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Biomedical subjects

P Katz

Publications and source records attributed to P Katz.

At least 19 recordsLinked to original sources
PubMed2006

Time use patterns among women with rheumatoid arthritis: association with functional limitations and psychological status.

OBJECTIVES: This study assessed time use patterns among 375 women with rheumatoid arthritis (RA). We hypothesized that (i) as functional limitations increased, time use imbalances would occur (i.e. time needed for obligatory activities would conflict with time needed for productive and free-time activities) and (ii) time use imbalances would be associated with psychological distress. METHODS: Time use estimates were obtained from written questionnaires; other study data were collected from annual telephone interviews. Activities were categorized as obligatory, committed or discretionary, as defined by Verbrugge. Time use estimates were aggregated to define number of obligatory (e.g. self-care) activities requiring >2 h/day and a number of committed and discretionary activities in which no time was spent each day. RESULTS: After adjusting for age, education, marital status and pain severity, women with more functional limitations were significantly more likely to spend >2 h/day in obligatory activities. As functional limitations increased, the proportion spending no time in each committed activity and many discretionary activities increased. Spending >2 h/day in obligatory activities was not significantly associated with poor psychological status, but spending no time in a greater number of committed and discretionary activities was associated with lower life satisfaction and higher levels of depressive symptoms. CONCLUSIONS: Having more severe functional limitations appears to shift time use patterns towards more time spent in obligatory activities and less time spent in committed and discretionary activities. These imbalances in time use were associated with psychological distress, highlighting the need for women with RA to maintain important productive, social and discretionary activities.

Activities of Daily Living↗
PubMed2002

A national study of medical care expenditures for respiratory conditions.

This study was undertaken to estimate the magnitude of medical care expenditures among persons with respiratory conditions in the USA in 1996, and the increment in expenditures attributable to these conditions. The study data were derived from the 1996 Medical Expenditure Panel Survey, a national sample of 21,571 persons. Of the 21,571, 1,027 reported one or more respiratory condition. After weighting, the individuals may represent about 12.1 million persons in the USA. All medical care expenditures of these individuals were tabulated, stratified by comorbidity status, and then compared to those among persons with nonrespiratory conditions or with no conditions. Regression techniques were then used to estimate the increment of healthcare expenditures attributable to the respiratory conditions. From a national total of $45.3 billion, medical care expenditures averaged $3,753 among persons with respiratory conditions. Hospital stays comprised the largest component (45%). The per capita increment in total expenditures attributable to respiratory conditions ranged from $1,003-2,588, from a national total ranging from $12.1-31.3 billion. The total medical care expenditure of persons with respiratory conditions was estimated to be $45.3 billion, of which $12.1-31.3 billion represents an increment in expenditures associated with the conditions themselves.

Case-Control Studies↗
PubMed2001

A Kantian claim permitting the randomised clinical trial.

Among the most contested aspects of medical research is the randomized clinical trial (RCT). While the majority of arguments justifying the RCT and its use in medical research rest within a utilitarian framework, many Kantians claim that a deontological ethical framework is prohibitive of the use RCTs in medical research. This paper argues that, in fact, the RCT is permissible within a deontological framework.

Ethical Theory↗
PubMed1998

Reorganizing an academic medical service: impact on cost, quality, patient satisfaction, and education.

