Managing depression in outpatients.
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Antidepressive Agents↗
Biomedical subjects
M Carnes
Publications and source records attributed to M Carnes.
The effects of lipid-lowering and antioxidant vitamin therapies on flow-mediated vasodilation of the brachial artery in older adults with hypercholesterolemia.
OBJECTIVES: The goal of this study was to determine the long-term effects of statins and antioxidant vitamins on flow-mediated vasodilation of the brachial artery in older adults with hypercholesterolemia. BACKGROUND: Lipid-lowering therapy and antioxidant vitamins improve endothelium-dependent vasodilation in young and middle-aged adults with hypercholesterolemia, but their effects in older adults are not known. METHODS: Two double-blind, placebo-controlled studies were performed in individuals > or =70 years old with low-density lipoprotein cholesterol (LDL-C) > or =140 mg/dl. In the first study, 37 subjects were randomized to receive (group 1) pravastatin for six months then pravastatin and vitamin E for six additional months or (group 2) vitamin E for six months, then pravastatin and vitamin E for six additional months. In the second study, additional 17 subjects sequentially received simvastatin for six months, then simvastatin and vitamins C and E for six additional months. Flow-mediated vasodilation of the brachial artery was measured by high-resolution ultrasound. RESULTS: At baseline, subjects in both studies were similar in age (mean +/- SD, 75.8 +/- 4.2 years), gender, systolic blood pressure, total cholesterol (261.6 +/- 37.4 mg/dl), LDL-C (180.3 +/- 28.1 mg/dl), high-density lipoprotein cholesterol and triglycerides levels. Flow-mediated vasodilation was severely impaired (2.2 +/- 3.9%). Both statins reduced total and LDL-C levels (p < 0.001); however, neither statin, antioxidant vitamin regimen nor the combination of statins and antioxidant vitamins improved flow-mediated vasodilation of the brachial artery. At baseline, nitroglycerin-mediated vasodilation also was impaired (10.7 +/- 5.6%) and did not change in either study. CONCLUSIONS: Older adults with hypercholesterolemia have impaired flow-mediated vasodilation of the brachial artery that does not improve after one year of therapy with statins and antioxidant vitamins, despite significant lipid-lowering.
Aged↗
Age effects on the temporal evolution of isometric and swallowing pressure.
BACKGROUND: The tongue plays a key role in bolus propulsion through the oropharyngeal chamber. In this study, possible age effects on the magnitude and timing of lingual pressure generation were analyzed. METHODS: Oral pressure was measured during isometric and swallowing tasks for 10 elderly (mean age = 81 years) and 10 young (mean age = 51 years) subjects. Three trials each of the isometric task and swallows of three different boluses (3 ml semisolid, 3 ml liquid, and 10 ml liquid) were performed by each subject. The timing and magnitude of isometric and swallowing pressure generation along with the pattern of the swallowing pressure waveform were analyzed. RESULTS: Whereas maximum lingual isometric pressures decreased with age (p < .001). no significant age difference was found for swallowing pressure. Time taken to reach peak pressure also was reduced with age in both the isometric task and swallows of liquid boluses (p < .05), while no significant age effect was found for semisolid swallows. Finally, only elderly subjects showed a pattern of liquid swallowing pressure generation in which multiple lingual gestures were required to reach peak pressure (termed "pressure building"), a pattern demonstrated by both young and elderly groups for semisolids. CONCLUSIONS: Decreased lingual strength with age combined with unchanging swallowing pressure leads to a decreased "pressure reserve," perhaps leaving older individuals more at risk for dysphagia resulting from insults directly or indirectly to the swallowing system. Additionally, swallowing is generally "slowed" with age, apparently due to both central and peripheral factors, and this change may have an impact on bolus flow outcomes.
Aged↗
Results of a gender-climate and work-environment survey at a midwestern academic health center.
