Biomedical subjects

Joseph E Schwartz

Publications and source records attributed to Joseph E Schwartz.

At least 19 recordsLinked to original sources

PubMed2007

Do blood pressure and heart rate responses to perceived stress vary according to endogenous estrogen level in women?

The results of experimental studies suggest that estrogen may blunt blood pressure responses to stress, but increase heart rate responses. We investigated whether within-person associations of perceived stress with blood pressure and heart rate during normal working life in 26 premenopausal and 7 postmenopausal women varied according to endogenous estrogen level. Each woman measured her own blood pressure and heart rate and completed a diary reporting perceived stress levels on six occasions on each of 2 working days. Premenopausal women were assessed once between days 4 and 6 of their menstrual cycle (low estrogen) and again between days 11 and 13 (high estrogen), and urine samples were taken to verify expected variation in estrogen level. Results showed that perceived stress was significantly positively associated with systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate in the group as a whole. This association did not differ according to menopausal status. There was no difference in the association of perceived stress with SBP or DBP in premenopausal women according to day of assessment, but heart rate reactivity to perceived stress was significantly higher on the high-estrogen day. Our findings thus provide evidence that heart rate responses to perceived stress during everyday working life vary according to estrogen level in premenopausal women, but no evidence that blood pressure responses to stress vary according to endogenous estrogen level in women.

Adult↗

PubMed2007

How does coping help people resist lapses during smoking cessation?

OBJECTIVES: To determine whether types of coping strategies have differential effects on preventing lapses and lowering urge levels and to investigate mechanisms by which coping strategies prevent lapses during smoking cessation. DESIGN: Sixty-one respondents performed ecological momentary assessment using palm-top computers and tape recorders to report their coping strategies and urge levels before and after temptations to smoke. Multilevel linear regression models were used to compare the effects of individual strategy types with the average strategy. MAIN OUTCOME MEASURES: Lapses versus resisted temptations and changes in urge levels. RESULTS: Number of strategies significantly predicted resisting smoking and change in urge levels. Compared with the effect of the average strategy, movement/exercise was marginally worse at preventing lapses, and food/drink was marginally related to higher postcoping urge levels. CONCLUSION: Although using multiple coping strategies helps people resist the urge to smoke, no particular coping strategy works better than any other. Coping strategies prevent lapses by reducing high urge levels during temptations.

Adaptation, Psychological↗

PubMed2006

Ambulatory pulse pressure and progression of urinary albumin excretion in older patients with type 2 diabetes mellitus.

We studied whether ambulatory blood pressure monitoring added to office blood pressure in predicting progression of urine albumin excretion over 2 years of follow-up in a multiethnic cohort of older people with type-2 diabetes mellitus. Participants in the Informatics for Diabetes Education and Telemedicine study underwent a baseline evaluation that included office and 24-hour ambulatory blood pressure measurement and a spot urine measurement of albumin-to-creatinine ratio (ACR). Measurements of albumin-to-creatinine ratio were repeated 1 and 2 years later. In bivariate analyses, ambulatory 24-hour pulse pressure was the blood pressure variable most strongly associated with follow-up ACR. Repeated-measures mixed linear models (n = 1040) were built adjusting for baseline ACR ratio, clustered randomization, time to follow-up, and multiple covariates. When both were entered into the model, ambulatory 24-hour pulse pressure and office pulse pressure were independently associated with follow-up ACR (beta [SE] = 0.010 [0.002], P < 0.001, and 0.004 [0.001], P = 0.002, respectively). Cox proportional hazards models examined associations with progression of albuminuria in 954 participants without macroalbuminuria at baseline, adjusting for all of the covariates independently associated with follow-up ACR in mixed linear models. Ambulatory 24-hour pulse pressure, but not office pulse pressure, was independently associated with progression of albuminuria (P = 0.015 and 0.052, respectively). The adjusted hazards ratio (95% CI) per each 10-mm Hg increment in ambulatory pulse pressure was 1.23 (1.04 to 1.42). In conclusion, ambulatory pulse pressure may provide additional information to predict progression of albuminuria in elderly diabetic subjects above and beyond office blood pressure.

