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M Kramer

Publications and source records attributed to M Kramer.

At least 163 records · Page 9Linked to original sources
PubMed1986

The abridged census method as an estimator of lifetime risk.

The abridged census estimator, also known as Weinberg's shorter method, is a device used to estimate lifetime incidence from the observed age distribution of a population at risk coupled with data on the current prevalence of a mental disorder. This method, which still enjoys considerable popularity, should have been replaced many years ago by more accurate techniques for making such estimates using similar information. In particular, the abridged census method uses the assumption that the remaining life expectancy of incident cases equals that of non-cases. This assumption is likely to lead to an underestimate of the lifetime risk. Two examples are presented from published literature which illustrate some problems encountered with the use of the abridged census method. Some alternative estimation methods are presented which can be implemented using only a hand calculator and which lead to more accurate results.

Alzheimer Disease↗
PubMed1986

Mental health and social characteristics of the homeless: a survey of mission users.

Selected mental health and social characteristics of 51 homeless persons drawn as a probability sample from missions are compared to those of 1,338 men aged 18-64 years living in households from the NIMH Epidemiologic Catchment Area survey conducted in Eastern Baltimore. Differences between the two groups were small with respect to age, race, education, and military service but the differences in mental health status, utilization patterns, and social dysfunction were large. About one-third of the homeless scored high on the General Health Questionnaire which measures distress. A similar proportion had a current psychiatric disorder as ascertained by the Diagnostic Interview Schedule (DIS), with the homeless exhibiting higher prevalence rates in every DIS/DSM III diagnostic category compared to domiciled men. Homeless persons reported higher rates of hospitalization than household men for both mental (33 per cent vs 5 per cent) and physical (20 per cent vs 10 per cent) problems but a lower proportion received ambulatory care (41 per cent vs 50 per cent). Social dysfunction among the homeless was indicated by fewer social contacts and higher rates of arrests as adults than domiciled men (58 per cent vs 24 per cent), including multiple arrests (38 per cent vs 9 per cent) and felony convictions (16 per cent vs 5 per cent). Implications of these findings are discussed in terms of research and health policy.

Adolescent↗
PubMed1986

The toxicology of non-narcotic analgesics.

The fact that aminopyrine is readily nitrosated and that the nitrosation product, dimethylnitrosamine, is potentially carcinogenic has led to the drug being withdrawn from therapeutic use. In the case of the other analgesics, nitrosation is not of any importance, neither in toxicological nor quantitative terms. The characteristic features of the metabolic pathways of phenacetin, paracetamol, and aspirin can occasionally entail toxicological consequences, such as methaemoglobin formation, liver damage, and long presence in the body, respectively. The prolonged and continuous administration of any of the three classes of drugs is not without risk. Adverse reactions of the allergic type cannot be detected by animal experiments.

Acetaminophen↗
PubMed1985

Comparison of the lay Diagnostic Interview Schedule and a standardized psychiatric diagnosis. Experience in eastern Baltimore.

We studied DSM-III diagnoses made by the lay Diagnostic Interview Schedule (DIS) method in relation to a standardized DSM-III diagnosis by psychiatrists in the two-stage Baltimore Epidemiologic Catchment Area mental morbidity survey. Generally, prevalence estimates based on the DIS one-month diagnoses were significantly different from those based on the psychiatric diagnoses. Subjects identified as cases by each method were often different subjects. Measured in terms of kappa, the chance-corrected degree of agreement between the DIS and psychiatrists' one-month diagnoses was moderate for DSM-III alcohol-use disorder (abuse and dependence combined), and lower for other mental disorder categories. The unreliability of either the DIS or psychiatric diagnoses is one potential explanation for the observed disagreements. Others include the following: insufficient or inadequate information (on which to base a diagnosis); recency of disorder; incomplete criterion coverage; overinclusive DIS questions; and degree of reliance on subject symptom reports. Further study of the nature and sources of these discrepancies is underway. This work should produce a more complete understanding of obstacles to mental disorder case ascertainment by lay interview and clinical examination methods in the context of a field survey.

Adolescent↗
PubMed1985

Analysis of morbidity and mortality in patients 70 years of age and over undergoing isolated coronary artery bypass surgery.

