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Biomedical subjects

L Harvill

Publications and source records attributed to L Harvill.

12 recordsLinked to original sources
PubMed1998

Use of the hand test in the assessment of combat-related stress.

This study investigated the effectiveness of the Hand Test in discriminating the differential symptomatology of posttraumatic stress (PTS) in Vietnam combat veterans (VCVs). Participants were 108 VCV outpatients, 85 of whom met the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) criteria for posttraumatic stress disorder (PTSD), and 23 patients that were found to meet some, but not the minimum criteria, required for a diagnosis of PTSD by the DSM-IV. The latter group of patients was classified into a subclinical PTSD, posttraumatic stress symptoms (PTSS) group. Results showed higher levels of overall psychopathology, a vulnerable capacity for coping, and a tendency for feelings of inadequacy and inferiority in the PTSD group. The PTSD group also exhibited more limited interaction with the world around them than the PTSS group, which may be indicative of withdrawal, apathy, or a lack of concern with environmental activities and goals. These findings are discussed in relation to the assessment, understanding, and treatment of PTS symptomatology and PTSD.

Adult↗
PubMed1996

Rorschach measures of posttraumatic stress in Persian Gulf War veterans: a three-year follow-up study.

The long-term psychological effects of war-related stress were assessed with the Rorschach 3 years after the Persian Gulf War. Rorschach data are presented for 30 U.S. Marine reservists at a 3-year follow-up who reported experiencing symptoms of posttraumatic stress (PTS) initially after Operation Desert Storm (ODS), and for 25 Marine reservist controls who did not participate in ODS. Results showed significant differences over time between the initial evaluation data and follow-up, and between initial evaluation and the control group on selected Rorschach variables associated with coping ability and PTS. Scores associated with acute distress, capacity for coping and control, and feeling overwhelmed all were found to significantly decrease over time. These findings are discussed in relation to the assessment and understanding of PTS symptomatology over time.

Adaptation, Psychological↗
PubMed1995

Use of the Mississippi scale for combat-related PTSD in detecting war-related, non-combat stress symptomatology.

This study investigated the effectiveness of the Mississippi Scale for Desert Storm War Zone Personnel (M-PTSD-DS), developed from the Mississippi Scale for Combat Related PTSD (M-PTSD; Keane, Caddell, & Taylor, 1988), in the measurement of varying degrees of war-related post-traumatic stress (PTS) symptomatology of non-combat Persian Gulf War veterans. Thirty Marines were administered the M-PTSD-DS after 3 months of active duty in Operation Desert Storm. The M-PTSD-DS scores of the Marines were related significantly to the number of PTS symptoms reported by the Marines. This scale appears to be quite effective in detecting varying degrees of war-related stress in non-combatants.

Adult↗
PubMed1995

Appearance of drug-resistant tuberculosis in rural Tennessee.

Drug-resistant tuberculosis (DRTB) is a growing national health concern in both urban populations and rural areas and is exacerbated by the growing epidemic of human immunodeficiency virus (HIV) infection. Between 1989 and 1992, 7 cases of DRTB (5 with multidrug-resistance) were diagnosed in an eight-county region of East Tennessee. During 1990 and 1991 alone, 5 of 100 patients with tuberculosis had drug-resistant strains (5%). All 7 patients with DRTB had 100% resistance to isoniazid; 5 also had resistance to streptomycin, 2 to rifampin, and 1 to pyrazinamide and ethambutol. All patients were white, U.S.-born, and without evidence of HIV infection. Contact investigation revealed that more contacts of patients with DRTB (13 of 74, 18%) were infected than were contacts of patients with drug-sensitive tuberculosis (46 of 290, 16%). Our study demonstrates that DRTB is not confined to geographically distinct areas, but may be a subtle and easily missed diagnosis in presumably low-risk rural populations.

Adult↗
PubMed1995

Rorschach measures of posttraumatic stress in Persian Gulf War veterans.