Aged↗

PubMed2006

Psychiatric comorbidities in a community sample of women with fibromyalgia.

Prior studies of careseeking fibromyalgia (FM) patients often report that they have an elevated risk of psychiatric disorders, but biased sampling may distort true risk. The current investigation utilizes state-of-the-art diagnostic procedures for both FM and psychiatric disorders to estimate prevalence rates of FM and the comorbidity of FM and specific psychiatric disorders in a diverse community sample of women. Participants were screened by telephone for FM and MDD, by randomly selecting telephone numbers from a list of households with women in the NY/NJ metropolitan area. Eligible women were invited to complete physical examinations for FM and clinician-administered psychiatric interviews. Data were weighted to adjust for sampling procedures and population demographics. The estimated overall prevalence of FM among women in the NY/NJ metropolitan area was 3.7% (95% CI=3.2, 4.4), with higher rates among racial minorities. Although risk of current MDD was nearly 3-fold higher in community women with than without FM, the groups had similar risk of lifetime MDD. Risk of lifetime anxiety disorders, particularly obsessive compulsive disorder and post-traumatic stress disorder, was approximately 5-fold higher among women with FM. Overall, this study found a community prevalence for FM among women that replicates prior North American studies, and revealed that FM may be even more prevalent among racial minority women. These community-based data also indicate that the relationship between MDD and FM may be more complicated than previously thought, and call for an increased focus on anxiety disorders in FM.

Chi-Square Distribution↗

PubMed2006

Office and ambulatory blood pressure are independently associated with albuminuria in older subjects with type 2 diabetes.

Blood pressure strongly predicts microalbuminuria and later progression to renal failure in people with diabetes. Ambulatory blood pressure monitoring seems to be superior to office blood pressure in predicting progression to microalbuminuria in type 1 diabetes. The associations of ambulatory blood pressure with office blood pressure and microalbuminuria in type 2 diabetes remain unclear. We studied the association of office blood pressure taken with an automated device and ambulatory blood pressure with spot urine albumin:creatinine ratio in 1180 older people with type 2 diabetes participating in the Informatics for Diabetes Education and Telemedicine Study. Office and awake systolic blood pressure were independently associated with albuminuria (P<0.001 for both) in a multivariate linear regression analysis that adjusted for age, gender, duration of diabetes, hemoglobin A1c, number of antihypertensive medications, and use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Twelve percent of participants had well-controlled office blood pressure but not ambulatory blood pressure, whereas 14% had well-controlled ambulatory but not office blood pressure. The prevalence of microalbuminuria and macroalbuminuria in these subgroups was intermediate between those with well-controlled or uncontrolled blood pressure by both methods. We found, in a multiethnic group of older subjects with type 2 diabetes, that office systolic blood pressure and awake systolic ambulatory blood pressure exhibited independent associations with degree of albuminuria.

Aged↗

PubMed2006

Preclinical carotid atherosclerosis in patients with rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis is associated with increased morbidity and mortality because of cardiovascular disease, independent of traditional risk factors. OBJECTIVE: To determine the prevalence of preclinical atherosclerosis in patients with rheumatoid arthritis and to identify clinical and biological markers for atherosclerotic disease in this patient population. DESIGN: Matched, cross-sectional study. SETTING: Hospital for Special Surgery in New York City. PATIENTS: 98 consecutive outpatients with rheumatoid arthritis who were followed by rheumatologists and 98 controls matched on age, sex, and ethnicity. MEASUREMENTS: Cardiovascular risk factor ascertainment and carotid ultrasonography in all participants; disease severity, disease treatment, and inflammatory markers in patients with rheumatoid arthritis. RESULTS: Despite a more favorable risk factor profile, patients with rheumatoid arthritis had a 3-fold increase in carotid atherosclerotic plaque (44% vs. 15%; P < 0.001). The relationship between rheumatoid arthritis and carotid atherosclerotic plaque remained after accounting for age, serum cholesterol levels, smoking history, and hypertensive status; adjusted predicted prevalence was 7.4% (95% CI, 3.4% to 15.2%) for the control group and 38.5% (CI, 25.4% to 53.5%) for patients with rheumatoid arthritis. Age (P < 0.001) and current cigarette use (P < 0.014) were also significantly associated with carotid atherosclerotic plaque. Among patients with rheumatoid arthritis, atherosclerosis was related to age, hypertension status, and use of tumor necrosis factor-alpha inhibitors (a possible marker of disease severity). LIMITATIONS: The study had a cross-sectional design, and inflammatory markers were determined only once. CONCLUSIONS: Patients with rheumatoid arthritis have a high prevalence of preclinical atherosclerosis independent of traditional risk factors, suggesting that chronic inflammation and, possibly, disease severity are atherogenic in this population.