With increasing frequency more elderly patients are referred for coronary artery bypass surgery. The operative results of 201 patients 70 years of age and over were compared with the results of 1242 patients under 70 years operated on since 1981. A larger percentage of the elderly patients had triple-vessel disease (66.2% vs 51.0%, p less than 0.001), left main coronary artery obstruction (34.8% vs 16.3%, p less than 0.01), and an ejection fraction of less than or equal to 45% (30.8% vs 21.1%, p less than 0.001). An increase percentage of the patients 70 years of age and over had perioperative myocardial infarction (7.9% vs 4.1%, p less than 0.05), required prolonged ventilatory support (7.9% vs 3.1%, NS), and had major neurologic complications (4.0% vs 1.1%, p less than 0.001). The mortality rate was significantly higher in the elderly patients (5.9% vs 1.9%, p less than 0.01) but did not correlate with degree of coronary artery disease, anginal pattern, or preoperative ventricular function. Only 2 of 12 deaths in the elderly patients were from cardiac causes. This data would suggest that elderly patients have an increased risk for significant cardiac and noncardiac morbidity and mortality following coronary artery bypass surgery and that the higher mortality rate in this age group may be a result of noncardiac organ failure.

Age Factors↗
PubMed1985

Investigations on the carcinogenicity of dipyrone in rats.

A carcinogenicity study with dipyrone (metamizol methanesulfonate) was conducted in male and female Wistar rats. The compound was administered with the feed for a period of 24 months in doses of 0, 1000, or 3000 ppm, followed by a 6-month recovery period (without compound administration). The rats in the high-dose group, especially the females, showed a statistically significant body weight gain retardation which was not correlated with reduced feed consumption. The chronic administration of dipyrone did not influence the survival of the rats. No treatment-related changes in clinical signs and hematological parameters occurred. The absolute and relative weights of thyroids and pituitaries in the high-dose males were increased statistically significantly but were still within the normal range of the rat strain used. Histological examination of the animals which died intercurrently or were killed in extremis or at the end of the recovery period did not reveal any nonneoplastic or neoplastic changes which were compound related under the test conditions used. All of the tumors in all groups of animals were considered spontaneous in nature. Dipyrone did not show carcinogenic potential in rats in this study.

Administration, Oral↗
PubMed1985

Effects of using liver fractions from different mammals, including man, on results of mutagenicity assays in Salmonella typhimurium.

Twenty chemicals, including 16 aromatic amines, were studied in the Salmonella/mammalian-microsome mutagenicity test using the bacterial strains TA100 and TA98 to compare the activation potential of liver preparations from several mammalian species. The hepatic post-mitochondrial supernatants (S-9 fractions) of rat, mouse, hamster, dog, monkey and man were used for metabolic activation. Striking quantitative and even qualitative differences were apparent in the capacity of the different preparations to activate the compounds to mutagens. All compounds that gave positive results in the Ames test when activated with a liver preparation from Aroclor-pretreated rats were also identified as mutagens when tested in the presence of S-9 from one or more other species. Four substituted anilines, however, were converted to mutagenic metabolites only in the presence of a post-mitochondrial fraction of hamster liver. Three human carcinogens, 2-aminoanthracene, benzidine and cyclophosphamide were detected as mutagens under various experimental conditions, including metabolic activation by human or monkey liver S-9. There were no qualitative differences in the mutagenic responses obtained in assays with human and monkey liver S-9.

Amines↗
PubMed1985

Brief report on the clinical reappraisal of the Diagnostic Interview Schedule carried out at the Johns Hopkins site of the Epidemiological Catchment Area Program of the NIMH.

A psychiatric examination was conducted on 810 community dwelling subjects previously given a diagnosis derived from the Diagnostic Interview Schedule (DIS). The agreement in allocating subjects to a particular disorder was never high enough to encourage the confident replacement of a psychiatric diagnosis with a DIS diagnosis.

Alcoholism↗
PubMed1985

Prevalence of treated and untreated DSM-III schizophrenia. Results of a two-stage community survey.

