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Biomedical subjects

R B Lipton

Publications and source records attributed to R B Lipton.

At least 163 records · Page 9Linked to original sources
PubMed1995

Low-dose, short-term oral prednisone in the treatment of carpal tunnel syndrome.

We evaluated the effectiveness of low-dose, short-term oral prednisone in ameliorating the pain and other symptoms of carpal tunnel syndrome (CTS) in a randomized, double-blind, placebo-controlled study of patients with mild to moderate CTS. Prednisone, in doses of 20 mg daily for the first week and 10 mg daily for the second week, resulted in significant improvement in global symptom scores. The effect was rapid, but gradually waned over 8 weeks of observation. This approach may provide a treatment alternative in the short-term, conservative management of CTS.

Anti-Inflammatory Agents↗
PubMed1995

Relationship of headache to phase of the menstrual cycle among young women: a daily diary study.

We investigated the relationship between headache occurrence and phase of the menstrual cycle in a 4-month daily diary study of 74 women, 22 to 29 years old, residing in Washington County, Maryland. We selected subjects from women reporting a history of migraine symptoms and at least two migraine headache attacks per month in a 1986 to 1987 population-based survey. Data collection was from March 1987 through April 1988. By using detailed headache symptom information collected daily, we classified headaches into four categories: migraine with aura, migraine without aura, tension-type, and all other headaches. Odds ratios were separately estimated for the individual headache types and all types combined during each of three phases of the menstrual cycle. Risk of migraine without aura was significantly elevated during the first 3 days of menstruation (odds ratio, 1.66; 95% confidence interval, 1.21 to 2.26), but headache risk was not significantly increased during the 2 days immediately preceding onset of menstruation or on the estimated day of ovulation (day 14 before the onset of menstruation). Participants reported headaches on 28% of the study days overall, suggesting that onset of menstruation is an independent but not exclusive precipitating factor for headache attacks among young adult women with migraine. Our data show that onset of menstruation only accounts for a small proportion of migraine attacks among young women with frequent episodes of migraine.

Adult↗
PubMed1995

High risk of IDDM in African-American and Hispanic children in Chicago, 1985-1990.

OBJECTIVE: To determine the incidence of insulin-dependent diabetes mellitus (IDDM) among African-American and Hispanic children < 18 years of age in the city of Chicago. These minority communities are large and heterogeneous with respect to socioeconomic status, length of time since migration, and place of origin, so that correlates of IDDM risk can be examined with precision. RESEARCH DESIGN AND METHODS: Cases occurring during the years 1985-1990 were drawn from records at 37 hospitals in Cook County. African-American and Hispanic patients using insulin, residing within the city limits, and < 18 years old at onset were included. Three secondary sources of cases were used: medical records of clinics associated with the Chicago Department of Health, a survey of unaffiliated neighborhood clinics, and lists of children attending diabetes camps. Overall ascertainment was estimated at 86%. RESULTS: There were 413 new cases during this 6-year interval. The average incidence of IDDM was 12.0/100,000 annually among African-American males, 12.1 among African-American females, 9.1 among Hispanic males, and 10.2 among Hispanic females. Mean age at onset was 11.1, 11.0, 10.7, and 10.1 years for African-American males, African-American females, Hispanic males, and Hispanic females, respectively. Fewer cases occurred during the summer months. Diabetes among the first-degree relatives of children from both ethnic groups was commonly noted on the medical charts. CONCLUSIONS: The incidence rates in Chicago fall near the upper limits of reports for both African-origin and Hispanic populations worldwide. The relatively early age at onset may point to an environmental factor associated with this high incidence of the disease. Further studies will provide valuable data on comorbid conditions, unusual diabetic syndromes, and family dynamics in childhood chronic disease.

Adolescent↗
PubMed1995

Event-related potential correlates of early processing in normal aging.

Auditory event-related potentials were recorded from normal elderly and young adult subjects during simple reaction time and discrimination conditions. In both response conditions, the stimuli were randomly presented, as in an auditory "oddball" paradigm. It was found that NA, an index of early information processing, was significantly delayed in the elderly. Although the latency of N1 was not significantly different between the groups, the latencies of N2 and P3 were significantly longer for the aged subjects. The amplitudes of N1, NA1, NA2 and N2 showed no group differences. The raw amplitude of P3 showed a group difference in topography: Pz was greater than Fz for the young group, but not for the aged. When the amplitudes of NA1, NA2, and P3 were scaled, however, the topography of these components showed no significant group differences. These findings suggest that the age-related slowing of later ERP components and behavior may be partially accounted for by delays in early attention dependent perceptual processes, as indexed by NA.

Adult↗
PubMed1994

Classification of daily and near-daily headaches: proposed revisions to the IHS criteria.

The International Headache Society (IHS) headache classification, while a major advance, does not adequately classify the daily and near-daily headache disorders known as chronic daily headache (CDH). We believe that chronic daily headache is a group of disorders which includes chronic tension-type headache (CTTH), transformed migraine (TM), new daily persistent headache (NDPH), and hemicrania continua (HC). We propose specific criteria for transformed migraine, new daily persistent headache, and hemicrania continua, and have modified the criteria for chronic tension-type headache.