CONTEXT: Academic medical centers are under enormous pressure to improve quality and cut costs while preserving education. OBJECTIVE: To determine whether a reorganized academic medical service, led by faculty members who attended more often and became involved earlier and more intensively in care, would lower costs without compromising quality and education. DESIGN: Alternate-day controlled trial. SETTING: Inpatient academic general medical service. PATIENTS: The 1623 patients discharged from the Moffitt-Long medical service between July 1, 1995, and June 30, 1996. INTERVENTIONS: We divided our 4-team inpatient general medical service into 2 managed care service (MCS) teams and 2 traditional service (TS) teams. The MCS faculty served as attending physicians more often and were required to provide early input into clinical decisions. Patients were assigned to teams based on alternate days of admission. MAIN OUTCOME MEASURES: Outcome measures included resource use and outcomes for MCS vs TS patients, and for MCS patients vs patients seen the previous year, adjusted for demographic characteristics and case mix. Satisfaction of patients, house staff, and faculty was also assessed, as was educational emphasis. RESULTS: A total of 806 patients were admitted to the MCS and 817 to the TS. Demographic characteristics and case mix were similar. Clinical outcomes, including mortality and readmission rates, were also similar, as was patient satisfaction. Resident and faculty satisfaction were high on both services. The average adjusted length of stay of patients on the MCS was 4.3 days vs 4.9 days on the TS and 5 days in 1994-1995 (adjusted P=.01 for MCS vs TS; MCS vs 1994-1995, P<.001). Average adjusted hospital costs were $7007 on the MCS vs $7777 on the TS and $8078 in 1994-1995 (adjusted P=.05 for MCS vs TS; MCS vs 1994-1995, P=.002). CONCLUSIONS: A reorganized academic medical service, led by faculty members who attended more often and became involved earlier and more intensively, resulted in significant resource savings with no changes in clinical outcomes or patient, faculty, and house staff satisfaction.

Academic Medical Centers↗
PubMed1998

Selecting a generic measure of health-related quality of life for use among older adults. A comparison of candidate instruments.

Selecting an outcomes assessment instrument requires knowledge of their relative merits, especially head-to-head comparisons. The authors compare health-related quality-of-life (HRQOL) instruments among older adults for their psychometric properties and subject burden, specifically the Sickness Impact Profile (SIP) and Medical Outcomes Study Short-Form 36 (SF-36). Subjects were 282 of 373 eligible older adults (75.6% response) ranging in age from 65 to 96. SIP scores demonstrated a strong skew toward low (good health) scores with a mean of 11.1% (+/- SD 11.5) on the Total SIP index score. Similar components of the SIP and SF-36 were moderately to strongly correlated. The SIP suffered from a ceiling (good health) scaling effect, and the SF-36 scales also demonstrated some scaling extremes. These results demonstrate the relative scaling limits, especially the ceiling effect, of the SIP compared to the SF-36, and in general, the SF-36 is preferred for use among community-living older adults.

Aged↗
PubMed1998

[A new therapeutic approach to salivary calculi: extracorporeal lithotripsy].

A common pathology of the salivary gland, salivary lithiases are usually removed by open surgery. Most frequently localized in the sub-mandibular gland, calculi can also occur in the parotid gland. We developed a new procedure to treat salivary lithiasis using extracorporeal electromagnetic shock waves. New material was especially adapted for the salivary gland for lithotripsy without anesthesia. Two-hundred patients were treated; 63% had not lithiasis after treatment and 37% had small residual stones measuring less than 3 mm; 97% of the patients were symptom-free and salivary excretion was improved. We believe that extracorporeal electromagnetic shock waves is a safe noninvasive and well tolerated alternative to open surgery. We use lithotripsy as first line therapy for salivary lithiasis.

Adolescent↗
PubMed1998

Psychiatric consultation in the nursing home. A survey of six states.

The authors examined availability, characteristics, and perceived adequacy of psychiatric consultation in nursing homes, as reported by directors of nursing, who returned 899 questionnaires. Thirty-eight percent of nursing home residents were judged to need a psychiatric evaluation; current frequency of consultation was rated as adequate by half of nursing directors. Nearly two-thirds reported that psychiatrists adequately provided diagnostic and medication recommendations; however, advice on nonpharmacologic management techniques, staff support, and dealing with staff stress and family conflicts was largely viewed as inadequate. Findings suggest that perceived need for psychiatric services is far greater than the level actually provided. Overall, more attention must be directed to identifying incentives for psychiatrists to practice in nursing homes, determining clinical effectiveness of mental health services, and examining effects of alternative payment mechanisms on level of care.

Humans↗
PubMed1996

Deficient expression in multiple sclerosis of the inhibitory transcription factor Sp3 in mononuclear blood cells.

To evaluate differential gene expression in multiple sclerosis (MS) patients and control subjects, we used differential display to screen for messenger RNAs that are differentially expressed in peripheral blood mononuclear cells from monozygotic twins who are discordant for MS. We identified a 232-bp complementary DNA fragment, present only in material from the normal twin, that exhibited 100% identity with the inhibitory transcription factor Sp3. Oligonucleotide primers corresponding to Sp3 messenger RNA sequences amplified complementary DNA of appropriate size from 83% of control subjects but from only 21% of MS patients (p < 0.001). These results suggest that Sp3 gene transcription is suppressed in peripheral blood mononuclear cells from most MS patients and that other genes whose expression is normally suppressed by Sp3 in immune cells may consequently be overexpressed.