Psychiatrists, using a standardized clinical method, examined a probability sample of 810 subjects in eastern Baltimore and made diagnoses of mental disorders among those subjects according to DSM-III criteria. The authors estimated that there were 4.6 active cases of schizophrenia per 1000 adult noninstitutionalized population, and 6.4 cases per 1000 population, including both active and remitted cases. Among the 17 active and remitted schizophrenics identified in the survey, one half were not receiving any form of mental health services at the time of the survey; these data yield a prevalence rate of untreated cases of 3.1 per 1000 population. All of the untreated schizophrenics were deemed by the examining psychiatrist to be in need of services.

Adolescent↗
PubMed1985

Measuring need for mental health services in a general population.

This article presents measures of need for mental health services estimated from the 1981 Eastern Baltimore Mental Health Survey, one of five sites participating in the NIMH Epidemiologic Catchment Area Program. Data were collected on the prevalence of specific psychiatric disorders, as determined by the standardized Diagnostic Interview Schedule (DIS), functional status, personal characteristics, patterns of medical and mental health care, and sources of care used. Need is based on mental health services use in the prior 6 months or the presence of two or more manifestations of emotional problems: a) one or more DIS disorders present in the past 6 months, b) a General Health Questionnaire (GHQ) score of four or more current symptoms, or c) the respondent's report of having been unable to carry out usual activities in the past 3 months for at least 1 entire day because of an emotional problem. Approximately 14% of adults met the criteria for need, half of whom had made no mental health visits in the prior 6 months and were considered to have unmet need. Need for care was influenced by a variety of sociodemographic and economic characteristics: it was low among the aged and high among persons living alone and the poor on Medicaid. The proportion of need that was unmet varied less but was relatively large for two groups, the aged and nonwhites. Those on Medicaid through public assistance were more likely to have their need met than the near poor.

Adult↗
PubMed1985

Patterns of mental disorders among the elderly residents of eastern Baltimore.

An extensive analysis of prevalence rates of cognitive impairment and other mental morbidities was carried out as part of a five-site national study on the health and mental health of an ambulatory population. This study reports on prevalence rates contrasted by age across the 18 and over population for cognitive impairment and other diagnoses in the Baltimore, Maryland, site of this study. Differences in prevalence rates by age are striking. Eight conditions have rates above 1 per cent among those 64 and younger: phobia (13.8 per cent), alcohol use disorder (6.5 per cent), obsessive compulsive disorder (2.2 per cent), schizophrenia (1.4 per cent), and panic disorder (1.2 per cent). For the older group, 65 to 74 years, five conditions have such prevalence rates: phobic disorder (12.1 per cent), severe cognitive impairment (3.0 per cent), alcohol use disorder (2.1 per cent), obsessive compulsive disorder (2.2 per cent), and dysthymia (1.0 per cent). For the oldest group, those 75 and over, only four conditions have rates of 1 per cent or more. These are: phobic disorders (10.1 per cent), severe cognitive impairment (9.3 per cent), major depression (1.3 per cent), and dysthymia (1.1 per cent). Rates of cognitive impairment increase markedly with age and high rates of this disorder were found among those never married, separated, divorced, or widowed. Implications of these findings for understanding mental morbidity among the elderly and issues for future planning are discussed.

Adolescent↗
PubMed1985

Mutagenicity studies of a carcinogenic nitrofuran and some analogues.

Earlier studies showed a strong carcinogenicity of the nitrofuran compound 1,2-dihydro-2-(5'nitro-2'furyl)-3-hydroxy-quinazoline-4-one since carcinomas of the urinary bladder in rats and dogs appeared already after six months of treatment. In order to compare possible mutagenic properties of the compound and to get some information on the genotoxic moiety of the molecule, the genotoxicity of four nitrofuran derivatives and of two chemical analogues without the nitrofuran residue was tested in the Ames Test, E. coli WP2 uvrA, and in the rec-assay with Bacillus subtilis. 2-Nitrofuran was also included in this study. Only 2-nitrofuran and the nitrofuran containing derivatives were active in these bacterial test systems. Metabolic activation by liver homogenate was not needed to demonstrate the genotoxic effects. 1,2-dihydro-2-(5'nitro-2'furyl)-3-hydroxy-quinazoline-4-one was more active in the mutagenicity tests in the presence of exogenous metabolic activation. Further studies revealed that this compound was able to induce unscheduled DNA synthesis but was not mutagenic in the micronucleus test.

Animals↗