UNLABELLED: AND CLIMATE determine how faculty's perceptions of medical school gender climate differ by gender, track, rank, and departmental affiliation. METHOD: In 1997, a 115-item questionnaire was sent to all University of Wisconsin Medical School faculty to assess their perceptions of mentoring, networking, professional environment, obstacles to a successful academic career, and reasons for considering leaving academic medicine. Using Fisher's exact two-tailed test, the authors assessed gender differences both overall and by track, rank, and departmental cluster. RESULTS: Of the 836 faculty on tenure, clinician-educator, and clinical tracks, 507 (61%) responded. Although equal proportions of men and women had mentors, 24% of the women (compared with 6% of men; p < .001) felt that informal networking excluded faculty based on gender. Women's and men's perceptions differed significantly (p < .001) on 12 of 16 professional environment items (p < .05 on two of these items) and on five of six items regarding obstacles to academic success. While similar percentages of women and men indicated having seriously considered leaving academic medicine, their reasons differed: women cited work-family conflicts (51%), while men cited uncompetitive salaries (59%). These gender differences generally persisted across tracks, ranks, and departmental clusters. The greatest gender differences occurred among clinician-educators, associate professors, and primary care faculty. CONCLUSIONS: Women faculty perceived that gender climate created specific, serious obstacles to their professional development. Many of those obstacles (e.g., inconvenient meeting times and lack of child care) are remediable. These data suggest that medical schools can improve the climate and retain and promote women by more inclusive networking, attention to meeting times and child care, and improved professional interactions between men and women faculty.
Career Mobility↗
Effects of estrogen replacement therapy on the circadian rhythms of serum cortisol and body temperature in postmenopausal women.
Estrogen replacement therapy (ERT) seems to enhance longevity in women. Both gender and aging have been shown to influence the regulation of circadian rhythms, yet little is known about the effect of ERT on circadian regulation. The aim of this study was to determine the effects of ERT (oral conjugated estrogen: Premarin, 0.625 mg) for 6-8 weeks on circadian serum cortisol by continuous blood sampling every 15 min for 24 h with simultaneous measurements of body temperature in six healthy postmenopausal women (range, 54-61 years). The results are presented as median values (range in quartiles). The circadian amplitude of cortisol increased during ERT from 20.20 (18.35, 23.61) to 25.97 (24.94, 27.74) microg/dL (p = 0.016), whereas the timing of nocturnal nadir and morning acrophase did not differ significantly. ERT lowered the 24-h body temperature from 37.03 degrees C (36.95 degrees C, 37.07 degrees C) to 36.90 degrees C (36.77 degrees C, 36.97 degrees C) (p = 0.038), but did not alter the peak and trough body temperatures significantly. These findings are noteworthy because the increased circadian amplitude of serum cortisol during ERT contrasts with the reduction in circadian amplitude seen with normal aging. The reduction in body temperature confirms the regulatory effect of ERT in thermoregulation and has implications regarding the correlation between basal metabolic rate and life span.
Body Temperature↗
Body piercing medical concerns with cutting-edge fashion.
OBJECTIVE: To review the current information on medical complications, psychological implications, and legislative issues related to body piercing, a largely unregulated industry in the United States. METHODS: We conducted a MEDLINE search of English language articles from 1966 until May 1998 using the search terms "body piercing" and "ear piercing." Bibliographies of these references were reviewed for additional citations. We also conducted an Internet search for "body piercing" on the World Wide Web. MAIN RESULTS: In this manuscript, we review the available body piercing literature. We conclude that body piercing is an increasingly common practice in the United States, that this practice carries substantial risk of morbidity, and that most body piercing in the United States is being performed by unlicensed, unregulated individuals. Primary care physicians are seeing growing numbers of patients with body pierces. Practitioners must be able to recognize, treat, and counsel patients on body piercing complications and be alert to associated psychological conditions in patients who undergo body piercing.
Body Image↗
Long-term efficacy of nonsurgical urinary incontinence treatment in elderly women.
