makes fewer demands on resources. Compared with normal subjects, depressives presented increased choice reaction times (CRT) and interference in both tests. Correlations were found between CRT and interferences only in depressives, favoring the processing resource hypothesis. Further exploratory analysis comparing the more rapid depressives and the slower normal subjects on CRT revealed that although these subgroups had comparable CRT, rapid depressives still exhibited increased interference on the Visuo-Spatial Interference Test. Thus, in non- or mildly retarded patients, a specific distractor inhibition deficit was observed in absence of resource deficit.

Adult↗
PubMed1996

Obesity and hypertension among African Americans: do African-American primary care providers address these conditions when secondary to primary illness?

This study examined the extent that black family medicine residents manage African-American patients with hypertension and obesity secondary to the primary health problem. A retrospective chart survey of 1806 outpatients was used to select a sample of 362 patients being treated by 12 African-American family medicine residents. Of the 362 patient charts, 31.2% of the patients had hypertension (ie, blood pressure > or = 140/90 mm Hg). A plan for managing hypertension was found in the charts for 77% of these patients. Obesity was present among 37% of the patients, and yet there was documentation of a treatment plan for managing this condition for only 38% of these patients. Black family medicine residents appear to be sensitized about addressing the problem of hypertension among African-American patients being treated for other illnesses. However, there is a vital need to teach family medicine physicians how to address and aggressively manage the problem of obesity among African-American patients, particularly those patients for whom obesity was not the primary reason for seeking medical care.

Black People↗
PubMed1994

HLA-DR mismatching correlates with early cardiac allograft rejection, incidence, and graft survival when high-confidence-level serological DR typing is used.

To determine if cardiac allograft outcome is improved among patients with fewer HLA-DR mismatches with their donors, we studied 132 recipients of a primary cardiac allograft who were transplanted between December 1985 and December 1991. These recipients and their donors all had high-confidence-level serological HLA-DR typing, previously shown to correlate highly with DNA DR typing. Patients were divided in two groups based on the HLA-DR mismatch with their donors. Group I consisted of 78 patients with 1 or zero DR mismatch and group II of 54 patients with 2 DR mismatches. Allograft outcome measurements included incidence of moderate rejection, incidence of allograft vasculopathy at 12 months, cardiac function measured as left ventricular ejection fraction (LVEF) and cardiac index (CI), and actuarial graft survival up to 7 years. Groups I and group II were not different with regard to recipient age, donor age, ischemia time, pulmonary vascular resistance, sex, or PRA greater than 0%. Group II had a higher incidence of moderate rejection on the first-week biopsy (47% vs. 25%, P = 0.019), and during the first month (84% vs. 58%, P = 0.006), but no difference was found in frequency of rejection from months 2 to 12. LVEF was not different in the groups at any point. CI was better in group I at 12 months (2.76 vs. 2.5, P = 0.03). No statistically significant difference was found in incidence of allograft vasculopathy (17% vs. 26%, P = 0.204). Actual graft survival at 1 year was better for group I (91% vs. 74%, P = 0.008), and actuarial graft survival at 6 years also favored group I (76% vs. 56%, P = 0.04). Using high-confidence-level serological HLA-DR typing assignments we demonstrated that HLA-DR mismatching correlates highly with cardiac allograft outcome. Implications are that heart transplant survival could be improved if prospective matching were feasible and prioritized or if immunosuppression were tailored to the HLA-DR match.

Coronary Circulation↗
PubMed1994

Changing from porcine to human insulin.

The development of hypoglycaemia unawareness is associated with long duration of diabetes, improved glycaemic control, alcohol intake and recurrent hypoglycaemia. However, current evidence suggests that neither frequency of severe episodes nor mortality from hypoglycaemia are increased following a change from animal to human insulin. Nevertheless, a small number of patients continue to report an alteration in the nature of hypoglycaemic warning symptoms following a change in insulin species. This is possibly a consequence of a reduced catecholamine response to lowering blood glucose levels or to species differences in the effect of insulin on central nervous system function. In practical terms, it seems sensible to warn patients that the nature of the symptoms associated with hypoglycaemia might alter following conversion from porcine to human insulin. At the time of the changeover, patients should be encouraged to perform frequent blood glucose measurements. Also, the usual insulin dose should be reduced by 10% at the start of human insulin treatment. Other aspects of insulin treatment including injection technique, meal timing, exercise, etc. should be discussed. For patients who are convinced that loss of warning of hypoglycaemia occurred after conversion from porcine to human insulin, a change back to animal insulin would be preferred to relaxing glycaemic control in the first instance. Pressure should be brought to bear on the pharmaceutical industry to maintain the availability of animal insulins for the small number of patients who have experienced problems with human insulin.

Animals↗
PubMed1992

Inhibition through negative priming with Stroop stimuli in schizophrenia.

Stroop stimuli were used to measure the negative priming effect in eight positive and 10 negative schizophrenics, 21 depressive and 35 healthy control subjects in order to test hypotheses of insufficient versus persistent cognitive inhibition in schizophrenia. Data show that schizophrenics do not increase their response times to suppressor Stroop items compared to identical but neutral Stroop stimuli because the insufficiency of their inhibitory processes weakens the distractor-suppression effect. However, pre-exposure of the lexical distractor can compensate for insufficient inhibitory mechanisms in positive but not negative schizophrenics, suggesting more severe deterioration in the latter. Depressed subjects showed a slower development of cognitive inhibition. The results suggest important differences in the temporal evolution of inhibitory processes, and are discussed in terms of Hemsley's (1977) and Frith's (1979) theories.

