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Biomedical subjects

J Kelsey

Publications and source records attributed to J Kelsey.

15 recordsLinked to original sources
PubMed2000

The management of depression: the implications for managed care--roundtable discussion: Part 1.

Depression affects not only the patient and the provider, but the employer as well. Up to 25% of all women experience major depressive disorder, compared with perhaps as many as 12% of all men. It is highly prevalent in patients with other acute and chronic disease. On October 4, 1999, a panel of managed care medical directors, pharmacy directors, clinicians, researchers, and health economists was convened in San Diego to discuss the optimal treatment of the disorder. This roundtable discussion is presented in three parts. The first portion lays the clinical foundation for the management of this critical disorder.

Antidepressive Agents↗
PubMed2000

The management of depression: the implications for managed care--roundtable discussion: Part 2.

One of the most commonly utilized drug classes today is antidepressant therapy, which accounts for billions of dollars in spending. Pharmacoeconomic tools may play an influential role in formulary decision making, particularly in this drug class. In part 2 of the roundtable discussion, a pharmacoeconomic model is presented that may clarify the health economic effects of placing serotonin-norepinephrine reuptake inhibitors on the drug formulary, particularly in the context of other antidepressant medications.

Antidepressive Agents↗
PubMed1998

Two measures of physical activity as predictors of bone mass in a young cohort.

OBJECTIVE: To compare the association of two measures of physical activity with bone mass in healthy children and young adults, as part of a larger study on bone mineral acquisition in youth. DESIGN: Cross-sectional observation study. SETTING: General community, outpatient study. PARTICIPANTS: Subjects included 103 non-Hispanic white female (n = 54) and male (n = 49) healthy volunteers aged 9 to 25 years. MAIN OUTCOME MEASURES: Self-reported physical activity was measured by a 3-day activity diary of all activities and a questionnaire designed to capture recreational activities throughout the year. Activity was expressed as hours per week of weight-bearing and non-weight-bearing activity. Bone mass at the hip, spine, and whole body was measured by dual x-ray absorptiometry. RESULTS: The activity measures were not well correlated with each other. In males, weight-bearing and non-weight-bearing activity reported in 3-day diaries was positively associated with bone mass at the hip, spine, and whole body (p < 0.05). Among females, only weight-bearing activity measured by the yearly questionnaires was significantly positively associated with bone mass (p < 0.05). In males and females, weight-bearing activity was more highly correlated with bone mineral than was non-weight-bearing activity. In addition, the associations between activity and bone mass varied by skeletal site. CONCLUSIONS: The association between physical activity and bone mass varied both in direction and in significance depending on the physical activity instrument used. Gender differences were observed in the associations between specific activity instruments, type of activity (weight-bearing and non-weight-bearing), and bone mass at different skeletal sites. Variability associated with the two physical activity measures may contribute to discrepant findings in this study and in the literature.

Adolescent↗
PubMed1998

A controlled trial of venlafaxine in trichotillomania: interim phase I results.

This article reports the preliminary findings of a two-phase trial examining the efficacy of venlafaxine in trichotillomania. Phase 1 is a 12-week, open-label, prospective trial of venlafaxine in trichotillomania. Venlafaxine was effective in significantly reducing the symptoms of trichotillomania; 8 of 12 patients were considered responders. The implications of the efficacy of venlafaxine in trichotillomania are discussed, including its important advantages over other available antidepressant and anxiolytic medications.

Adult↗
PubMed1997

Exotic reptile bites.

Reptiles are a growing part of the exotic pet trade, and reptile bites have been considered innocuous in the emergency medicine literature. Two cases are reported of reptile bites, one from a green iguana and the other from a reticulated python. The treatment concerns associated with reptile bites are discussed.

Adult↗
PubMed1996

Predictors of ankle and foot fractures in older women. The Study of Osteoporotic Fractures Research Group.

To determine risk factors for ankle and foot fractures, data collected from 9704 women 65 years of age or older from four areas of the United States were analyzed. Self-reported baseline questionnaires covered areas such as lifestyle factors (physical activity, diet, and smoking habits) and functional impairment (history of fracture, falling, and other diseases). Bone mineral density (BMD) and performance on neuromuscular tests were also measured. During 5.9 years of follow-up, 191 women fractured an ankle and 204 women fractured a foot. Proportional hazard models were used to estimate relative risks. In multivariable models, factors associated with ankle fracture included one or more falls in the year prior to baseline (relative risk [RR] 1.5; 95% confidence interval [CI] 1.1-2.1), greater vigorous physical activity (RR per 2 times/week, 1.2; CI 1.1-1.3), weight gain since age 25 (RR per 20% gain, 1.4; CI 1.2-1.5), self-reported osteoarthritis (RR 0.5; CI 0.3-0.8), a sister's history of hip fracture after age 50 (RR 1.7; CI 1.0-3.0), out of house < or = 1 per week (RR 3.0; CI 1.4-6.6), and low distal radius BMD (RR per -0.1 g/cm2, 1.2; CI 1.0-1.4). Factors associated with foot fracture included insulin-dependent diabetes (RR 2.9; CI 1.2-7.2), use of seizure medications (RR 2.3; CI 1.0-5.7) or of benzodiazepines (RR 1.5; CI 1.1-2.2), history of hyperthyroidism (RR 0.5; CI 0.3-1.0), poor far depth perception (RR 0.7; CI 0.5-1.0), and low distal radius BMD (RR per -0.1 g/cm2, 1.3; CI 1.1-1.5). Ankle and foot fractures have different profiles of risk factors that are largely independent of low bone mass.