Adult↗

PubMed2006

Thinking and/or doing as strategies for resisting smoking.

The effects of behavioral strategies and cognitive strategies, individually or in combination, on the likelihood of lapsing during smoking cessation were examined by random effects regression analyses of 1,499 temptations reported by 61 smokers during the first 2 weeks of cessation. Compared to using no strategies, using either type exclusively or in combination was significantly protective from lapsing. The combination was not significantly better than using multiple cognitive strategies, but was superior to using a single behavioral strategy, a single cognitive strategy, or multiple behavioral strategies. Use of coping strategies during temptation episodes was highly related to resisting smoking. Maximum benefit accrued to using more than one strategy of which at least one was a cognitive strategy.

Adaptation, Psychological↗

PubMed2006

Albumin-to-creatinine ratio predicts change in ambulatory blood pressure in normotensive persons: a 7.5-year prospective study.

BACKGROUND: The relationship between urinary albumin excretion and blood pressure (BP) has been found to be positive in hypertensive and normotensive subjects. It is not known, in a normotensive and nondiabetic sample, whether elevated urinary albumin levels predict future increases in BP. METHODS: In this prospective study, we followed a cohort of 108 individuals who were initially free of hypertension and diabetes for an average of 7.7 years. Urinary albumin excretion was determined at baseline by radioimmunoassay in a 24-h collection. Ambulatory BP monitoring was used to assess BP at baseline and at 7.5-year follow-up. Regression models were used to evaluate the relationship of baseline urinary albumin-to-creatinine ratio to baseline BP and average rate of change in BP before and after controlling for several potential confounding variables. RESULTS: Baseline albumin-to-creatinine ratio was not associated with baseline ambulatory BP, but was positively associated with change in ambulatory BP. Before and after controlling for sex, race/ethnicity, age, body mass index at baseline, and change in body mass index, urinary albumin-to-creatinine ratio was found to be a significant independent predictor of change in awake and sleep systolic and diastolic BPs (all P < .05). It also independently predicted hypertension status at follow-up. CONCLUSIONS: In healthy normotensive individuals, the urinary albumin-to-creatinine ratio predicts change in ambulatory BPs 7.5 years later. This finding suggests that urinary albumin excretion may be an important marker for processes that increase BP over time.

Adult↗

PubMed2006

Recalled pain ratings: a complex and poorly defined task.

UNLABELLED: Self-report ratings of pain intensity are ubiquitous in research and clinical practice. In addition to rating their current pain, patients are often asked to provide ratings to represent pain intensity over several days or weeks. Few data are available that provide insight into how people understand and accomplish this recall task. This study describes the results of structured interviews with 106 rheumatology patients with chronic pain about how they arrived at their ratings of pain intensity on a visual analog scale referenced to the past week. Most patients were unable to coherently articulate how they derived their ratings. Moreover, there was no consistency across patients. A variety of different strategies were identified that guided their responses. These results support the concern about the meaning and validity of retrospective recall ratings. Recall of pain, a seemingly simple task, is a deceptively more complex phenomenon. Efforts to improve the measurement of recalled pain need to be explored. Improving instructional sets, clearer specification of the dimensions of pain being targeted, avoiding use of a single item to measure pain, improved description of intended reference groups, and determining the length of time that patients are able to remember pain and limiting recall periods are reasonable methods that need to be explored. PERSPECTIVE: These results emphasize our lack of a full understanding of the meaning of the information elicited by commonly used pain recall questions. They point to the potential importance of clearly specifying what qualities of pain are sought and how the patient should summarize them over the reporting period.