Adult↗
PubMed1996

Autoantibody titers to oxidized low-density lipoprotein in patients with coronary atherosclerosis.

Oxidation of low-density lipoprotein (LDL) is considered to be the initial step in the atherosclerotic process. Autoantibodies to oxidized LDL (ox-LDL) have been detected in human serum. We used an enzyme-linked immunosorbent assay technique to measure autoantibody titers in 63 normal subjects and patients with coronary artery disease. Thirty-five patients underwent coronary angiography for suspected coronary artery disease. Patients were divided into the following categories: group 1, 20 healthy young volunteers; group 2, 8 patients age-matched to the catheterization patients; group 3, 10 patients with normal coronary angiograms; and group 4, 25 patients with angiographic coronary artery disease. Autoantibody titers to ox-LDL were group 1, 0.142 +/- 0.023; group 2, 0.197 +/- 0.039; group 3, 0.183 +/- 0.038; and group 4, 0.340 +/- 0.026. There was no statistical difference among groups 1, 2, and 3, but the difference between these groups and group 4 was highly significant (p < 0.05). This study demonstrates that (1) autoantibodies to ox-LDL can be detected in normal subjects and in patients with abnormal coronary angiograms and (2) significantly higher titers of autoantibodies to ox-LDL were seen in patients with angiographic evidence of coronary artery disease.

Adult↗
PubMed1996

Test-retest performance of a mailed version of the Medical Outcomes Study 36-Item Short-Form Health Survey among older adults.

OBJECTIVES: This study reports the reliability, internal consistency, and response patterns for a mailed version of the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) among older adults. METHODS: The SF-36 surveys were mailed to patients living in the community aged 65 years and older who were enrolled in two primary care practice clinics. Comorbidity scores also were assigned to patients based on their diagnoses from computerized clinic encounter forms using Deyo et al's modification of the Charlson Index. Subjects repeated the SF-36 by mail after 1 months. RESULTS: Four-hundred twenty-two subjects were mailed surveys and 253 returned them (60.0%). Missing items further reduced the number of subjects with scores on all SF-36 scales. A total of 186 subjects completed both base-line and retest SF-36 surveys. Intraclass correlation coefficients generally were high and ranged from 0.648 to 0.868. Internal consistency of scales also was high (0.802 to 0.924). Mean SF-36 scale scores decreased significantly with increasing comorbidity levels. CONCLUSIONS: The SF-36 demonstrated good retest reliability and internal consistency among these older adults and also showed a strong relationship to an external measure of comorbidity/health status. Mailed surveys pose a problem of response among older adults, a problem not unique to the SF-36, and methods for increasing response are needed when personal interviews are not feasible.

Aged↗
PubMed1996

Tenidap in patients with rheumatoid arthritis. A 4-week, placebo-controlled study.

The present double-blind, placebo-controlled study was conducted to compare the safety and efficacy of tenidap in patients with rheumatoid arthritis (RA). Patients with flare of active RA following NSAID withdrawal were randomized to receive either placebo (n = 67) or tenidap (n = 131; 40-200 mg/day). The mean changes from baseline in efficacy and biochemical variables were compared between treatment groups at endpoint (4 weeks). The improvements in four of the five primary efficacy variables were significantly greater in the tenidap group compared with the placebo group (p < 0.01). Tenidap was also associated with an 18% reduction in erythrocyte sedimentation rate (ESR) and a marked, 51%, reduction in serum C-reactive protein (CRP) level, both of which were significantly greater than the changes in the placebo group (p < 0.05). The percentage of patients who discontinued because of side effects was the same in both groups (3%). In conclusion, tenidap 40-200 mg/day was effective and well tolerated in the treatment of patients with RA for 4 weeks.

Administration, Oral↗
PubMed1995

Activation of the SAPK pathway by the human STE20 homologue germinal centre kinase.