Aged↗
PubMed1995

Spinal meningiomas in women in Los Angeles County: investigation of an etiological hypothesis.

A series of 3 studies explored the hypothesis that the preponderance of spinal meningiomas among postmenopausal women relates to their higher prevalence of spinal osteoporosis: (a) medical records showed that meningiomas in women, unlike other spinal tumors, usually arise in the mid thoracic spine where osteoporotic vertebral fractures predominate; (b) radiographic evidence of osteoporosis was seen commonly with meningiomas but not with other spinal tumors; and (c) age-adjusted multivariate analysis of data from an interview study of 81 women with spinal meningioma and 155 random digit dial controls showed 6 factors related to risk. Four factors were protective: (a) current use (at diagnosis) of estrogen replacement therapy [odds ratio (OR) = 0.2; 95% confidence interval (CI) = 0.1-0.6]; (b) past use of oral contraceptives (P trend < 0.01); (c) past participation in sports (OR = 0.5; CI = 0.2-0.9); and (d) premenopausal status (OR = 0.2; CI = 0.1-0.7). Risk increased among women who had ever smoked cigarettes (OR = 1.7; CI = 0.9-3.1) or had a history of high dose radiography (> 500 mrad exposure to active marrow/examination; includes upper or lower gastrointestinal series and/or cardiac angiography; OR = 2.9, and CI = 1.6-5.3), although no association was seen with prior radiotherapy. Other results that did not support the hypothesis include findings that cases and controls were similar in mean body weight and in the proportion who had postmenopausal fractures or height loss. In conclusion, these studies lend some support to our hypothesis, but other known meningioma risk factors such as ionizing radiation also appear important.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Bone mass among premenopausal women.

Bone mass in early adult life, or peak bone mass, is primarily under genetic control, although recent data suggest that alterations in nutrition and life style during growth may modify the genetic potential. Cross-sectional data indicated that upon completion of growth, there was a period of skeletal consolidation that resulted primarily from increased width of cortical bones. Data on cancellous bone are conflicting. Cross-sectional data suggest that cancellous bone mass reaches a maximum at about age 18 years. Bone mass in the spine appears stable until the beginning of menopause, unless there are other disturbances of ovarian function. On the basis of cross-sectional data, significant bone loss in the femoral neck in premenopausal women appears to occur prior to changes in ovarian function. This decline in hip density is also independent of body size, nutritional influences, or other variables thought to influence bone mass. Longitudinal data are not available to confirm the reduction in femoral neck bone mass. Preliminary data indicate that modest disruptions of ovarian function, insufficient to result in frank amenorrhea, might impact negatively on bone mass. A detailed longitudinal study of menstrual and other factors controlling bone mass in premenopausal women is needed. If bone mass can be modified, ensuring a maximal skeletal mass becomes a viable possibility for prevention of osteoporosis.

Adolescent↗
PubMed1980

The significance and a comparative analysis of the epidemiology of hip fractures.

A review of the literature on the epidemiology of hip fractures demonstates the predominance of females. Women comprise 70 to 80% of patients with hip fractures. The average age is generally in the eighth decade. Actual incidence rates vary from one study to another, with lower rates among blacks and apparently lower rates from tropical countries. Osteoporosis is more common among patients with hip fractures than in controls and is somewhat more common in intertrochanteric fractures than in femoral neck fractures. Most hip fractures result from comparatively minor falls, such as falls from a bed, a chair, or from a standing position, especially among the elderly. It is estimated that more than 200,000 hip fractures occur each year in the United States, and that the cost of caring for these patients is more than $750,000,000. Approximately 19% of these patients die as a result of the fracture. This contributes significantly to the total number of accidental deaths, which in turn is the fourth largest category in the list of causes of death in the United States.

Adolescent↗
PubMedDate not supplied

Subcutaneous cysticercosis.

With the increasing numbers of immigrants coming to the United States from areas where Taeniasis and cysticercosis are endemic, it is important to be familiar with some of these more common entities. We present a patient with both neurologic and soft tissue cysticercosis as well as a review of the available literature.

Brain Diseases↗