Biomedical subjects

P Levinson

Publications and source records attributed to P Levinson.

At least 19 recordsLinked to original sources

PubMed1995

The department of Veterans Affairs oral health services and eligibility.

The Department of Veterans Affairs (VA) operates one of the largest health care systems in the nation; more than 2.5 million veterans receive care annually. Among the special foci of care within VA is the Dental Service. The Department of Veterans Affairs Dental Service is the largest dental care system in the nation and the largest hospital-based dental care system in the world, receiving more than 1.2 million visits annually. The authors describe the VA dental care system and the larger health care system in which it is embedded. How the system is organized, who is eligible for services, who uses care, and what types of services are used are detailed. Compared with medical care, eligibility for VA dental care is more complex and differs for inpatients and outpatients. Outpatients account for 65% of patient visits and 76% of treatment provided in VA dental clinics. The two largest groups of users are inpatients with compelling medical needs (17%) and outpatients who are totally disabled (24%). A wide variety of services is provided, ranging from diagnostic and preventive care to insertion of crowns, bridges, and removable prostheses. Changes in the nation's health care system mandate introspection by all health agencies. The goal of the VA Dental Service is to become veterans' first choice for dental care. Information needed by VA to best respond to the needs of veterans include the following: (1) reasons for why eligible veterans do not use VA dental care; (2) veterans' oral health needs; (3) definition of optimum care and whether it varies as a person moves from functional independence to dependence; (4) whether VA is providing the most cost-efficient care possible and is best utilizing allied health professions; and (5) whether this care is best provided in a hospital setting. Modifications of data gathering systems are required as a first step to providing the needed information.

Aged↗

PubMed1994

Prevalence of hypertension, dyslipidemia, and dyslipidemic hypertension.

BACKGROUND: It has been proposed that dyslipidemic hypertension is part of a distinct metabolic syndrome related to insulin resistance. This paper describes the prevalence and cross-sectional relations of dyslipidemic hypertension in a population-based sample of men and women. METHODS: In two southeastern New England communities, 11,199 randomly selected participants were evaluated as part of a cross-sectional surveillance program of coronary heart disease risk factors between 1981 and 1990. RESULTS: The frequency of dyslipidemia was 38% and of hypertension was 26.5%; the conjoint frequency (dyslipidemic hypertension) was 15.0%, which is 1.49 times the expected value if the two diseases were independent P < .05). Using a discrete multivariate model, dyslipidemia and hypertension were associated with sex, obesity, and diabetes mellitus. The excess association of dyslipidemic hypertension, compared with individual effects of dyslipidemia and hypertension, was not related to these factors. CONCLUSIONS: This study suggests that dyslipidemic hypertension is common but may not be a unique entity associated with a distinct metabolic syndrome.

Adolescent↗

PubMed1990

Severe hyponatremia: an association with lisinopril?

A 63-year-old white woman with a history of hypertension and chronic obstructive pulmonary disease presented to the emergency room with worsening shortness of breath, anorexia, coughing, increased thirst, and leg edema of two weeks' duration. Medications included lisinopril 10 mg/d, which had been started six weeks earlier, sustained-release theophylline 300 mg q12h, and an albuterol inhaler. The lisinopril was discontinued on admission. Serum sodium concentration was 109 mmol/L; the osmolality of the blood and of the urine were 253 mOsmol and 438 mOsmol, respectively, with a specific gravity of 1.025 and a urine sodium of 17 mmol/L. The hyponatremia initially was considered to be the syndrome of inappropriate antidiuretic hormone secretion in response to the patient's suspected pneumonia. Due to worsening blood pressure, lisinopril was restarted and the serum sodium concentration dropped from 134 to 126 mmol/L. Evaluation of the patient's hyponatremia included assessment of thyroid, adrenal, hepatic, and cardiac function that were within normal limits. The patient was discharged on the following medications: sustained-release theophylline 300 mg tid, prednisone 10 mg/d, albuterol inhaler 2 puffs q6h, and sustained-release verapamil 240 mg/d for blood pressure control. Her serum sodium concentration has remained between 135 and 140 mmol/L during hospitalizations for exacerbations of chronic obstructive pulmonary disease and for pneumonias 10 and 12 months after discharge.