The effectiveness of the Rorschach in detecting acute posttraumatic stress (PTS) in Persian Gulf War veterans was investigated. Subjects were 30 U.S. Marine Reservists who reported experiencing symptoms of PTS after 3 months of active duty in Operation Desert Storm. Subjects were administered the Rorschach and MMPI-2 soon after their return from the Persian Gulf War. Results showed acute distress, a vulnerable capacity for coping and control, and a tendency to be overwhelmed by internal and external stimulation. Selected Rorschach variables were significantly related in a conceptually valid manner to MMPI-2 scales associated with defensiveness, coping ability, and PTS. These findings are discussed in relation to the assessment, understanding, and treatment of PTS symptomatology and posttraumatic stress disorder.

Adaptation, Psychological↗
PubMed1993

Changes in bone mineral content and density after stroke.

The purpose of this study was to determine whether there are differences in bone mineral content and density between paralyzed and nonparalyzed sides of patients who had sustained strokes associated with unilateral muscle weakness, to determine the relationship between duration of stroke and degree of demineralization and to compare the degree of demineralization in upper and lower limbs. The bone mineral content and density were measured by dual photon absorptiometry (high resolution scanning mode, Lunar DP4) in ambulant patients with a history of single completed strokes associated with unilateral weakness. The bone mineral content and density of each limb was determined by the region of interest analysis program. In the 30 patients included in this study, the bone mineral content and density were significantly less on the paralyzed than on the nonparalyzed side. The degree of demineralization was more pronounced in the upper than in the lower limbs. The mean percentage differences in bone mineral content and density between paralyzed and nonparalyzed arms were 13.8% (P < 0.00001) and 7.95% (P = 0.0003), respectively, and between paralyzed and nonparalyzed legs the differences were 4.5% (P = 0.0012) and 3.42% (P = 0.0028), respectively. A better correlation was noted between the time elapsed since the stroke and the degree of demineralization in the upper limbs (r = 0.75, P < 0.0001), than in the lower limbs (r = 0.60, P = 0.0004). In conclusion, patients who have strokes associated with muscle weakness are at an increased risk of developing osteoporosis on the paralyzed side and particularly in the upper limbs.

Aged↗
PubMed1993

Flexible bronchoscopy as a diagnostic tool in the evaluation of pulmonary tuberculosis in an elderly population.

OBJECTIVE: This study intends to determine what role fiberoptic bronchoscopy (FOB) plays in the diagnosis of tuberculosis (TB), particularly in a geriatric population. DESIGN: Cases of tuberculosis reported to the Tennessee Department of Health during the years 1989 and 1990 were divided into two age groups: Group A (< 65 years) and Group B (> or = 65 years). Natural sputum smears and cultures positive for M. tuberculosis (M. TB) in each group were compared with FOB specimens, acid-fast bacilli (AFB) smears and cultures. Data were analyzed by chi-square tests of independence for each year, then compared to determine statistical significance. SETTING AND PATIENTS: Of the 601 TB cases reported to the State of Tennessee in 1989, 285 patients were in Group A and 316 in Group B. For 1990, 525 cases were reported, 269 in Group A and 256 in Group B. All cases met CDC-approved criteria for diagnosis of tuberculosis. MEASUREMENTS: The number of positive AFB smears and M. TB cultures were compared in each group. In cases with sputum negative but FOB specimens positive for TB, identification was made by FOB only. MAIN RESULTS: In Group A, 26 (9.1%) were diagnosed by FOB; only eight of these had positive sputum cultures. In Group B, 77 (24.4%) were diagnosed by FOB. Of these, 23 had positive sputum cultures; the remaining 54 patients (17.1%) had diagnoses based on FOB alone. In 1990, 269 cases of TB were reported in Group A. Of these, 38 (14.1%) were diagnosed by FOB. There were 256 TB cases reported among Group B, 83 (32.4%) of which were diagnosed by FOB. Of these 83 cases, 60 (23.4%) were diagnosed by FOB only. While no statistically significant difference was seen between the 1989 and 1990 rates of TB diagnosis by FOB for those in Group A (age < 65), the difference in rates for those in Group B (age > or = 65) was statistically significant (P < 0.05). CONCLUSIONS: A steady increase in the use of FOB as a diagnostic tool was noted, suggesting that a significant number (19.9%) of geriatric TB cases might have been missed without the aid of FOB. While the exact reason for its increased utilization is not known, this study indicates that FOB has become a more important source of diagnosis in pulmonary TB, particularly among the elderly.

