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Biomedical subjects

L S Miller

Publications and source records attributed to L S Miller.

At least 19 recordsLinked to original sources
PubMed1995

Prevention of depression with primary care patients: a randomized controlled trial.

The prevention of major depression is an important research goal which deserves increased attention. Depressive symptoms and disorders are particularly common in primary care patients and have a negative impact on functioning and well-being comparable with other major chronic medical conditions. The San Francisco Depression Prevention Research project conducted a randomized, controlled, prevention trial to demonstrate the feasibility of implementing such research in a public sector setting serving low-income, predominantly minority individuals: 150 primary care patients free from depression or other major mental disorders were randomized to an experimental cognitive-behavioral intervention or to a control condition. The experimental intervention group reported a significantly greater reduction in depressive levels. Decline in depressive levels was significantly mediated by decline in the frequency of negative conditions. Group differences in the number of new episodes (incidence) of major depression did not reach significance during the 1-year trial. We conclude that depression prevention trials in public sector primary care settings are feasible, and that depressive symptoms can be reduced even in low-income, minority populations. To conduct randomized prevention trials that can test effects on incidence with sufficient statistical power, subgroups at greater imminent risk have to be identified.

Adolescent↗
PubMed1995

Correlation of high-frequency esophageal ultrasonography and manometry in the study of esophageal motility.

BACKGROUND & AIMS: No studies correlate manometric measurements with morphological changes during the esophageal peristaltic sequence. The aim of this study was to develop and use a system for sonographically imaging the esophageal wall while simultaneously recording esophageal pressure changes. METHODS: An ultrasonography transducer attached to a manometric probe was used to evaluate the esophagus. RESULTS: Four sonographic phases of an esophageal peristaltic sequence were identified. The esophageal lumen was not open at rest in phase 1 (resting), increased to a maximum mean circumference of 4.90 +/- 0.57 cm in phase 2 (passive distention), and returned to a closed position in phases 3 (contraction) and 4 (relaxation). The muscle layers of the esophageal wall were baseline resting width in phase 1, decreased in width during phase 2, increased and reached maximum mean widths during phase 3, and returned to baseline widths during phase 4. The measurement of esophageal intraluminal pressure remained at a baseline resting level during phases 1 and 2, increased to a maximum mean peak of 67.95 +/- 9.18 mm Hg during phase 3, and returned to baseline during phase 4. CONCLUSIONS: A combined ultrasonography transducer/manometry probe was used to dynamically and simultaneously evaluate esophageal wall motion, muscle thickness, and esophageal pressure changes during peristalsis.

Adult↗
PubMed1995

Caffeine and time of day effects on a force discrimination task in humans.

The effects of caffeine (0 mg/kg, 1 mg/kg, 3 mg/kg) and time of day (TOD) on human performance were studied using a multiple forceband discrimination task (MFDT) and subjective ratings. Self-rated measures of energy level were affected by TOD and caffeine, while mood was affected by TOD. Energy level decreased throughout the day and was offset by caffeine which increased energy level independent of TOD. Self-reported anxiety was not affected by TOD or caffeine. Mood was affected by TOD in a complex cubic trend with late morning and late evening peaks 12 h apart. MFDT performance was affected by TOD, caffeine dosage, and their interaction. Trend analyses showed varying patterns of TOD effects across peak force variability, response latency, response duration, and correct responding. Results support and extend previous findings of TOD influences on the MFDT and support the utility of multicomponent proprioceptive tasks for examining drug effects on performance.

Adult↗
PubMed1995

Evaluation of asymptomatic microhematuria.

OBJECTIVES: The purpose of this study was to evaluate a comprehensive urine cytodiagnostic assay to assist in localizing the site of origin and the etiology of asymptomatic microhematuria. This analysis, which assesses various qualitative and quantitative aspects of the voided urine, is compared simultaneously with controls obtained from the established routine urologic evaluation. METHODS: One hundred consecutive subjects who presented solely for the evaluation of asymptomatic microhematuria were evaluated by the established routine urologic evaluation and a refined urine cytodiagnostic assay. For the purpose of this study, only calculi and neoplasms were considered significant findings. RESULTS: The incidence of significant urologic disease was 13% (3 renal neoplasms, 2 urothelial bladder carcinomas, and 8 urinary calculi). The refined urine cytodiagnostic assay identified both uroepithelial vesical neoplasms, 7 of the 8 urinary calculi, and none of the 3 renal neoplasms. The presence of dysmorphic urinary red blood cells (RBCs) and RBC casts was strongly suggestive of renal parenchymal bleeding. Overall, 43 of 44 subjects (98%) with dysmorphic RBCs and RBC casts failed to demonstrate any significant urologic etiology. CONCLUSIONS: These preliminary results suggest that the refined cytodiagnostic urine assay may be helpful in distinguishing whether a given patient's microhematuria is of a significant urologic or a renal parenchymal cause. The addition of this specialized urinalysis may prove a useful adjunct in improving the diagnostic yield in patients with asymptomatic microhematuria.