BACKGROUND: Although urinary incontinence affects up to 35% of community-dwelling elderly women, the long-term efficacy of conservative treatment in this population is unknown. METHODS: Between April 1991 and January 1994, 81 community-dwelling women over age 60 underwent nonsurgical incontinence treatment that included pelvic muscle exercises, bladder retraining, estrogen replacement, biofeedback, functional electrical stimulation, and pharmacologic therapy. Information about intercurrent medical problems, urogynecologic diagnoses, treatment recommendations, and provider-documented outcome were collected from medical records. We mailed structured questionnaires evaluating persistent incontinence, treatment efficacy, interval therapy, and quality of life to women who had last attended clinic at least one year previously. RESULTS: Fifty-three of 81 (65%) women, mean age (+/- SD) 76 +/- 8 years, returned the questionnaire. The mean follow-up interval was 21 +/- 8 months. At follow-up, 43% of women reported incontinence was not a problem or mild, 33% reported moderate incontinence, and 21% reported severe incontinence. When patients compared their initial with current incontinence severity, improvement was significant (p < .01). Genuine stress incontinence was diagnosed in 18 women, detrusor overactivity in 14, and mixed incontinence in 13. Improvement did not vary consistently by incontinence diagnosis. Older patients had more severe incontinence at presentation (r = .94, p = .02) and reported less improvement (r = .97, p < .01) than younger ones. However, the overall likelihood of improvement was greatest among patients with the most severe incontinence at presentation (r = .534, p < .001). Subjects considered pelvic muscle exercises, delayed voiding, and caffeine restriction most effective in reducing incontinence severity. CONCLUSIONS: Elderly women derive long-term clinical benefit from nonsurgical incontinence therapy. Younger patients and those with more severe incontinence are most likely to respond to treatment.
Age Factors↗
Managing dyslipidemia in older adults.
OBJECTIVES: To summarize and critically review clinical trial data regarding dyslipidemia as a risk factor for coronary heart disease (CHD) and the efficacy and safety of lipid-lowering interventions in older adults. Based on these data, clinical recommendations for diagnosing and managing dyslipidemia in older adults are provided. METHODS: Peer-reviewed journal articles were identified by a MEDLINE search and a review of journal article references. Studies that were performed exclusively in subjects older than 65 years or that included a large subgroup of older adults were included. CONCLUSIONS: Elevated low density lipoprotein and total cholesterol levels are independent risk factors for CHD events in patients aged older than 65 years. Older adults have a higher risk of mortality attributable to hypercholesterolemia. Diet and lipid-lowering medications safely and effectively lower cholesterol levels in this age group. Exercise increases high-density lipoprotein cholesterol levels and decreases triglyceride levels. If accompanied by weight loss, exercise may reduce low-density lipoprotein and total cholesterol levels. Improving lipid levels in older adults with CHD decreases the risk of future coronary events by up to 45%, and significant effects on outcome measures may be observed within 2 years of the initiation of therapy.
Aged↗
Health care in the US: is there evidence for systematic gender bias?
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Acquired Immunodeficiency Syndrome↗
Gender differences in acute myocardial infarction: the University of Wisconsin experience.
OBJECTIVE: To investigate gender differences in baseline characteristics, presentation, and treatment of patients with acute myocardial infarction (MI) admitted to the University of Wisconsin Hospital Coronary Care Unit (CCU) over a 1-year period. METHODS: A retrospective review was performed on the charts of all patients (n = 293) admitted to the CCU in 1996 with a discharge diagnosis of acute MI. In 83 women and 187 men with analyzable data (n = 270), 42 factors related to baseline characteristics, presentation, treatment, and outcomes were identified and analyzed for gender differences. RESULTS: On average, women were 5 years older than men (p < .01). By univariate comparison, women were less likely than men to be smokers (p < .001); more likely to have underlying hypertension (p < .01), diabetes mellitus (p < 0.05), non-Q-wave infarctions (p < .01), and congestive heart failure (CHF, p < .05); and more likely to have received diuretics (p < .001) and ACE inhibitors (p < .01). While women were less likely than men to undergo coronary angiography (p < .05) and more likely to have echocardiograms (p < 0.05), rates of coronary artery bypass graft surgery, angioplasty, and the use of thrombolytics were similar for men and women. Clinical outcomes were similar in both groups. CHF, hypertension, and use of ACE inhibitors remained the only significant gender differences when data were adjusted for age. CONCLUSION: Comparing men and women with acute MI at UW Hospital revealed some differences in clinical characteristics and management. Except for CHF, hypertension, and use of ACE inhibitors (all of which may be related), these differences disappeared when the data were adjusted for age. This is particularly notable for the disappearance of the difference in the use of coronary angiography between men and women. The comparable use of beta-blockers, aspirin, and nitrates, and the similar clinical outcomes in men and women, suggest less gender difference in MI management at UW Hospital than reported in other studies.