Age Factors↗
PubMed1991

Epidemiology of extrapulmonary tuberculosis. A comparative analysis with pre-AIDS era.

To study the changes in the epidemiology of extrapulmonary tuberculosis in Tennessee, we compared the 454 cases of extrapulmonary tuberculosis reported between 1977 and 1981 with 356 cases encountered between 1982 and 1986. The data were analyzed by age, sex, race and site of the disease which were compared with the national statistics during the periods. We observed that 11.3 percent of the total TB cases were extrapulmonary. Unlike national statistics, the proportion of extrapulmonary tuberculosis had remained unchanged between the two study periods. Except for a significant decline (p less than 0.001) in genitourinary tuberculosis, the incidence of other extrapulmonary TB had remained the same. The higher incidences of lymphatic, miliary, and meningeal TB were noted in nonwhites, particularly in the younger population, during both study periods. While the national trend showed a steady increase in the percentage of extrapulmonary TB cases, there was no change in Tennessee. The reason for a continued decline of GU TB remains unclear. Although AIDS may have contributed toward the increase nationally, fewer cases of AIDS in the state have not influenced the proportion of extrapulmonary TB. Awareness of such regional differences in the epidemiology of TB, and the impact of HIV infection, will be very useful to physicians and other health care providers involved in the diagnosis, treatment, and prevention of tuberculosis.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Fiberoptic bronchoscopy in the diagnosis of pulmonary tuberculosis.

We reviewed the records of 80 patients with culture-positive pulmonary tuberculosis. Forty (50%) had their diagnoses established by sputum smears and cultures alone, 20 (25%) by brush/wash specimens from fiberoptic bronchoscopy alone, 18 (22.5%) from both sources, and two (2.5%) by gastric smears. The average age of the patients was 71.3 years, and only 20% had symptoms typical of pulmonary tuberculosis. Our data reveal that findings in smears from fiberoptic bronchoscopy were of comparable sensitivity (80%) to those of sputum (72.5%); in 25/80 (31.25%), diagnosis was made exclusively by fiberoptic bronchoscopy. Such a high sensitivity of fiberoptic bronchoscopy in the diagnosis of pulmonary tuberculosis indicates a threefold rise (P = .018) in the number of diagnoses made in this manner compared to our figures from 1983 (10% of diagnoses made by fiberoptic bronchoscopy). Forty-three of the 80 patients (53.8%) had either a negative sputum smear or no sputum available. Thirty of the 43 patients (69.8%) had diagnostic bronchoscopy, which provided an immediate diagnosis (smear positivity) in 18 patients (60%). Transbronchial biopsy was most useful in excluding associated malignancy. Fiberoptic bronchoscopy is playing an increasingly significant role in the diagnosis of pulmonary tuberculosis. Further studies are essential to evaluate cost effectiveness, specificity of fiberoptic bronchoscopy, and the influence of the procedure on morbidity and mortality in pulmonary tuberculosis.

Age Factors↗
PubMed1988

Isoniazid preventive therapy for tuberculosis. Are we losing our enthusiasm?

Contact investigation activities of the Tennessee Department of Health and Environment (TDHE) Tuberculosis (TB) Control Program from 1979 to 1985 were reviewed. Out of 32,722 identified contacts, 6,030 (20.1 percent) were infected (positive purified protein derivative [PPD]). Only 2,731 (45 percent) of the infected contacts were started on preventive therapy. Both the absolute number and the relative percentage of infected contacts starting on INH prevention therapy have gradually declined over the years. While 569 (67 percent) of the infected contacts were started on preventive treatment in 1979, only 296 (37.5 percent) received isoniazid (INH) preventive therapy in 1985. Although an increasing percentage of those starting preventive therapy completed the prescribed course, the enthusiasm for recommending preventive therapy has declined for the infected individuals above the age of 15. More enthusiasm and efforts are needed from physicians in initiating and maintaining INH preventive therapy to accomplish tuberculosis eradication.

Adolescent↗