Adolescent↗
PubMed1995

The New York Teacher Rating Scale for disruptive and antisocial behavior.

OBJECTIVE: A teacher rating scale designed to reflect current diagnostic descriptors of oppositional defiant disorder and conduct disorder was developed and standardized. METHOD: Teacher ratings were obtained for 1,258 1st-through 10th-grade children from two school districts in New York and for 81 clinically referred children with conduct disorder. RESULTS: Three factors relevant to oppositional defiant disorder and conduct disorder were generated: defiance, physical aggression, and delinquent aggression. A fourth factor reflects peer problems. Internal consistency, test-retest reliability, and interrater reliability are documented using a population and a conduct disorder sample. The validity of the factors is supported by the factors' ability to discriminate between children in the general population and those with conduct disorders, by correlations with global impairment items, and by expected sex differences. CONCLUSION: The scale has utility for assessing symptoms of conduct disorder in school settings.

Adolescent↗
PubMed1995

Gender differences in schizotypic features in a large sample of young adults.

Research with self-report measures of schizotypic or psychosis-prone features in nonclinical populations suggests that, similarly to schizophrenic populations, males score higher on more "negative" schizotypic features and females score higher on more "positive" schizotypic features. We administered the Schizotypal Personality Questionnaire and the Chapman Scales of Psychosis Proneness--impulsivity/nonconformity, magical ideation, perceptual aberration, physical anhedonia, and social anhedonia--to a large, nonclinical, young adult sample (N = 1179: 453 males and 726 females). Results indicated increased negative symptomatology in males compared with females, but not increased positive symptomatology in females compared with males. Findings on Schizotypal Personality Questionnaire factors suggested that interpersonal deficits differed by gender as well. Finally, a measure of impulsive behavior and nonconformity not typically associated with negative symptomatology indicated gender differences not predicted by a negative/positive dichotomy.

Adolescent↗
PubMed1995

The use of high frequency endoscopic ultrasonography probes in the evaluation of achalasia.

Because its ultrasound beam cannot penetrate beyond a radius of 2 cm, HRES is limited in evaluating abnormalities within or adjacent to the esophageal wall. To date, however, it has provided new diagnostic capabilities in evaluating patients with several different esophageal disorders. EUS at lower frequencies has shown inconsistent results in evaluating the thickness of esophageal muscle layers in patients with achalasia. HRES has been able to more accurately measure the individual CSM, LSM, and TM layers of the muscularis propria and the mean measurements have been noted to increase in achalasia patients when compared with normals. HRES has been found to be clinically useful in assessing histologic damage following pneumatic dilatation and in localizing the LES during the administration of intrasphincter botulinum toxin injection in the treatment of achalasia.

Endoscopy, Digestive System↗
PubMed1995

The economic burden of affective disorders.

BACKGROUND: This paper summarises the methods and sources of data used to estimate costs of affective disorders and presents the results. METHOD: A timing model employing regression analysis was developed to estimate morbidity costs. This model measures the lifetime effect on current income of individuals with affective disorders, taking into account the timing of onset and the duration of these disorders. RESULTS: Affective disorders imposed an estimated US$ 20.8 billion burden in 1985 and US$ 30.4 billion in 1990 in the US. Affective disorders represent 21% of the costs of all mental illnesses. Direct treatment costs comprised 58.4% of the total in 1985; morbidity costs, 8.1%; mortality costs, the present value of future earnings lost due to premature mortality, 28.9%, based on a 6% discount rate; and other related costs, including the cost of crime, lost productivity due to incarceration, and caregiver services, 4.6%. Private sources account for 49% of the total direct expenditures for treatment of persons with affective disorders; state and local funds, 26%; and federal funds, 25%. CONCLUSION: In light of the high burden of affective disorders on societal resources, more attention should be directed at comprehensive, research-based strategies to reduce the prevalence of these disorders in the United States.

