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Biomedical subjects

J Husted

Publications and source records attributed to J Husted.

At least 19 recordsLinked to original sources
PubMed2004

Elevated rates of schizophrenia in a familial sample with mental illness and intellectual disability.

BACKGROUND: It is unknown whether intellectual disability (ID) is more familially related to psychotic mood disorders or schizophrenia. L. S. Penrose's large sample of families with two or more members admitted to psychiatric hospitals provided a unique opportunity to investigate the familial relationship between mild ID, schizophrenia and psychotic affective disorders. METHOD: There were 183 affected relative pairs comprising probands with mild ID (95 male, 88 female) and their first or second degree relatives with schizophrenia or psychotic affective disorder. RESULTS: There were nearly twice as many relatives with a diagnosis of schizophrenia (n = 121) as relatives with affective disorders (n = 62) among the intellectually impaired probands. This excess of schizophrenia was statistically significant, even after accounting for the increased risk of hospitalization for schizophrenia (P = 0.005), and was fairly constant across the different relative types. First-degree relatives with either mental illness were more likely to be parents (n = 77) than siblings (n = 51) or children (n = 3), but there was no excess of mother-son pairs. CONCLUSIONS: These results suggest a stronger familial relationship of ID with schizophrenia than psychotic affective disorder, and lend some support to the neurodevelopmental hypothesis of schizophrenia.

Adult↗
PubMed2003

Postmaturity in a genetic subtype of schizophrenia.

OBJECTIVE: To determine whether postmaturity (gestation > 41 weeks), small for gestational age (SGA), and other pregnancy and birth complications that may elevate risk for neurodevelopmental disorders, are associated with elevated risk for schizophrenia in 22q11 Deletion Syndrome (22qDS), a genetic subtype of schizophrenia. METHOD: Antepartum and intrapartum features were examined in 20 adults with 22qDS-schizophrenia and three comparison groups: newborn encephalopathy (n = 164) and healthy newborn controls (n = 400) from Badawi et al.'s (Br Med J 1998, 317: 1549) study, and 16 non-psychotic 22qDS adults (22qDS-NP). RESULTS: Postmaturity (OR 13.0, 95% CI 3.95, 42.77; P < 0.001) and SGA (OR 3.59, 95% CI 1.23, 10.5; P = 0.03) were more prevalent in 22qDS-SZ than controls. Postmaturity was non-significantly more prevalent in 22qDS-SZ than in newborn encephalopathy (P = 0.06) or 22qDS-NP (P = 0.2). SGA showed similar rates in the two 22qDS groups and newborn encephalopathy, but was more prevalent in 22qDS-NP than controls (P = 0.05). CONCLUSION: The results suggest that postmaturity may be associated with expression of schizophrenia in a 22qDS subtype of schizophrenia. SGA may be a non-specific marker of neurodevelopmental disturbance.

Adult↗
PubMed2001

Euroscreen 2: towards community policy on insurance, commercialization and public awareness.

The project Euroscreen 2 has examined genetic screening and testing with particular reference to implications for insurance, commercialization through marketing of genetic tests direct to the public, and issues surrounding raising public awareness of these and other developments in genetics, including the practical experiment of a Gene Shop. This paper provides a snapshot of the three year project. The study group's work included monitoring developments in different European countries and exploring possibilities for regulation in insurance and commercialization together with public attitudes to regulation. The success or failure of different strategies is not independent of public awareness. Exploration of policy, however, also requires examination of fundamental concepts such as solidarity and geneticization.

Attitude to Health↗
PubMed2001

Comparison of hemodynamic responses to social and nonsocial stress: evaluation of an anger interview.

Hemodynamic responses to an anger interview and cognitive and physical stressors were compared, and the stability of associated hemodynamic reactions examined. Participants experienced control, handgrip, counting, and mental arithmetic tests and an anger interview on two occasions. Systolic and diastolic blood pressure, heart rate, stroke volume, and cardiac output were measured. Total peripheral resistance was also derived. The anger interview produced larger, more sustained changes in blood pressure in both sessions than the other stressors. These changes were largely a consequence of increased peripheral resistance. Consistent with previous findings, handgrip was associated with a resistance-type reaction whereas arithmetic was associated with a cardiac output-type reaction. There was low-to-modest stability of hemodynamic reactions to the interview. Further research is necessary to optimize its utility in studies of cardiovascular function. Nevertheless, the findings underscore the ability of ecologically relevant stressors to provoke unique configurations of cardiovascular activity.

Adult↗
PubMed2001

Understanding successful community living by individuals with serious and persistent mental illness.