Angiotensin-Converting Enzyme Inhibitors↗

PubMed1985

Initial and long-term effects of prazosin on sympathetic vasopressor responses in essential hypertension.

In 10 untreated hypertensive patients who received an initial dose of 3 to 5 mg prazosin, supine blood pressure (BP) decreased significantly, from an average of 171 +/- 24/96 +/- 10 to 157 +/- 22/90 +/- 10 mm Hg (p less than 0.025). The Valsalva overshoot, response to cold pressor test and digital vasoconstrictor response to a deep breath were not inhibited. However, during 55 degrees passive headup tilt there was a significant decrease in BP. Seven patients received prazosin for a period of 3 months. After long-term therapy BP returned to baseline levels and a dose of prazosin similar to that given initially produced an average decrease in BP from 174 +/- 20/101 +/- 8 to 167 +/- 23/99 +/- 7 mm Hg. Upright tilting no longer resulted in a decrease in BP. The Valsalva overshoot, cold pressor test and digital vasoconstrictor responses remained unchanged. Orthostatic hypotension after the first dose of prazosin without blockade of the other sympathetic reflex responses suggests that the drug has a greater blocking effect on capacitance vessels than on resistance vessels. Prazosin showed a loss of antihypertensive effectiveness during long-term treatment.

Blood Pressure↗

PubMed1985

Intrinsic growth control in the imaginal primordia of Drosophila, and the autonomous action of a lethal mutation causing overgrowth.

Cell proliferation in Drosophila imaginal discs appears to be regulated by a disc-intrinsic mechanism involving local cell interactions that also control the formation of patterns of differentiation. This growth-control mechanism breaks down in animals homozygous for the mutation lethal (2) giant discs (l(2)gd) which remain as larvae for up to 9 days longer than normal. During this time cell proliferation continues in the imaginal discs as well as in the imaginal rings for the salivary glands, foregut, and hindgut, so that these tissues become greatly overgrown. When wild-type wing discs from mid-third instar larvae were removed and cultured for up to 28 days in wild-type female adult hosts, they grew and terminated growth at a cell number close to that which would be attained in situ by the time of pupariation. On the other hand, wing discs from l(2)gd homozygotes grew rapidly and continuously when cultivated in wild-type hosts, reached an enormous size, and acquired abnormal folding patterns. Overgrowth of mutant imaginal rings also continued during culture of these tissues in wild-type hosts. We conclude that overgrowth in this mutant is due to an autonomous defect in the imaginal primordia, which requires an extended larval period for its expression in situ.

Animals↗

PubMed1984

Withdrawal phenomena in subjects with essential hypertension on clonidine or tiamenidine.

The incidence and pathogenesis of withdrawal phenomena with the centrally acting drugs clonidine (CLON) and tiamenidine (TIAM) were evaluated. Thirty subjects with hypertension on hydrochlorothiazide (HCTZ) were randomized to TIAM or CLON. Blood pressure and integrated plasma catecholamine levels fell equally in response to both drugs. On withdrawal, blood pressure and pulse rose in both groups with no difference between them. Three subjects had symptoms of withdrawal, four had blood pressure overshoot above pretreatment levels of 10 mm Hg or more, and eight had a rise in blood pressure of 30 mm Hg systolic or 20 mm Hg diastolic. There was no difference between TIAM and CLON in these effects. There was a direct correlation between blood pressure rise and increase in integrated plasma norepinephrine levels. We conclude that the incidence of withdrawal phenomena in subjects on TIAM or CLON is infrequent and that there is a direct relationship between the rise in blood pressure and the loss of suppression of catecholamines by these drugs.

Adult↗

PubMed1983

Plasma and urinary catecholamines during the human ovulatory cycle.