Adolescent↗
PubMed1994

Primary prevention of conduct disorder.

Conduct disorders represent one of the most troubling and persistent childhood psychiatric disorders. This serious condition has a poor long-term prognosis and entails a wide range of negative consequences over the life span. No single intervention strategy has been identified that successfully alters its negative course. This article reviews developmental findings and previous intervention efforts and provides a rationale for approaching the problem of Conduct Disorder through primary preventive intervention. A comprehensive, family-based prevention model and specific clinical strategies for intervention are described. A case example is used to illustrate the integration of program components.

Antisocial Personality Disorder↗
PubMed1992

Therapeutic advantage of high-affinity anticarcinoma radioimmunoconjugates.

The effect of the relative affinity (Ka) on the antitumor efficacy of monoclonal antibodies (MAbs) has been questioned. It has previously been shown in experimental models that the use of MAbs with higher relative Kas manifests itself in a higher percentage of injected dose of MAb bound to tumor. On the other hand, mathematical models have proposed that the use of higher affinity MAbs may be disadvantageous for antitumor effects, since higher Ka MAbs would bind more antigen and prevent penetration of MAb through tumor. To test this hypothesis, three MAbs reacting to the human pancarcinoma antigen TAG-72 were used as radioimmunoconjugates for therapeutic efficacy versus the LS-174T human colon carcinoma xenograft. MAbs B72.3, CC49, and CC83 have all been shown by depletion studies to react to the same molecule and to all react with overlapping epitopes. While the relative Ka of B72.3 is 2.5 x 10(9) M-1, the relative Kas of CC49 and CC83 are 16.2 and 27.7 x 10(9) M-1, respectively. Each MAb was radiolabeled with 131I, and each radioimmunoconjugate was assayed at five dose levels for therapeutic efficacy using the human xenograft model. The results of these studies demonstrate substantial therapeutic advantage of the higher affinity MAbs CC49 and CC83 versus B72.3 at every dose level. While 500 microCi of B72.3 were required to reduce tumor growth in only a minority of tumor-bearing animals, the use of the same amount or less of the radioimmunoconjugates of CC49 or CC83 resulted in strong antitumor effects in 80 to 100% of tumor-bearing animals. Thus, stronger antitumor effects were seen using as little as 2.5- to 3-fold less of the higher Ka immunoconjugates CC49 and CC83 as compared with B72.3. While we acknowledge the potential disadvantages of higher Ka MAbs in some situations, at least the experimental studies and model system described here show that a distinct therapeutic advantage exists with the use of higher affinity immunoconjugates.

Adenocarcinoma, Mucinous↗
PubMed1992

Help-seeking behavior and attitude of Chinese Americans regarding psychological problems.

Investigated the help-seeking behavior and attitude regarding psychological problems as mediated by mental health status, acculturation level, and sociodemographic characteristics in a community sample of Chinese Americans. Of the 128 respondents, 17 (13.3%) had consulted professional help for a nervous or emotional problem. Compared to the others, they reported significantly poorer mental health status (i.e., had more physical symptoms, had once come close to experiencing a "nervous breakdown," and had a relative who had been in treatment), and were more likely to be American-born. For those who had not previously sought help, attitude toward help seeking was examined. A positive attitude was mediated by superior English ability, being younger, married, and from a lower SES background. The findings suggested help-seeking behavior is primarily mediated by presence of need, whereas attitude reflected a general propensity. Acculturation was an important predictor of both behavior and attitude, with the less acculturated most in need of education about the utility of mental health service.

Acculturation↗
PubMed1992

Acetylator genotype-dependent N-acetylation of arylamines in vivo and in vitro by hepatic and extrahepatic organ cytosols of Syrian hamsters congenic at the polymorphic acetyltransferase locus.