34 volunteers diagnosed as chronically mentally ill were administered a questionnaire to evaluate what factors were important in preventing rehospitalization. The volunteers were divided into two groups based on their relapse history. Analysis showed the nonrelapse group were more likely to attribute factors such as in-home therapy, taking medication, and having fun with friends than did the group who had experienced at least one relapse in the past 24 months.

Activities of Daily Living↗
PubMed2000

The effectiveness of day treatment with persistently mentally ill in rural areas.

PURPOSE/METHOD: This study investigated the effectiveness of day treatment programmes in rural Minnesota by comparing 2 groups in terms of yearly rates of re-hospitalization. RESULTS: It was found that the group that responded positively to day treatment was much less likely to be re-hospitalized. Their rates of re-hospitalization were much lower than the state of Minnesota. The other group that dropped out of day treatment has a re-hospitalization rate as much as 10 times higher. CONCLUSION: This demonstrates the cost effectiveness of day treatment programmes.

Bipolar Disorder↗
PubMed1998

Paternal transmission and anticipation in schizophrenia.

Recent studies have observed anticipation (earlier age at onset (AAO) or increased disease severity in successive generations) in familial schizophrenia. In other disorders, where the molecular mechanism (repeat expansion) is known, anticipation varies in degree depending on the sex of the transmitting parent. We investigated parental sex effects on anticipation in schizophrenia, using a familial sample of affected two-generation pairs in which anticipation had previously been demonstrated using the median intergenerational difference (MID) in AAO. A Wilcoxon rank sum test for independent samples was used to determine whether MID in AAO was significantly different for paternal and maternal transmission. Results suggested that in a sample of 127 parent-offspring pairs, anticipation was greater with paternal than with maternal transmission (MID = 18 and 14 years, respectively, P = 0.05). Paternal effects were strongest in 39 parent-offspring pairs with early-onset offspring (< or = 21 years) (MID = 22 and 17 years, respectively, for paternal and maternal transmission, P = 0.01). However, assessment of the effect of possible selection biases suggests that preferential ascertainment of late-onset fathers may have exerted important effects. While the results support possible paternal effects, further studies are needed to draw firm conclusions about true parent-of-origin effects on anticipation in familial schizophrenia.

Adolescent↗
PubMed1998

Mortality studies in psoriatic arthritis: results from a single outpatient center. II. Prognostic indicators for death.

OBJECTIVE: To investigate prognostic factors associated with mortality in patients with psoriatic arthritis (PsA). METHODS: Patients followed up at the Toronto PsA Clinic between 1978 and 1994 were included. Patients were reviewed at initial clinic entry and at 6-month intervals using a standard protocol. Data on deaths were collected in a prospective manner, and death certificates were used to identify the primary and antecedent cause(s) of death. All death information was recorded in the clinic's computerized database. Only factors that represented standard clinical measures of disease activity and progression were studied. The relationship between potential prognostic factors recorded at the time of the first clinic visit and the mortality rate was determined using the Cox relative risk regression model. RESULTS: There were 428 patients (234 men and 194 women), of whom 68% were known to be alive on September 1, 1994, 20% were lost to followup but assumed to be alive, and 12% had died. Multivariate analysis revealed that an erythrocyte sedimentation rate (ESR) > 15 mm/hour, medications used prior to initial clinic visit, radiologic damage, and the absence of nail lesions were associated with an increased overall mortality rate. There is some suggestion that prior medication use was least important for deaths associated with the circulatory system, while radiologic damage was particularly important for such deaths. A marked sex-associated effect was noted among deaths caused by injuries/poisoning, since 6 of the deaths occurred in men and only 1 was in a woman. CONCLUSION: Patients with PsA are at an increased risk of death compared with the general population. Evidence of previously active and severe disease, as manifested by the prior use of medications and by radiologic changes as well as an elevated ESR at presentation, are prognostic indicators for death. The presence of nail lesions appears to be a protective factor that has the most clinical importance in the context of previously active and severe disease.

Adolescent↗
PubMed1998

Genetic screening and ethics: European perspectives.

Analysis and comparison of genetic screening programs shows that the extent of development of programs varies widely across Europe. Regional variations are due not only to genetic disease patterns but also reflect the novelty of genetic services. In most countries, the focus for genetic screening programs has been pregnant women and newborn children. Newborn children are screened only for disorders which are treatable. Prenatal screening when provided is for conditions for which termination may be offered. The only population screening programs for adults are those for thalassaemia carrier status in Cyprus, Greece and Italy. Social responses to genetic screening range from acceptance to hostility. There is a fundamental tension between individual and community in the debates in various European countries about implementation of screening programs. Opposition to genetic screening is frequently expressed in terms of arguments about "eugenics" with insufficient regard to the meaning of the term and its implications. Only a few countries have introduced explicit legislation on genetic screening. Legislation to address discrimination may provide more safeguards than legislation protecting genetic information itself.