Adult↗

PubMed2006

A population approach to the study of emotion: diurnal rhythms of a working day examined with the Day Reconstruction Method.

To date, diurnal rhythms of emotions have been studied with real-time data collection methods mostly in relatively small samples. The Day Reconstruction Method (DRM), a new survey instrument that reconstructs the emotions of a day, is examined as a method for enabling large-scale investigations of rhythms. Diurnal cycles were observed for 12 emotion adjectives in 909 women over a working day. Bimodal patterns with peaks at noon and evenings were detected for positive emotions; peaks in negative emotions were found at mid-morning and mid-afternoon. A V-shaped pattern was found for tired and an inverted U-shaped pattern for competent. Several diurnal patterns from prior studies were replicated. The DRM appears to be a useful tool for the study of emotions.

Adult↗

PubMed2006

Assessment of the white-coat effect.

BACKGROUND: A limitation of blood pressure measurements made in the physician's office is the transient elevation in pressure seen in many patients that does not appear to be linked to target organ damage or prognosis. This has been labeled the 'white-coat effect' (WCE), computed as the difference between blood pressure measurements taken by the physician and the ambulatory level or resting measures. It is unclear, however, which resting measure is most appropriate. The awake ambulatory blood pressure is the most widely used. However, while arguably the most useful measure for prediction of clinical outcomes, it is less appropriate for use as a resting measure, because it is influenced by many factors, including posture and physical activity level. Resting levels taken in the clinic may also be elevated, and will therefore underestimate the WCE. METHODS: We addressed this question by taking resting measures in a non-medical setting on the day before patients were seen at a Hypertension Clinic (day 1), and comparing these with resting measures taken on the following day, in the clinic before the patient saw the physician. RESULTS: As predicted, the day 1 resting levels were lower than those taken in the clinic prior to seeing the physician (P < 0.05 and P < 0.001 for systolic and diastolic pressures, respectively) in both normotensive and hypertensive patients. Using the day 1 resting levels, the estimated WCE for hypertensive patients was 5.3/6.9 mmHg (systolic/diastolic blood pressures), compared with estimates, using the clinic resting levels, of 0.3/0.5 mmHg. The pattern of changes was different in normotensive patients and hypertensive patients, with the physician pressures being slightly lower than day 1 pressures in the former, and substantially higher in the latter. Heart rate changes were similar and modest in both groups. CONCLUSION: The WCE may not just be limited to that narrow interval in which the patient actually sees the physician, but may generalize to the clinic setting, rendering a clinic 'resting' level invalid. While it is strongly positive in most hypertensive patients, it is frequently negative in normotensive patients. Our results suggest that improved methods of measuring blood pressure in the clinic setting are unlikely to resolve the confounding influence of the WCE, and that greater reliance will need to be placed on out-of-office monitoring.

Adolescent↗

PubMed2006

Superiority of ambulatory to physician blood pressure is not an artifact of differential measurement reliability.

BACKGROUND: Ambulatory blood pressure is a better predictor of target organ damage and the risk of adverse cardiovascular events than office measurements. Whether this is due to the greater reliability owing to the larger number of measurements that are usually taken using ambulatory monitoring, or the greater validity of these measurements independent of the number, remains controversial. METHODS: We addressed this issue by comparing physician readings and ambulatory measurements as predictors of left ventricular mass index. The number of readings was controlled by using the average of three physician readings and randomly selecting three awake readings from a 24-h ambulatory recording. RESULTS: In a multiple regression analysis that included both the ambulatory and physician blood pressure measurements, only the ambulatory systolic measurements significantly predicted left ventricular mass index (B=0.37, t=3.11, P=0.002); the coefficient for physician's systolic measurements was essentially zero (B=-0.01, t=-0.26, NS). CONCLUSIONS: These findings suggest that the superiority of ambulatory blood pressure as a predictor of target organ damage, compared with physician measurements, cannot be adequately/fully explained by the impact of the larger number of measurements obtained with ambulatory monitoring.

Adolescent↗

PubMed2005

Messenger RNA for FOXP3 in the urine of renal-allograft recipients.