Age Distribution↗
Detecting iron deficiency in anemic patients with concomitant medical problems.
OBJECTIVE: To determine the sensitivity and specificity of mean corpuscular volume, transferrin saturation, total iron-binding capacity, and ferritin level in determining iron deficiency in a population of anemic veterans with a wide variety of general medical diagnoses. DESIGN: Retrospective chart review. SETTING: Hospitals of the Department of Veterans Affairs in Madison and Milwaukee, Wisconsin. PARTICIPANTS: One hundred one anemic veterans with any medical condition who underwent bone marrow aspiration and serum iron studies. MEASUREMENTS AND MAIN RESULTS: Using the presence or absence of bone marrow hemosiderin as the reference standard, the sensitivity and specificity of the following serum iron indicators were calculated: mean corpuscular volume, transferrin saturation, total iron-binding capacity, and ferritin level. Of these patients, 41 (40.6%) were categorized as iron deficient, with no stainable bone marrow hemosiderin. A serum ferritin level < or =100 microg/L provided the best sensitivity (64.9%) and specificity (96.1%) for evaluating iron stores in this patient population. When performed within 24 hours of bone marrow examination, a serum ferritin level < or =100 microg/L was 100% accurate in separating iron-deficient from iron-sufficient patients. None of the other serum iron indicators alone or in combination performed better than ferritin level alone. CONCLUSIONS: In a population of anemic veterans with a wide variety of concomitant medical problems, a serum ferritin level < or =100 microg/L was optimal for determining iron deficiency. This is higher than the ferritin level of < or =50 microg/L cited in standard textbooks as evidence of iron deficiency in patients with inflammation, infection, or malignancy.
Acute Disease↗
Pulsatile adrenocorticotropic hormone: an overview.
Adrenocorticotropic hormone (ACTH) is secreted by corticotrophic cells in pulsatile bursts. This paper reviews the extant literature on the phenomenon of pulsatile ACTH after addressing basic issues of hormone pulsatility in neuroendocrine systems. The following themes emerged from reviewing 51 studies measuring plasma ACTH at intervals of 20 min or less: marked inter-individual variability in the pattern of ACTH, the dependence of pulse identification on sampling frequency, the similarity in ACTH pulse amplitude and frequency across species, and the predominance of amplitude over frequency changes in ACTH pulses in altered physiological states. As the hypothalamic-pituitary-adrenocortical (HPA) axis plays a critical role in orchestrating adaptation and survival, the ability to modulate the shape of ACTH signals may prove to be an important means of transmitting complex information to ACTH responsive cells. The clinical and neurobiological significance of temporal alterations in ACTH secretion represents an area for future investigation.
Adrenocorticotropic Hormone↗
Intensive venous sampling of adrenocorticotropic hormone in rats with sham or paraventricular nucleus lesions.
