Biomedical subjects
N Rappaport
Publications and source records attributed to N Rappaport.
Psychiatric consultation to school-based health centers: lessons learned in an emerging field.
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Emerging models.
In all these models, the potential of child psychiatrists and other mental health professionals in decreasing student barriers to learning is promising. While expanding the traditional client service model, child psychiatrists can serve as advocates for identifying student's unmet mental health needs, encourage schools to build capacity for effective responses, be vigilant for quality assurance, develop and initiate new programs that systematically respond to needs of the school community, and provide training opportunities that demystify the psychiatric concepts that can help administrators and teachers. Relatively few child psychiatrists are active in the school setting or have developed a presence in the national movement to provide mental health services in schools. In recognition of the fact that traditional models of psychiatric care such as outpatient clinics and hospital-based programs do not reach many children and adolescents, it is hoped that child psychiatrists will be more motivated to have a more active and rewarding presence in the school setting. Even with the variety of responses to the need for increasing mental health services to children, there are a lot of unanswered questions. With only 8000 child psychiatrists in the United States and 80,000 schools, it is clear that we need to be strategic about how best to utilize our resources. The big question is whether there are predictable and alterable characteristics, mechanisms, and interactive processes that enable high-risk students to attain educational and personal success, despite seemingly poor odds. Emerging models have the potential to begin answering this question.
The meaning of psychotropic medications for children, adolescents, and their families.
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Relapsing group B streptococcal infection.
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Vasoactive effects of smoking as mediated through nicotinic stimulation of sympathetic nerve fibers.
Patients who smoke have higher complication rates than nonsmokers following many surgical procedures. It is not known if the adverse effects of smoking are caused by a nicotine effect or by some other potentially harmful agents that exist in tobacco smoke. It is also not known if these vasoactive effects are mediated through sympathetic nerve fibers (via nicotinic receptors in ganglia) or through elevated circulating levels of vasoactive hormones. We designed a 5-day protocol to measure relative blood flow both before and after a digital sympathetic block in the digits of subjects who were regular smokers following both smoking and wearing of a transdermal nicotine patch. Suitable pulse/wave tracings were recorded on 23 subjects. We also measured serum levels of nicotine, cotinine, vasopressin, norepinephrine, epinephrine, dopamine, and carboxyhemoglobin on each test day. Data for these serum levels were available in 30 test subjects. Digital sympathetic block had a significant beneficial effect in reversing the decreased digital blood flow that occurred after smoking (and also with use of the nicotine patch), despite the elevated circulating levels of vasopressin and norepinephrine seen with smoking. The vasoactive effects of smoking are probably due to the nicotinic effects on sympathetic fibers at the ganglionic levels.
Diagnoses, symptoms, and attribution of symptoms among black and white inpatients admitted for coronary heart disease.
OBJECTIVES: This study examined health care-seeking behaviors to elucidate factors that contribute to differences in patterns of coronary heart disease between African Americans and Whites. The prevalence of diagnosed coronary heart disease, patients' perceptions of symptoms and attribution of symptoms, and predictors of painful symptoms and attribution of cardiac symptoms were examined. METHODS: The study involved 2416 patients admitted with diagnoses of coronary artery disease, ischemic heart disease, or myocardial infarction or to rule out myocardial infarction. Structured interview questions were used to obtain demographic information, symptoms precipitating admission, and patients' attribution of their symptoms. Discharge diagnoses were obtained from hospital records. RESULTS: Acute myocardial infarction, unstable angina, nonacute ischemic heart disease, and atherosclerosis were more frequent in White patients. For Blacks, the odds of reporting painful symptoms were only 64% of the odds found for Whites when other factors were controlled, and the odds of attributing symptoms to cardiac origins were almost 50% lower for Blacks than for Whites. CONCLUSIONS: The tendency of Blacks to report fewer painful symptoms and to attribute their symptoms to noncardiac origins may contribute to differences in care-seeking and in medical management of heart disease in Blacks.
Rose Questionnaire responses among black and white inpatients admitted for coronary heart disease: findings from the Birmingham-BHS Project.
Evidence of higher coronary heart disease mortality rates among blacks than among whites raises questions concerning differences in health care-seeking for heart disease between blacks and whites. As part of a larger project evaluating health care-seeking behavior for coronary heart disease, we interviewed hospitalized patients who had diagnoses of coronary artery disease, ischemic heart disease, chest pain, or myocardial infarction, or who were admitted to rule out myocardial infarction. The sample included 1140 white men, 347 black men, 574 white women, and 355 black women. The interview included demographic information, usual care, access to usual care, and chest pain items. Demographic and medical care access differences emerged between African-American and white participants. We also compared the prevalence of Rose Questionnaire angina between blacks and whites. Among patients who scored positively for Rose angina, black men reported more recent onset of their angina and fewer episodes during the past 6 months compared to all other groups, and they sought medical care less often compared with white men. Multiple logistic regression analyses suggest that African-American respondents were less likely to score positively for Rose angina and were less likely to seek treatment for their symptoms among those who had angina, when controlled for demographic, risk factor, and access to care variables. Blacks and whites in our sample also differed in factors associated with scoring positive for angina and seeking medical care for their symptoms, among those who reported angina. We interpret these findings as suggesting that promoting routine usual care among whites may be an important approach for increasing care-seeking for coronary heart disease symptoms. For blacks, improved coronary heart disease case identification and/or educational approaches to promote greater awareness of symptoms and of the need for seeking treatment for symptoms may be important to increase the likelihood that they will seek medical care for their symptoms.
Regulation of thyroxine 5'-deiodinase activity by 3,5,3'-triiodothyronine in cultured rat anterior pituitary cells.
The influence of the medium T3 concentration on iodothyronine 5'-deiodinase activity was studied in cultured anterior pituitary cells derived from chronically hypothyroid rats. Type II (propylthiouracil-insensitive) enzyme activity, measured with T4 as substrate, was reduced by T3 in a dose-dependent manner, with an ED50 of approximately 1.4 X 10(-10) M free T3. Density gradient centrifugation was used to obtain populations of pituitary cells relatively enriched in thyrotrophs, somatotrophs, mammotrophs, or gonadotrophs, and the effect of T3 on type II 5'-deiodinase activity was evaluated in each of these four populations. In the absence of T3, the enzyme activity was 1.5- to 2-fold greater in the somatotroph- and mammotroph-enriched cell pools than in the thyrotroph- and gonadotroph-enriched pools. In contrast, when the cells were cultured in the presence of T3, enzyme activity was reduced to the same low level in all four enriched pools. The results suggest that the increase in whole pituitary type II 5'-deiodinase activity associated with hypothyroidism is due largely or totally to increases occurring within somatotrophs and mammotrophs. The data also suggest that the intrinsic responsiveness of the deiodinase to hypothyroidism is greater in somatotrophs and mammotrophs than in other anterior pituitary cells.
Gallbladder perforation into the lesser sac.
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