Our laboratory recently reported the successful construction of homozygous rapid (Bio. 82.73/H-Patr) and homozygous slow (Bio. 82.73/H-Pat(s)) acetylator congenic Syrian hamsters. These hamsters are isogenic except for the polymorphic acetylator gene locus (Pat) and perhaps other closely linked loci. The purpose of the present investigation was to assess the expression of acetylator genotype both in vivo and in vitro in a variety of hepatic and extrahepatic organ cytosols. Levels of arylamine N-acetyl-transferase were generally high and in the relative order: liver greater than colon greater than kidney greater than pancreas greater than prostate, urinary bladder, and lung. However, an acetylator gene dose-response was clearly expressed in each tissue, with highest levels in homozygous Patr acetylators, intermediate levels in heterozygous Patr/Pat(s) acetylators, and lowest levels in homozygous Pat(s) acetylators. The magnitude of the acetylator genotype-dependent differences in N-acetyltransferase activity were substrate specific, wherein p-aminobenzoic acid showed the largest differences and p-aminophenol the smallest. The N-acetylation of p-aminobenzoic acid in vivo also reflected acetylator genotype in the congenic hamsters. These results further document the successful construction of rapid and slow acetylator congenic hamsters which should prove very valuable in future studies to assess the role of acetylator genotype in the toxicity and carcinogenicity of arylamine chemicals.

Acetylation↗
PubMed1992

Acute esophageal hemorrhage from a vagal neurilemoma.

A man with known systemic neurofibromatosis developed an acute upper gastrointestinal hemorrhage while hospitalized after a neurosurgical procedure. Endoscopic evaluation showed a vascular lesion with an appearance consistent with a Dieulafoy-type lesion in the distal esophagus. Despite multiple endoscopic procedures with attempted coagulation of the bleeding lesion, the patient continued to have life-threatening hemorrhaging. At thoractomy, a tumor was found to arise from the vagus nerve at the site of bleeding. This tumor was resected and histologically determined to be a neurilemoma. Acute bleeding into the esophagus associated with this type of tumor has not been previously reported.

Cranial Nerve Neoplasms↗
PubMed1992

Time of day effects on a human force discrimination task.

Although numerous studies have demonstrated reliable relationships between various human performance measures and time of day, disagreement exists concerning the shape of these relationships and their dependence on task variables. Most perceptual-motor tasks emphasize responsiveness to exteroceptive stimuli. We used a multiple force-band discrimination task that requires responsiveness to both exteroceptive and proprioceptive information. Results for a response duration measure showed a quadratic time of day trend similar to previously reported performance tasks. Response latency to the force emission cue and number of correct inband force emissions showed cubic time of day trends not typically reported in the time of day and performance literature. These results have implications for time-of-day effects on real world perceptual performance.

Body Temperature↗
PubMed1992

Transnasal US of the esophagus: preliminary morphologic and function studies.

High-frequency catheter-based ultrasound (US) transducers can be inserted into the esophagus transnasally to evaluate esophageal wall structures. Studies were performed in two sheep esophagus specimens in vitro, in 17 healthy human subjects, and in 16 patients with esophageal abnormalities (eight with achalasia, four with scleroderma, three with esophageal carcinoma, and one with esophagitis). In the sheep specimens, endoluminal US delineated seven layers of the esophageal wall; these results correlated closely with histologic findings. Real-time US of the normal esophageal wall was performed during resting and swallowing. Muscles at the lower esophageal sphincter (LES) were shown to be thicker than muscles in the body of the esophagus. Thickening of the muscular layers at the LES in achalasia, dilated blood vessels within the submucosa in esophagitis, and fibrotic changes within the muscular layers in scleroderma were demonstrated. Extramural structures adjacent to the esophagus were also seen. These preliminary results suggest that transnasal esophageal US may become an important diagnostic tool in evaluation of the esophagus.

Adult↗
PubMed1992

The economic burden of mental illness.

Mental illness imposes a substantial burden on individuals and society. Using data from national surveys and a newly developed methodology for calculating costs, the authors estimate that in 1985 the total economic costs of mental illness were $103.7 billion. Of this total, direct treatment and support costs were $42.5 billion, or 11.5 percent of total personal health care spending for all illnesses. Morbidity costs--the value of reduced or lost productivity--amounted to $47.4 billion. Mortality costs--the lost value of productivity due to premature death resulting from mental illness--were estimated to be $9.3 billion, or 5.1 percent of total productivity losses for all deaths. Other related costs, including the cost of caregiver services, amounted to $4.5 billion.

Activities of Daily Living↗