Adult↗
PubMed1997

Mortality studies in psoriatic arthritis: results from a single outpatient clinic. I. Causes and risk of death.

OBJECTIVE: To identify the causes of death and mortality risk in patients with psoriatic arthritis (PsA) who were being followed up at a single outpatient clinic in Toronto, Ontario, Canada. METHODS: Patients enrolled in the PsA Clinic between 1978 and 1993 were compared with the general population of Ontario. Deaths were identified from the clinic database and through linkage with the provincial mortality database, and causes were confirmed by death certificates. A standardized mortality ratio (SMR) was computed, based on the assumption that patients lost to followup were alive at the end of the study. RESULTS: Of the 428 patients with PsA (194 women and 234 men), 53 (26 women and 27 men) died. The 4 leading causes of death were diseases of the circulatory (36.2%) or respiratory (21.3%) system, malignant neoplasms (17.0%), and injuries/poisoning (14.9%). The SMR for the female cohort was 1.59, and for the men, it was 1.65, indicating a 59% and 65% increase in the death rate, respectively. Deaths due to respiratory causes were particularly increased in these patients. CONCLUSION: The results suggest that this PsA Clinic outpatient population had an increased mortality risk.

Adolescent↗
PubMed1997

Anticipation or ascertainment bias in schizophrenia? Penrose's familial mental illness sample.

Several studies have observed anticipation (earlier age at onset [AAO] in successive generations) in familial schizophrenia. However, whether true anticipation or ascertainment bias is the principal originating mechanism remains unclear. In 1944 L. S. Penrose collected AAO data on a large, representative sample of familial mental illness, using a broad ascertainment strategy. These data allowed examination of anticipation and ascertainment biases in five two-generation samples of affected relative pairs. The median intergenerational difference (MID) in AAO was used to assess anticipation. Results showed significant anticipation in parent-offspring pairs with schizophrenia (n = 137 pairs; MID 15 years; P = .0001) and in a positive control sample with Huntington disease (n = 11; P = .01). Broadening the diagnosis of the schizophrenia sample suggested anticipation of severity of illness. However, other analyses provided evidence for ascertainment bias, especially in later-AAO parents, in parent-offspring pairs. Aunt/uncle-niece/nephew schizophrenia pairs showed anticipation (n = 111; P = .0001), but the MID was 8 years and aunts/uncles had earlier median AAO than parents. Anticipation effects were greatest in pairs with late-AAO parents but remained significant in a subgroup of schizophrenia pairs with early parental AAO (n = 31; P = .03). A small control sample of other diseases had MID of 5 years but no significant anticipation (n = 9; P = .38). These results suggest that, although ascertainment-bias effects were observed in parent-offspring pairs, true anticipation appears to be inherent in the transmission of familial schizophrenia. The findings support investigations of unstable mutations and other mechanisms that may contribute to true anticipation in schizophrenia.

Adolescent↗
PubMed1997

Psychopathology and quality of life in schizophrenia.

This study was conducted to evaluate the relationship between psychopathology and quality of life in individuals with schizophrenia. The findings indicate that psychopathology, as determined by total Brief Psychiatric Rating Scale (BPRS) score, correlates negatively with global life satisfaction and subjective quality of life subscales, but not with objective ones. When positive and negative symptom clusters were examined, negative symptoms appeared to have a greater impact on subjective measures of quality of life.

Adult↗
PubMed1996

Validation of the revised and expanded version of the Arthritis Impact Measurement Scales for patients with psoriatic Arthritis.

OBJECTIVE: To assess the validity of the revised and expanded version of the Arthritis Impact Measurement Scales (AIMS2) in patients with psoriatic arthritis (PsA). METHODS: The AIMS2 was administered to all patients attending our Psoriatic Arthritis Clinic between June and December 1993. Clinical and radiological assessments were performed during the clinic visits. RESULTS: The patient population included 124 patients, 75 men and 49 women with a mean age of 48.4 years and a mean arthritis duration of 14.6 years. Most of the physical function scales as well as the pain and work scales were moderately to highly correlated with clinical measures of function (r = 0.27-0.64) and disease activity (r = 0.28-0.50), but they were not correlated with measures of disease severity. The psychosocial scales were poorly correlated with all clinical measures. CONCLUSION: Our data suggest that, like the original AIMS, the AIMS2 is valid for use as an adjunct outcome measure for clinical trials in PsA.