Adult↗
PubMed1992

[Frontal lobe hypoactivity in schizophrenia: change in perspective].

Many attempts to isolate a dysfunctional site in the brain of schizophrenic patients have converged in a neuropathological conception of the disease based on frontal lobe hypoactivity. Recent data from studies using cytoarchitectony, computerized tomographic scans, cerebral regional blood flow, smooth pursuit eye movements and neuropsychological assessments are discussed. Current data on the hypofrontality hypothesis in schizophrenia seem to suggest an associationist rather than a localisationist perspective of the disorder.

Cerebrovascular Circulation↗
PubMed1992

[Selective attention in major depression: clinical retardation and cognitive inhibition].

Relationships between clinical retardation (measured by the Hamilton Depression Inventory) and selective attention (measured with a computerized version of the Stroop word colour test) were studied in a population of 21 depressed patients. Stroop interference was higher in depressed patients than in normals. Desynchronized presentations of the distractor and the target and intervals between responses and succeeding stimuli permitted depressed subjects to respectively apply and lift inhibition of the distractor so that their interference was reduced to control levels. Finally, successive inhibition scores were correlated with the retardation score in depressed subjects. The results are consistent with the hypothesis of a retardation in the application and the lifting of cognitive inhibition in depression.

Adult↗
PubMed1991

Cognitive effects of psychostimulant medication in hyperactive children.

Hyperactive and normal children were given a test of selective attention (Stroop test) and a neurocognitive test sensitive to a functional deficit of prefrontal cortex (Wisconsin Card Sorting Test). Hyperactive children showed significant deficits on both measures. After a year of psychostimulant medication, the hyperactive children all showed clinical and neurocognitive improvement, but continued to show a selective attention deficit compared with normal children. The results indicate a dissociation between the cognitive processes measured by the Wisconsin test and selective attention as measured by the Stroop, and that the selective attention deficit is more resistant to psychostimulant intervention.

Attention↗
PubMed1989

The selective attention deficit in schizophrenia. Limited resources or cognitive fatigue?

The Stroop Word-Color Test was used to study selective attention deficits in schizophrenic and nonschizophrenic psychiatric patients, compared with nonpsychiatric control subjects. Parts of the Weschler Memory Test and a shortened version of the Stroop Test were administered to test the hypotheses that the attentional deficit could be explained by problems of memory or cognitive fatigue. All patients showed deficits on all of the Stroop scales, but closer analysis of the results permitted discrimination of schizophrenic from nonschizophrenic patients. Schizophrenic patients showed as much difficulty as nonschizophrenic subjects on a limited-duration selective-attention task, but deteriorated significantly more when selective attention had to be maintained. The results could not be attributed to memory problems in the schizophrenic group. The results support the existence of two separable selective attention deficits in schizophrenic patients: a difficulty in selectively attending to the salient aspect of a complex stimulus, a difficulty shared with nonschizophrenic subjects, and a difficulty in maintaining selective attention over time that seems to be more marked in schizophrenic subjects.

Adult↗
PubMed1988

Effects of chronic iron deficiency anaemia on myoglobin content, enzyme activity, and capillary density in the human skeletal muscle.

The influence of chronic iron deficiency anaemia on myoglobin content, maximal enzyme activities and capillarization in the human skeletal muscle was investigated. Muscle samples from musculus vastus lateralis were screened in an Indonesian population. The causes of iron deficiency were chronic intestinal bleeding or repeated pregnancy combined with low iron intake. The maximal activities of iron-dependent and non-iron-dependent glycolytic and oxidative enzymes as well as myoglobin showed similar values in the iron-deficient group and the matched control group. The activities of the oxidative enzymes in both the iron-deficient group and the controls were lower, however, compared even to untrained Swedish subjects. The capillary density was essentially within a normal range in both groups. It is concluded that chronic iron deficiency anaemia of a moderate or severe degree, with Hb concentrations of about 80-100 g.1(-1), does not cause an impaired biochemical function of the human skeletal muscle.

Adult↗
PubMed1987

Spin-echo proton NMR spectroscopy of urine samples. Water suppression via a urea-dependent T2 relaxation process.

Spin-echo methods have been used to effect solvent suppression during the collection of 400 and 500 MHz 1H NMR spectra of urine samples containing urea in the concentration range 0.7-1.2 M. There was a marked trough of water Tobs2 values in the pH range 2.6 to 4.1, due to acid-catalyzed proton exchange between urea and the solvent water. Minimum values of Tobs2 (9 ms at 500 MHz) of water were obtained at about pH 3.2 in urine samples containing 1.2 M urea. However, good solvent suppression factors were obtained with endogenous urea concentrations of only 0.7 M. There was a strong field dependence on the water, T2, over the pH range 2 to 4. Attenuation of the water signal was estimated to be at least an order of magnitude greater at 500 MHz rather than at 400 MHz. Using the Carr-Purcell-Meiboom-Gill spin-echo pulse sequence, water signals broader than 13 Hz were attenuated by factors of greater than 10(3), and factors of greater than 10(4) were possible with water linewidths greater than 20 Hz, thus allowing the signals from metabolites in the sample to be efficiently digitized. This approach allowed metabolite signals at or near the water resonance to be observed without serious distortion of their intensities. The utility of this approach to solvent suppression in real systems is illustrated by observation of paracetamol and benzyl penicillin metabolites in human urine samples.

Humans↗