Biomedical subjects

L R Muenz

Publications and source records attributed to L R Muenz.

At least 37 records · Page 2Linked to original sources

PubMed1997

A measure of readiness for substance abuse treatment. Psychometric properties of the RAATE-R interview.

The Recovery Attitude and Treatment Evaluator-Research (RAATE-R) scale is a structured interview that assesses readiness for substance abuse treatment in five subscales: resistance to treatment, resistance to continuing care, bio-medical acuity, psychological acuity, and environmental/ social problems. Psychometric properties, based on an interrater reliability analysis of 23 raters and administration of the scale to 116 cocaine-dependent outpatients, included high interrater reliability, high internal consistency, independence of subscales, and a factor structure that partially supports the scale's original design. The authors discuss limitations of these conclusions and the lack of concurrent validity with a self-report measure of therapy readiness.

Attitude to Health↗

PubMed1997

Early prediction of initiation of abstinence from cocaine. Use of a craving questionnaire.

The authors administered a five-item craving questionnaire daily to 86 outpatients to determine whether initial craving scores predicted the likelihood of initiation of abstinence within a 30-day period. Patients with higher mean craving scores during the first 3 days of the study were less likely to initiate abstinence. However the relationship between craving and abstinence initiation was not linear. Rather, patients in the top quartile of craving scores were significantly less likely to abstain than were patients in the lower three quartiles. The findings suggest that this rapid, easily administered craving questionnaire may have short-term predictive validity.

Cocaine↗

PubMed1996

The role of avoidance and obsessiveness in matching patients to cognitive and interpersonal psychotherapy: empirical findings from the treatment for depression collaborative research program.

This article examines the hypothesis that cognitive therapy (CT) is more effective than interpersonal therapy (IPT) for treatment of depressed patients with an elevated level of avoidant personality, whereas the reverse holds for depressed patients with elevated level of obsessive personality. This hypothesis was derived in part from the preliminary results of previous unpublished pilot work, which examined the course of dynamic and cognitive therapies for avoidant and obsessive-compulsive personality disorders. With the "completer" data set available from the Treatment for Depression Collaborative Research Program (I. Elkin et al., 1989), the expected significant interactions between treatment (CT vs. IPT) and avoidance and between treatment and obsessiveness were found. A significant interaction was also found between marital status and treatment, indicating that married patients did better after CT, whereas single and noncohabiting patients improved more after IPT. Similar patterns of results were found using the Hamilton Rating Scale for Depression and the Beck Depression Inventory. A matching factor formula of patients to CT vs. IPT is presented.

Adult↗

PubMed1996

Neurologic status of human immunodeficiency virus 1-infected infants and their controls: a prospective study from birth to 2 years. Mothers and Infants Cohort Study.

OBJECTIVE: To determine the timing, extent, severity, and persistence of neurologic abnormalities in children with perinatally acquired human immunodeficiency virus 1 (HIV-1) infection compared with similar uninfected children of HIV-1-infected women and control children. METHODS: Serial neurologic examinations and head circumference measurements were performed on a cohort of HIV-1-infected children born to HIV-1-infected women, seroreverting children born to HIV-1-infected women, and control children born to uninfected women. Examination data from 32 HIV-1-infected children, 99 reverters, and 116 control children were summarized by eight neurologic domains. Data were analyzed by longitudinal analysis. RESULTS: Reverter children were not different from control children in neurologic function for any of the eight domains or head circumference. HIV-1-infected children had significantly more neurologic problems than the control and reverter children for seven of the eight domains. The HIV-1-infected children were further classified by whether they had acquired immunodeficiency syndrome (AIDS)-defining clinical conditions (other than lymphoid interstitial pneumonitis) in the first 24 months of life (the AIDS-opportunistic infection group) or did not (the infected-other group). Neurologic abnormalities were early, severe, pervasive, and persistent in the AIDS-opportunistic infection group, and nearly all in this group had head circumference measurements below the 10th percentile. The infected-other group had no statistically significant differences from the uninfected children, although individual children in the infected-other group had some abnormalities. CONCLUSIONS: In utero exposure to HIV-1 without infection seems to have no negative impact on neurologic function in children in the first 2 years of life. Among children with perinatally acquired HIV-1 infection, the most severe and pervasive neurologic problems occur in those children who have early serious HIV-1 clinical disease. Most children without serious AIDS-defining clinical conditions in the first 2 years of life are also free from serious neurologic problems during that period.