We measured plasma catecholamine concentrations and urinary catecholamine excretion during the ovulatory cycle in six healthy women. Plasma norepinephrine was consistently at its lowest during the follicular phase of the cycle. Plasma norepinephrine began to increase about 2 days before ovulation and continued to increase after ovulation, so that the average luteal phase NE concentration was significantly higher than the average follicular phase concentration (217 versus 143 pg/ml, p less than 0.001). Urinary norepinephrine excretion showed a similar but attenuated pattern. The results suggest that sympathetic neural activity changes with the phase of the ovulatory cycle. Cyclic patterning of plasma norepinephrine is one of many factors which should be considered in the design and analysis of studies which use plasma norepinephrine as an indicator of sympathetic neural activity in human disease states.

Adult↗

PubMed1978

A comparison of four scales that assess premorbid competence.

Premorbid competence has come to be considered an important dimension in predicting outcome in schizophrenia. From the growing number of social adjustment scales, this study focused on the four instruments that are currently used to assess premorbid competence specifically. The usefulness of these instruments was compared using the degree of inter-rater reliability and scale intercorrelation. Although the concept of premorbid adjustment appears increasingly complex, consisting of stages of adjustment and different levels for a single patient, at present the Phillips Scale has the best relative accuracy and clinical applicability.

Adolescent↗

PubMed1978

Psychological factors in susceptibility to drug-induced extrapyramidal symptoms.

In an effort to identify nonneurobiologic factors in the susceptibility to neuroleptic-induced extrapyramidal symptoms (EPS), the EPS response in 20 patients was correlated with field dependence, self-object differentiation, and premorbid social competence. Only the last proved to be a good predictor, which suggests that psychosocial factors play a role in a patient's EPS response.

Adult↗

PubMed1978

Causes for the premature interruption of psychotherapy by private practice patients.

Thirty patients who discontinued private psychotherapy prematurely were evaluated. Factors stemming from the dynamic interaction between the patient and the treatment process were the most common reasons for dropping out, followed by chronic character traits such as impulsivity and masochism. It is hoped that this assessment of variables in the premature termination of therapy will serve to alert the therapist to the probability that treatment will be aborted, suggest which mechanisms will cause interruption, and enable the therapist to use preventive measures sooner.

Adult↗

PubMed1975

A clinical application of subliminal psychodynamic activation. On the stimulation of symbiotic fantasies as an adjunct in the treatment of hospitalized schizophrenics.

This study attempted to utilize the subliminal psychodynamic activation method as an aid in the treatment of hospitalized schizophrenics. More specifically, we inbestigated whether the subliminal activation of a fantasy of symbiotic gratification would produce an increment in the degree of improvement that schizophrenics manifested as a result of hospitalization. Forty male patients were seen individually for three weekly sessions over a 6-week period for a fantasy expression task carried out by a psychology graduate student. Both at the beginning and at the end of each session and whenever during the session anxiety was in evidence, the patient was exposed to subliminal stimulation. The patients were divided into two groups equated for intelligence, pathology level, and other pertinent variables. For one group, the tachistoscopically presented stimulus consisted of MOMMY AND I ARE ONE, a verbal message which, in several prior studies, produced a significant reduction in ego impairment within a laboratory session. The other group served as a control, and their stimulus was PEOPLE ARE WALKING. The subjects in each group were subdivided in order to investigate the effects of two other interventions in addition to the subliminal symbiotic stimulation. One of these was aggressive expression consisting of an attempt to elicit specifically aggressive fantasies in the fantasy expression task. The other was self-focuing, designed to strengthen self-boundaries. All patients were blindly assessed for seven measures of ego impairment before and after the intervention period and for the number of rehospitalizations over a 9-month follow-up period. Of the three types of interventions impairment measures. For on of the variables, the symbiotic group showed significantly more improvement than the control group, while for two others the results approached significance. In addition, on an overall measure of ego impairment, there was significantly mor improvement for the symbiotic group than for the control patients.

Aggression↗

PubMed1975

Obstacles in the treatment of dying patients.

Theory and practice in the management of the dying patient have moved forward in the past two decades. However, the author believes the benefits of this progress have not reached a large segment of the population of dying patients--those individuals who have a higher level of psychopathology or are from a lower socioeconomic group. Obstacles in the treatment of such patients are described and illustrated by case histories; the author makes specific recommendations related to the care of these more difficult cases.

Adult↗

PubMed1973