Activities of Daily Living↗
PubMed1996

Relationship of the Arthritis Impact Measurement Scales to changes in articular status and functional performance in patients with psoriatic arthritis.

OBJECTIVE: To examine the relationship of the Arthritis Impact Measurement Scales (AIMS) to changes in articular status and functional performance in a group of patients with psoriatic arthritis (PsA). METHODS: The AIMS was administered to 65 patients attending the University of Toronto Psoriatic Arthritis Clinic in 1989 and in 1993. Clinical and laboratory assessments of function, active inflammation, and damage were also performed at these 2 clinic visits. Linear regression analysis was performed to relate changes in the number of actively inflamed joints and number of deformed joints to AIMS measurements, while logistic regression was used to relate the American College of Rheumatology (ACR) functional class and the AIMS scores taken at the 2 clinic visits. RESULTS: There were 27 women and 38 men with a mean age of 46 years and arthritis duration of 13 years. Based only on information derived from the AIMS questionnaire, the maximum percentage of variation explained was 21 and 9% for the number of active joints and deformed joints, respectively. The strongest relationship was between the pain component scales measured at the 2 visits and the number of active joints. In all cases the initial clinical value made a significant additional contribution to the regression. CONCLUSION: The finding that the AIMS was sensitive to articular changes that occurred in patients over a 4 year period provides further support for the utility of the AIMS as an outcome measure in clinical studies of PsA. However, changes in the AIMS did not capture the full extent of the changes in both articular status and ACR functional class. This suggests that the AIMS and traditional measures of disease activity and function assess somewhat different aspects of clinical status and that it may be beneficial to use both types of measures in monitoring the course of PsA.

Activities of Daily Living↗
PubMed1995

Multi-dimensional adolescent treatment with American Indians.

The purpose of this study was to determine the effectiveness of an American Indian adolescent treatment program. A two-year follow-up study was conducted measuring school performance and antisocial behavior. It was found that American Indian adolescents who completed the program tended to have improved school performance and less involvement with the criminal justice system.

Adolescent↗
PubMed1995

Measuring health status in psoriatic arthritis: the Health Assessment Questionnaire and its modification.

OBJECTIVE: The Health Assessment Questionnaire (HAQ) has proven to be a reliable and valid measure of outcome for a variety of arthritides. A recent modification of HAQ for spondyloarthropathy (HAQ-S) has also been reported. Our purpose was to evaluate the HAQ and HAQ-S as outcome measures in the assessment of patients with psoriatic arthritis (PsA). METHODS: The HAQ, including HAQ-S was administered to all patients attending our Psoriatic Arthritis Clinic between June and December, 1993. Clinical and radiological assessments were performed according to a standard protocol that measures disease activity, fibrositic tender points (TP), disease severity and damage. Analysis was performed using SAS for the PC. RESULTS: The patient population included 114 patients, 70 men and 44 women with a mean age of 49.3 years and a mean arthritis duration of 15.1 years. The mean HAQ score was 0.50, while the mean HAQ-S score was 0.53 (scores range 0 to 3 for this instrument). The overall HAQ and HAQ-S disability scores were highly correlated with several clinical measures of function, including grip strength (r = -0.63 and -0.59, respectively). American College of Rheumatology functional class (r = 0.59 and 0.60, respectively), as well as the number of fibrositic TP (r = 0.54 and 0.57, respectively). These disability scores also correlated highly with the overall number of actively inflamed joints (r = 0.49 and 0.50, respectively); however, they correlated only moderately or poorly with other measures of disease activity such as morning stiffness, total number of joint effusions, erythrocyte sedimentation rate (ESR) and the PASI score for psoriasis and with all measures of disease severity. A similar pattern of correlations was found between the individual subscales of the HAQ and HAQ-S and the clinical measures of function, activity, and severity, as well as between the pain scale and the various clinical measures. However, the correlations are generally lower. CONCLUSION: Our data suggest that HAQ and HAQ-S capture clinical measures of function and pain in PsA but do not correlate with disease severity. The HAQ and its modification for spondyloarthropathy may reflect fibromyaglia as a measure of pain and tenderness in these patients. Thus, the clinical assessment of disease activity and both clinical and radiological assessments of joint damage remain important outcome measures in PsA.

Activities of Daily Living↗