BACKGROUND: The outcome of renal transplantation after an episode of acute rejection is difficult to predict, even with an allograft biopsy. METHODS: We studied urine specimens from 36 subjects with acute rejection, 18 subjects with chronic allograft nephropathy, and 29 subjects with normal biopsy results. Levels of messenger RNA (mRNA) for FOXP3, a specification and functional factor for regulatory T lymphocytes, and mRNA for CD25, CD3epsilon, perforin, and 18S ribosomal RNA (rRNA) were measured with a kinetic, quantitative polymerase-chain-reaction assay. We examined associations of mRNA levels with acute rejection, rejection reversal, and graft failure. RESULTS: The log-transformed mean (+/-SE) ratio of FOXP3 mRNA copies to 18S ribosomal RNA copies was higher in urine from the group with acute rejection (3.8+/-0.5) than in the group with chronic allograft nephropathy (1.3+/-0.7) or the group with normal biopsy results (1.6+/-0.4) (P<0.001 by the Kruskal-Wallis test). FOXP3 mRNA levels were inversely correlated with serum creatinine levels measured at the time of biopsy in the acute-rejection group (Spearman's correlation coefficient = -0.38, P=0.02) but not in the group with chronic allograft nephropathy or the group with normal biopsy results. Analyses of receiver-operating-characteristic curves demonstrated that reversal of acute rejection can be predicted with 90 percent sensitivity and 73 percent specificity with use of the optimal identified cutoff for FOXP3 mRNA of 3.46 (P=0.001). FOXP3 mRNA levels identified subjects at risk for graft failure within six months after the incident episode of acute rejection (relative risk for the lowest third of FOXP3 mRNA levels, 6; P=0.02). None of the other mRNA levels were predictive of reversal of acute rejection or graft failure. CONCLUSIONS: Measurement of FOXP3 mRNA in urine may offer a noninvasive means of improving the prediction of outcome of acute rejection of renal transplants.

Acute Disease↗

PubMed2005

Epidemiology of psychiatric and alcohol disorders in Ukraine: findings from the Ukraine World Mental Health survey.

BACKGROUND: This study presents the lifetime, 12-month, and 1-month prevalence estimates of nine psychiatric and alcohol disorders in Ukraine assessed as part of the World Health Organization (WHO) World Mental Health (WMH) research program. The Ukraine WMH survey is the first psychiatric epidemiologic study in a former Soviet Union country to administer a structured psychiatric interview to a nationally representative sample. METHOD: In 2002, a national probability sample of 4,725 respondents ages 18 and older were interviewed with the WMH version of the Composite International Diagnostic Interview (WMH-CIDI). Prevalence estimates, age-of-onset curves, comorbidity, demographic and geographic risk factors, and treatment seeking were examined. RESULTS: Close to one third of the population experienced at least one Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) disorder in their lifetime, 17.6% experienced an episode in the past year, and 10.6% had a current disorder. There was no gender difference in the overall prevalence rates. In men, the most common diagnoses were alcohol disorders (26.5% lifetime) and mood disorders (9.7% lifetime); in women, they were mood disorders (20.8% lifetime) and anxiety disorders (7.9% lifetime). The odds ratios for most pairs of disorders were highly significant. Age of onset was primarily in the teens and early 20s. Age, education, and living in the Eastern region of Ukraine were significant risk factors across disorders, with respondents older than 50 years having the highest prevalence of mood disorder and the lowest prevalence of alcoholism and intermittent explosive disorder. Only a minority of respondents talked to a professional about their symptoms. CONCLUSION: Prevalence estimates of alcoholism among men and recent depression among women were higher in Ukraine than in comparable European surveys. The results argue for the need to develop and implement educational programs focused on the recognition and treatment of mental and alcohol disorders for the general population, psychiatrists, and general medical providers, who are the main source of mental health care.

Adolescent↗

PubMed2005

Arterial stiffness in chronic inflammatory diseases.