AIDS-Related Opportunistic Infections↗

PubMed1996

Iodine-123-IPT SPECT imaging of CNS dopamine transporters: nonlinear effects of normal aging on striatal uptake values.

UNLABELLED: Iodine-123-labeled IPT (N-(3-iodopropen-2-yl)-2 beta-carbomethoxy-3 beta-(4-chlorophenyl)tropane) is an analog of cocaine that selectively binds the presynaptic dopamine transporter. This study sought to characterize changes in the striatal uptake of IPT with normal aging. METHODS: The sample included 18 healthy human volunteers. Their ages ranged from 19 to 67 yr. Dynamic SPECT scans of the brain were acquired with about 185 MBq (5 mCi) of IPT on a triple-headed camera. The images were reconstructed with a three-dimensional restorative filter and corrected for attenuation. The mean concentration of radioactivity [microCi/ml] was measured in the head of the caudate and body of the putamen. The remainder of the supratentorial brain was used as a reference. RESULTS: The specific uptake of IPT was higher in the caudate than in the putamen of each subject. It decreased significantly with age in both regions. The mean specific uptake in seven volunteers who were less than 30 yr old was 17.6 +/- 4.9 in the caudate and 13.3 +/- 4.0 in the putamen, compared to only 11.97 +/- 3.30 and 7.8 +/- 2.68, respectively, in the six middle-aged subjects (t = 2.53 and 2.90, df = 11, p = 0.027 and 0.014). However, there were no significant differences between the six middle-aged subjects and the five volunteers who were older than 60 yr, whose respective means were 9.0 +/- 1.6 and 6.2 +/- 0.7 (t = 1.83 and 1.28, df = 9, p = 0.10 and 0.23). The results were supported by regression analysis, which indicated that changes with age were not optimally described as a linear function when compared to several nonlinear alternatives. The fit improved when the models accounted for relatively rapid rates of decline during young adulthood, followed by less rapid decline throughout middle age. CONCLUSION: The results are consistent with the findings from previous studies that have shown that the specific uptake values for radiopharmaceuticals that bind the dopamine transporter decline with advancing age. However, results of this study suggest that the effects of aging may be nonlinear and regionally distinct.

Adult↗

PubMed1995

Natural history of HIV-1 cell-free viremia.

OBJECTIVE: To characterize the natural history of viremia with human immunodeficiency virus type 1 (HIV-1) and its association with disease progression from infection to acquired immunodeficiency syndrome (AIDS). DESIGN: Prospective cohort study. Annual specimens were tested for quantitative virion-associated HIV-1 RNA, p24 antigen, and CD4+ lymphocyte levels. PARTICIPANTS: A total of 42 homosexual men who seroconverted to HIV-1 between 1982 and 1985. MAIN OUTCOME MEASURES: Trends over time in serum HIV-1 RNA level, correlations between serum HIV-1 RNA and other markers, and prediction of AIDS using these markers. RESULTS: HIV-1 RNA levels were stable over time, increasing by 10-fold or more in only six (14%) of the 42 subjects during 3 to 11 years of follow-up. Mean HIV-1 RNA levels were 10(3.8) copies/mL if AIDS occurred in less than 4 years, 10(3.07) copies/mL if AIDS developed within 4 through 9 years, and 10(2.27) copies/mL if AIDS did not develop within 6 through 11 years. In both univariate and multivariate models, initial and subsequent HIV-1 RNA levels, p24 antigenemia, and percentage of CD4+ lymphocytes were independently predictive of AIDS. CONCLUSIONS: The stability of virion-associated HIV-1 RNA levels suggests that an equilibrium between HIV-1 replication rate and efficacy of immunologic response is established shortly after infection and persists throughout the asymptomatic period of the disease. Thus, defective immunologic control of HIV-1 infection may be as important as the viral replication rate for determining AIDS-free survival. Because individual steady-state levels of viremia were established soon after infection, HIV-1 RNA levels may be useful markers for predicting clinical outcome.