Eukaryotic cells respond to different extracellular stimuli by recruiting homologous signalling pathways that use members of the MEKK, MEK and ERK families of protein kinases. The MEKK-->MEK-->ERK core pathways of Saccharomyces cerevisiae may themselves be regulated by members of the STE20 family of protein kinases. Here we report specific activation of the mammalian stress-activated protein kinase (SAPK) pathway by germinal centre kinase (GCK), a human STE20 homologue. SAPKs, members of the ERK family, are activated in situ by inflammatory stimuli, including tumour-necrosis factor (TNF) and interleukin-1, and phosphorylate and probably stimulate the transactivation function of c-Jun. Although GCK is found in many tissues, its expression in lymphoid follicles is restricted to the cells of the germinal centre, where it may participate in B-cell differentiation. Activation of the SAPK pathway by GCK illustrates further the striking conservation of eukaryotic signalling mechanisms and defines the first physiological function of a mammalian Ste20.

Anisomycin↗
PubMed1995

The psychotherapeutic treatment of suicidal adolescents.

The therapeutic work with a suicidal adolescent begins with the therapist's recognition that there are a multitude of causes for suicidal behavior and that the risk of a serious suicide attempt lies in the patient's feeling of desperation about his situation, the feeling that he faces intolerable pain due to shame or embarrassment, degradation, guilt or loss. The patient can not assess whether his view of his situation is realistic or not, and he is unable to conceive of alternative solutions. The therapist must throw the patient a lifeline to give him hope of escaping from his belief that he is trapped in a world of unending pain. That lifeline may be an active intervention in the life of a patient, reality testing of the patient's perceptions that he is trapped, or both. The choice of interventions is based on an exploration of the psychodynamic and psychopathological constellations that have caused the patient to feel so trapped. Patients, in their anguish, will resort to extremes of coercion and manipulation; the therapist must be able to tolerate and work with these behaviors. The therapist must maintain his belief that he can find ways to help the patient, while accepting the possibility that some day he might fail. He can succeed only if he is prepared to fail. Meeks (1984) summed up his article on suicidal adolescents in the following way: Success in the therapy of these youngsters does not depend on brilliant insights as much as on persistence, patience, and a sustained hope for the future. The treatment process may become a demonstrated proof that the therapist can stand to feel the patient's feelings and live the patient's painful existence, without giving up on life or the patient [p. 5].

Adolescent↗
PubMed1994

Differential expression of a novel protein kinase in human B lymphocytes. Preferential localization in the germinal center.

B lymphocytes which reside in the germinal center region of lymphoid follicles are functionally and phenotypically distinct from the surrounding mantle zone B cells. We have isolated cDNA clones for several genes that are differentially expressed between these two populations of B lymphocytes. One such gene, BL44, is preferentially expressed in germinal center B cells. The nucleotide sequence of a 2,874-base pair BL44 cDNA was determined and a 2,451-bp open reading frame found that encodes for a 97-kDa serine/threonine protein kinase referred to as GC kinase. It has an NH2-terminal catalytic domain most similar to that of the Drosophila NinaC protein and the yeast STE20 protein. GC kinase mRNA transcripts are not unique to germinal center B cells and are found in several other tissues, including brain, lung, and placenta. The GC kinase protein was immunoprecipitated from transfected COS cells and from the Burkitt cell line RAMOS. GC kinase immunoprecipitated from transfected COS cells phosphorylated the substrates casein and myelin basic protein. In addition, a 97-kDa phosphoprotein likely to be GC kinase itself was detected. GC kinase may participate in an important signal transduction pathway in germinal center B cells.

3T3 Cells↗
PubMed1994

Mortality risk among elderly workers.

We analyzed population-based data for respondents aged 70 and older from the Longitudinal Study on Aging. We compared mortality risk among 358 baseline-year working with 4,373 nonworking respondents. Including other demographic and health status predictors in a multiple logistic regression model, employment remained a significant predictor of survival (mortality odds ratio (OR) = 0.4). Diabetes mellitus was the only factor that displayed a mortality risk that was significantly interactive with work (OR = 3.5). These data suggest that a healthy worker effect persists in older age groups, but that within the working stratum, patterns of risk may differ as compared to those among the nonworking.

Aged↗