Chronic inflammatory diseases are associated with premature atherosclerosis; however, it is unknown whether arterial stiffness is increased in this setting, possibly as a manifestation of vascular disease preceding and/or independent of atherosclerosis. Carotid ultrasonography and radial applanation tonometry were performed in 101 patients with systemic lupus erythematosus, 80 patients with rheumatoid arthritis, and 105 healthy control subjects. The 3 groups were comparable in age, gender, and carotid artery absolute and relative wall thickness. Atherosclerotic plaque was more common in lupus (46%) and rheumatoid arthritis (38%) patients than in controls (23%) (P<0.003). Although control subjects had higher central and peripheral blood pressures, arterial stiffness was increased in patient groups compared with controls (lupus, rheumatoid arthritis, controls, respectively: beta: 3.36 versus 3.22 versus 2.60, P<0.001; Young's modulus: 441 versus 452 versus 366 mm Hg/cm, P=0.004; Peterson's elastic modulus: 278 versus 273 versus 216 mm Hg, P<0.001) after adjustment for differences in mean brachial pressure. In multivariate analysis involving the entire population, arterial stiffness was independently related to age, serum glucose, and the presence of chronic inflammatory disease. In multivariate analysis restricted to the patients, arterial stiffness was independently related to age at diagnosis, disease duration, serum cholesterol, and C-reactive protein (and IL-6, when substituted for C-reactive protein). When analyses were repeated in the 186 study subjects without carotid plaque, arterial stiffness remained significantly elevated in patient groups after adjustment for differences in age and mean brachial pressure. In conclusion, arterial stiffness is increased in chronic inflammatory disorders independent of the presence of atherosclerosis and is related to disease duration, cholesterol, and the inflammatory mediator C-reactive protein and the cytokine that stimulates its production, IL-6.

Adult↗

PubMed2005

Epidemiology of heavy alcohol use in Ukraine: findings from the world mental health survey.

AIMS: To describe the epidemiology of heavy alcohol use in Ukraine, using data from the world mental health (WMH) survey in Ukraine. METHODS: The WMH composite international diagnostic interview was administered in 2002 to a national probability sample of Ukrainian adults (n=4725). An algorithm for classifying heavy use in the past year was developed from self-reports about the quantity and frequency of drinking, and its convergent validity was demonstrated. Prevalence rates and socio-demographic risk factors were examined separately for men and women. RESULTS: The 12-month rates of heavy alcohol use were 38.7% in men and 8.5% in women (22.0% overall). Among heavy alcohol users, 92% of men and 52% of women consumed at least 80 g of ethanol in a typical drinking day on a monthly basis in the year before the interview. The most significant risk factors in men and women were age (26-54 years for men; 18-25 years for women), living in the Southeast region, being in the labour force whether employed or unemployed, and for men, low education and being the father of a young child. A highly significant linear relationship of number of risk factors with heavy alcohol use was found for both sexes. CONCLUSIONS: The rates for men were similar to those reported in a Russian national survey with the exception of Southeast Ukraine where the rate was >10% higher. The highest rates were among men who were middle-aged, fathers and unemployed. Future prospective studies are needed to assess the impact of heavy alcohol use on Ukrainian health, mental health and occupational and social functioning.

Adolescent↗

PubMed2005

Depressive symptoms are independently predictive of carotid atherosclerosis.

The investigators tested whether depressive symptoms were predictive of carotid atherosclerosis, a marker of coronary atherosclerosis. Healthy participants (n = 219) underwent the baseline assessment of cardiovascular risk factors, including self-reported depressive symptoms, and were assessed for carotid plaque at 10-year follow-up. Adjusting for baseline cardiovascular risk factors, participants with elevated depression scores at baseline were >2 times as likely as those with no depressive symptoms to have carotid plaque.

Adult↗

PubMed2005

Generalizability of carry-over effects in the emotional Stroop task.

The emotional Stroop task has been the most widely used task to examine attentional bias to emotionally salient stimuli. In one format of this task, words are presented to participants in a mixed randomized or quasi-randomized sequence. Using a mixed smoking Stroop task, we have previously demonstrated that smokers are slower to respond to words which follow smoking-related words than words which follow neutral words. Here we show that this carry-over effect is present in heroin addicts-but not control subjects-in a heroin Stroop task, and in normal subjects in a stress Stroop task. Thus, the effect generalizes to other populations. In addition, an examination of the studies that have collected data from both mixed and blocked formats provides converging evidence for the presence of carry-over effects. We discuss the implications of the carry-over effect for research using the emotional Stroop task.

Adult↗