Acquired Immunodeficiency Syndrome↗

PubMed1995

The relationship of the duration of ruptured membranes to vertical transmission of human immunodeficiency virus.

OBJECTIVE: Intrapartum events may play a role in determining the likelihood of vertical transmission of human immunodeficiency virus-1. Timing and duration of rupture of membranes have been shown to modify transmission risk of other organisms but have not been examined for human immunodeficiency virus. This study was undertaken to assess the relationship between duration of rupture of membranes, maternal immune status, and transmission of human immunodeficiency virus. METHODS: The Mothers' and Infants' Cohort Study enrolled 207 human immunodeficiency virus-positive women and their infants at five study sites in Brooklyn and the Bronx, New York between January 1986 and January 1991. One hundred twenty-seven woman-infant sets for whom antepartum CD4+ levels were available, the infant's human immunodeficiency virus infection outcome was known, and the duration of ruptured membranes could be determined were included in this analysis. RESULTS: Thirty of the 127 evaluable infants (24%) were infected. Women with low CD4+ levels (< 20%) were significantly more likely to transmit the virus if rupture of membranes was > or = 4 hours (relative risk 4.53, 95% confidence interval 1.14 to 1.81, p = 0.02). The same association was not observed among women with higher CD4+ levels (relative risk 1.11, 95% confidence interval 0.52 to 2.69, p = 0.69). No association with the duration of labor or mode of delivery was seen. CONCLUSIONS: In this urban North American cohort women with low CD4+ levels were significantly more likely to transmit human immunodeficiency virus to their offspring if the duration of rupture of membranes was > or = 4 hours.

Acquired Immunodeficiency Syndrome↗

PubMed1994

Standardized mood induction with happy and sad facial expressions.

The feasibility of applying ecologically valid and socially relevant emotional stimuli in a standardized fashion to obtain reliable mood changes in healthy subjects was examined. The stimuli consisted of happy and sad facial expressions varying in intensity. Two mood-induction procedures (happy and sad, each consisting of 40 slides) were administered to 24 young healthy subjects, who were instructed to look at each slide (self-paced) and try to feel the happy or sad mood expressed by the person in the picture. On an emotional self-rating scale, subjects rated themselves as relatively happier during the happy mood-induction condition and as relatively sadder during the sad mood-induction condition. Conversely, they reported that they were less happy during the sad mood-induction condition and less sad during the happy mood-induction condition. The effects were generalized to positive and negative affect as measured by the Positive and Negative Affect Scale. The intraindividual variability in the effect was very small. In a retest study after 1 month, the mood-induction effects showed good stability over time. The results encourage the use of this mood-induction procedure as a neurobehavioral probe in physiologic neuroimaging studies for investigating the neural substrates of emotional experience.

Adult↗

PubMed1994

Effects of new brochures on blood donor recruitment and retention.

BACKGROUND: Currently, donors may arrive at blood collection sites without prior knowledge of eligibility and deferral criteria. STUDY DESIGN AND METHODS: The effects of distributing newly developed recruitment brochures 2 weeks in advance of blood drives and the provision of brochures on temporary deferral at the taking of health history were examined in four southeastern regional blood collection centers. Twenty-four similar pairs of worksites, with employee-only recruitment, were randomly assigned to a control (C) or experimental (E) group. Information about sponsor recruitment strategies, worksite factors, and first-time, repeat, and temporarily deferred donors was obtained at three collection drives per site over a 1-year period. Drive 1 was used as a baseline. Two weeks before Drives 2 and 3, the recruitment brochures were distributed to all Group E employees, with temporary deferral brochures provided as needed when the health history was taken. RESULTS: No significant differences between groups or drives were found in the total percentage of employees recruited or returning as a result of recruitment or deferral brochure distribution (Wilcoxon's signed rank test and t test). Substantiating previous observations by donor recruiters, the study results showed decreased donations during vacation periods and busier times at the workplace. Loudspeaker announcements led to decreased donations; increased donations followed special appeals in relation to a specific patient, an accident, or a natural disaster. CONCLUSION: The brochures may have encouraged previous donors to return, but their use did not significantly increase the recruitment of new donors or the return of temporarily deferred donors.