Adrenocorticotropic hormone (ACTH) secretion from the anterior pituitary is predominantly regulated by corticotropin-releasing hormone (CRH) and arginine vasopressin (AVP) synthesized in neurons of the paraventricular nucleus (PVN) of the hypothalamus. Secretion of ACTH occurs in pulsatile bursts. To explore the relationship between hypothalamic control and the pulsatile pattern of ACTH secretion, we measured ACTH in 2 min blood samples over 4 h in rats with intact and lesioned PVN during hypovolemic-stress or control conditions and also measured median eminence (ME) levels of CRH, AVP, and oxytocin (OT). Mean plasma ACTH was highest in the sham lesioned-hypovolemic group, lowest in the sham lesioned-control group and intermediate in the two PVN-lesioned groups. CRH in the ME was negligible in the lesioned animals and correlated with OT and AVP. Pulsatile secretion was observed despite PVN ablation. Visual inspection of composite time series suggested different temporal patterns of ACTH secretion. Principal components analysis of the individual ACTH time series revealed three significant eigenvectors which correlated differentially with the three treatment groups. Neither lesioned group had the steep rise over 10 min seen in plasma ACTH in the non-lesioned groups. Delayed ACTH rise after 30-60 min occurred in all but the sham control group. Our data suggest that CRH is responsible for immediate secretion of ACTH in response to hypovolemic stress and that regulators from non-PVN sites may be responsible for more delayed secretion of ACTH in this setting. The persistence of ME AVP and OT levels in the face of > 90% reduction in ME CRH levels leaves open the question of a role for one or both of these peptides in the delayed ACTH response following stress onset and in the generation of pulsatile ACTH secretory bursts.
Adrenocorticotropic Hormone↗
Serum concentrations of interleukin-6 are increased when sampled through an indwelling venous catheter.
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Blood Specimen Collection↗
Balancing family and career: advice from the trenches.
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Career Choice↗
Neuroendocrine and cardiovascular effects of serotonin: selective role of brain angiotensin on vasopressin.
Central serotonin (5-HT) and angiotensin (ANG II) stimulate arginine vasopressin (AVP), oxytocin (OT), and adrenocorticotropin (ACTH) secretion and increase blood pressure. Studies were conducted in conscious rats to determine whether neuroendocrine activation by 5-HT requires a brain angiotensinergic intermediate pathway. In the first study, ANG II formation was inhibited by the angiotensin-converting enzyme inhibitor enalapril before injection of the 5-HT releaser/uptake inhibitor d-fenfluramine. Fenfluramine (2 mg/kg ip) stimulated AVP, OT, corticosterone, and prolactin (PRL) secretion (P<0.01). Enalapril (60 mg/l in drinking water for 4 days and 10 mg/kg ip 2 h before the rats were killed) inhibited only the AVP response (P<0.01) to d-fenfluramine. In the second study, the effect of intracerebroventricular injection of the 5-HT2A/2C antagonist LY-53857 (10 microgram), or the ANG II AT1 antagonist DuP-753 (10 microgram), on intracerebroventricular 5-HT (10 microgram)-stimulated AVP, OT, ACTH, PRL, renin secretion, mean arterial pressure (MAP) and heart rate (HR) was tested. LY-53857 inhibited the AVP, OT, and ACTH responses to 5-HT (P<0.01), whereas DuP-753 inhibited only the AVP response (P<0.01). Intraventricular injection of 5-HT increased MAP and decreased HR. The MAP response was not affected by LY-53857 or DuP-753, and at no time did MAP decline below starting levels. The decreased HR was inhibited by LY-53857 but not by DuP-753. These results demonstrate that 5-HT-induced AVP secretion is mediated selectively via brain angiotensinergic mechanisms by way of the AT1 receptor.
Adrenocorticotropic Hormone↗
Geriatric assessment: making it work in primary care practice.
Geriatric assessment has become an established part of medical practice, a trend driven by the growing population of older patients, positive patient outcomes, and increase interest in controlling healthcare cost. Geriatric assessment is a diagnostic process that can be performed in a variety of clinical settings, including the primary care office. The interdisciplinary assessment team usually includes at least three members: a physician, a nurse,and a social worker. Patients who appear to derive the greatest benefit are over age 75, have mild to moderate disabilities, may be at risk of nursing home placement, and may have a poor social network. For optimal effectiveness, assessment must be coupled with a comprehensive therapeutic plan and long-term follow-up.
Age Factors↗