Blood Donors↗

PubMed1994

Consistency of interpersonal themes for patients in psychotherapy.

In this study the extent to which patients in psychotherapy display similar interpersonal themes across multiple narratives of their interactions with others was investigated. Interpersonal themes were measured using a new instrument entitled the Quantitative Assessment of Interpersonal Themes (QUAINT) method, which assesses the wishes, responses from others, and responses of self that occur in narratives about interactions with others. For 60 patients in psychotherapy, evidence for repetitiveness of themes was found; the effect was relatively small but was highly statistically significant. Individual differences in the degree of repetitiveness of themes were not related to type of treatment (dynamic vs. cognitive), but they were related to length of time in treatment. The limitations of the study are reviewed and future research directions are outlined.

Adolescent↗

PubMed1994

An alternative approach to dietary exposure assessment.

The method of dietary exposure assessment currently used by the Environmental Protection Agency (EPA), the Dietary Residue Evaluation System (DRES), combines a consumption distribution derived from the United States Department of Agriculture (USDA) 1977-1978 Nationwide Food Consumption Survey (NFCS) with a single estimate of residue level. The National Academy of Sciences recommended that EPA incorporate both the distribution of residues and the distribution of consumption into their exposure assessment methodology and proposed using a Monte Carlo approach. This paper presents an alternative method, the Joint Distributional Analysis (JDA), that combines the consumption and residue distributions, without relying on random sampling or fitting theoretical distributions like the Monte Carlo method. This method permits simultaneous analysis of the entire diet, including assessing exposure from residues in different foods.

Aldicarb↗

PubMed1994

Classical analytical methods for detecting matching effects on treatment outcome.

This article presents a classical approach for analyzing repeated measures designs with specific application to treatment matching studies. The generic treatment matching hypothesis is formulated under the multivariate general linear model, transforming the dependent variables to account for the repeated measures structure of the data. Issues of primary importance in the use of this approach (such as correcting for inflated Type I error and robustness of statistical tests to parametric assumptions) are discussed. The article concludes with an assessment of the strengths and weaknesses of this approach compared with alternative approaches.

Alcoholism↗

PubMed1994

Alternative analytical methods for detecting matching effects in treatment outcomes.

Project MATCH presented a unique opportunity for a team of statisticians, data analysts and content experts to come together and explore the strengths and weaknesses of the application of various statistical models to the data of the type being collected in this large trial. The following models were evaluated: multilevel models, event history models, multiple were structural equation modeling, time series models, ordinal repeated measures designs and generalized estimating equations. No one model was found to be the perfect solution and each seemed to have something to recommend it. Future research on these methods will shed light on many issues raised. It is hoped that alcohol researchers will find useful guidelines within this chapter as they plan and carry out their studies.

Alcoholism↗

PubMed1994

Cigarette smoking, premature rupture of membranes, and vertical transmission of HIV-1 among women with low CD4+ levels.

To examine the possible influence of obstetric factors, substance use during pregnancy, and other maternal factors on the relationship between a low maternal CD4+ level and vertical transmission of human immunodeficiency virus type 1 (HIV-1), data were analyzed from the Mothers and Infants Cohort Study, a prospective cohort followed for up to 4 years between 1986 and 1992 in Brooklyn and the Bronx, New York. The overall transmission rate for the cohort was 25.1% (95% confidence interval (CI) = 19.0-31.3). Prenatal CD4+ lymphocyte measurements were available for 162 HIV-seropositive mothers of infants with known infection outcomes. Among mothers who smoked cigarettes after the first trimester, those whose mean prenatal CD4+ level was < 20% had more than a threefold increased risk of transmitting their infection to their infants [relative risk (RR) = 3.30; 95% CI = 1.46-7.44; p = 0.004]. Among mothers who developed premature rupture of membranes, those with a low CD4+ level had a similarly increased risk of vertical transmission (RR = 4.33; 95% CI = 1.78-10.5; p = 0.003). These relative risks were much higher than those for mothers who did not smoke after the first trimester (RR = 1.14; 95% CI = 0.48-2.70; p = 0.76) or have premature rupture of membranes (RR = 1.29; 95% CI = 0.61-2.74; p = 0.50), indicating that these factors modified the effect of CD4+ level on transmission. Among all mothers without regard to CD4+ level, those who experienced preterm premature rupture of membranes were also at greater risk of transmission (RR = 2.24; 95% CI = 1.07-4.69; p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

Adjuvant active specific immunotherapy for human colorectal cancer: 6.5-year median follow-up of a phase III prospectively randomized trial.

PURPOSE: Patients with colon or rectal cancer were entered onto a prospectively randomized, controlled clinical trial of active specific immunotherapy (ASI) with an autologous tumor cell-bacillus Calmette-Guérin (BCG) vaccine. We investigated whether ASI could improve disease-free status and survival. PATIENTS AND METHODS: Ninety-eight patients with Dukes' stage B2-C3 colon or rectal cancer were randomized into groups treated by resection alone or resection plus ASI. Eighty patients met all eligibility criteria. All patients with rectal cancer were to receive 50 Gy of pelvic irradiation. Analysis of distribution of survival and disease-free survival was made on all eligible patients until December 31, 1990. RESULTS: As a single study, no statistically significant differences were detected in survival or disease-free survival for all 80 eligible patients. However, since it was recognized at the outset that there were treatment differences, in that rectal cancer patients were to receive postimmunotherapy radiation, it was considered that a cohort analysis of the colon and rectal cancer patients might be informative. With a median follow-up of 93 months, there is a significant improvement in survival (two-sided P = .02; hazards ratio, 3.97) and disease-free survival (two-sided P = .039; hazards ratio, 2.67) in all eligible colon cancer patients who received ASI. With a median follow-up of 58 months, no benefits were seen in patients with rectal cancer who received ASI. CONCLUSION: This study suggests that ASI may be beneficial to patients with colon cancer.

Adult↗

PubMed1993

Ten-year results utilizing chemotherapy as primary treatment in nonmetastatic, rapidly progressing breast cancer.

Eighty-three patients with rapidly progressing breast cancer (RPBC) were entered into a study of primary chemotherapy (cyclophosphamide, methotrexate, and 5-fluorouracil) and subsequent randomization to surgery or radiotherapy for control of local/regional disease. Eighty-three of these patients with redness, warmth, and edema compatible with clinical "inflammatory breast cancer" served as the focus for our analysis of factors associated with improved survival. The stage-specific disease-free intervals (DFI) of 36 and 21 months were substantially longer than in the earlier series (26 and 16 months) from the same institution. The evaluation of individual prognostic indicators revealed that the initial tumor size and the initial response to chemotherapy were the two independent factors most important in predicting the DFI. The continuing unmaintained 1-year remission in at least 12 patients supports the rationale for aggressive therapy in RPBC or "inflammatory breast cancer."

Adult↗

PubMed1992

Neuropsychological functioning in nonmentally retarded autistic individuals.

To investigate several neurobiological theories we evaluated the neuropsychological functioning of 15 non-mentally retarded autistic adolescents and young adults and 15 controls matched on age, gender, IQ, and race. The autistic subjects were found to perform less well than controls on measures of abstraction involving cognitive flexibility, verbal reasoning, complex memory, and complex language comprehension in the absence of significant differences on measures of attention, associative memory, and the rule-learning aspects of abstraction. These findings are most consistent with a generalized abnormality in complex information processing and would not support theories purporting fundamental deficits in attention or information acquisition.

Adolescent↗

PubMed1990

Thyroparathyroidectomy produces a progressive escape deficit in rats.

Abnormal thyroid status and affective disorders have been associated in the human clinical literature. It has recently been shown that pretreatment with thyroid hormone can prevent escape deficits produced by inescapable shock in an animal analogue of depression. In this report we provide evidence that hypothyroid status can produce an escape deficit in rats. While sham-operated rats improved their performance on a simple escape task over three days of testing, thyroparathyroidectomized rats showed a pronounced decrease in their responses. Markov transition analysis was used to obtain conditional probabilities of escaping given a prior escape or failure to escape for the two groups. This analysis shows that the structure of the data set may be similar for the two groups. These results suggest that if intact rats learn to escape, then hypothyroid rats may learn not to escape.

Affect↗