Chronic Disease↗
PubMed1994

An update on the epidemiology of migraine.

Epidemiologic studies provide estimates of the scope and distribution of the public health problems posed by migraine. These studies have been facilitated by the development of the International Headache Society criteria for migraine, which have now been used in separate prevalence studies in several countries. In this article, we review some of the methodological challenges in studying migraine epidemiology, report recent results from studies using IHS criteria, and suggest directions for future research.

Adolescent↗
PubMed1994

The epidemiology of migraine.

To obtain accurate estimates of migraine prevalence, population-based studies are required. Clinic-based studies include a highly selected group of migraine sufferers. Even in population-based studies, there have been wide variations in estimates of migraine prevalence. A meta-analysis has shown that age, gender and case definition account for 70% of this variance. Recent studies using International Headache Society (IHS) diagnostic criteria have given relatively consistent estimates of migraine prevalence (about 15-18% of women and 6% of men) and indicate that migraine occurs most commonly in men and women aged 25-55 years. Migraine is a heterogeneous condition with a spectrum of severity and associated disability, and it is under-diagnosed worldwide.

Adolescent↗
PubMed1994

The economic and social impact of migraine.

Migraine is an episodic disorder which is often disabling both during and between attacks. While pain intensity is the most important symptom to individual sufferers, headache-related disability is the major determinant of the economic impact of illness. Because migraine is underdiagnosed and under-treated, cost-effective healthcare interventions could serve to reduce the burden of illness on individual sufferers and society. Measures which assess both pain intensity and disability might serve to capture the essential elements of migraine and provide the basis for effective healthcare interventions.

Cost of Illness↗
PubMed1994

Comorbidity of migraine and epilepsy.

We investigated comorbidity of migraine and epilepsy by using information from structured telephone interviews with 1,948 adult probands with epilepsy and 1,411 of their parents and siblings. Epilepsy was defined as a lifetime history of two or more unprovoked seizures, and migraine as severe headaches with two or more of the following symptoms: unilateral pain, throbbing pain, visual aura, or nausea. Cumulative incidence of migraine to age 40 was 24% in probands with epilepsy, 23% in relatives with epilepsy, and 12% in relatives without epilepsy. Using Cox proportional hazards analysis to control for years at risk and gender, the rate ratio for migraine was 2.4 (95% CI, 2.02 to 2.89) among probands and 2.4 (1.58 to 3.79) among relatives with epilepsy in comparison with relatives without epilepsy. Migraine risk was highest in probands with epilepsy due to head trauma, but it was significantly higher in every subgroup of probands than in unaffected relatives when probands were stratified by seizure type, age at onset, etiology of epilepsy, and history of epilepsy in first-degree relatives. Age-specific incidence of migraine among probands was increased to a greater extent after onset of epilepsy than before, but it was also significantly increased more than 5 years before onset and 1 to 5 years before onset. These results indicate that migraine and epilepsy are strongly associated, independent of seizure type, etiology, age at onset, or family history of epilepsy.

Adolescent↗
PubMed1994

Hemicrania continua: ten new cases and a review of the literature.

We describe 10 new patients and review the 24 prior reports of hemicrania continua, an uncommon, unilateral headache disorder. The disorder is characterized by a continuous baseline headache of moderate severity with superimposed exacerbations of more severe pain. These exacerbations are sometimes associated with ipsilateral autonomic disturbances. There are three temporal patterns: a chronic, nonremitting headache from onset; a remitting variety consisting of distinct phases of continuous unilateral headaches that persist for weeks to months followed by pain-free remissions; and an evolving form in which initially remitting headaches transform into the chronic, non-remitting pattern. Accurate diagnosis is important as all forms are characterized by a dramatic and selective response to indomethacin.

Adult↗
PubMed1994

Neuropsychological prediction of dementia and the absence of dementia in healthy elderly persons.

Identification of elderly individuals with low and high risk for future dementia has emerged as an important clinical and public health issue. To address this issue, we assessed neuropsychological performance in 317 initially nondemented elderly persons between 75 and 85 years of age and followed them for at least 4 years as part of the Bronx Aging Study. Four measures of cognitive function from the baseline assessment (delayed recall from the Buschke Selective Reminding Test, recall from the Fuld Object Memory Evaluation, the Digit Symbol subtest from the Wechsler Adult Intelligence Scale, and a verbal fluency score) can identify one subgroup with an 85% probability of developing dementia over 4 years and another with a 95% probability of remaining free of dementia. The model achieved an overall positive predictive value of 68%, or three times the base rate, for prediction of the development of dementia in our sample. The overall negative predictive value for prediction of absence of dementia was 88%. Baseline measures of cognitive function, often performed many years before the actual diagnosis of dementia, can provide important information about dementia risk. The group likely to develop dementia becomes a target for preventive or early therapeutic interventions, and the group unlikely to develop dementia can be reassured.

Aged↗
PubMed1994

The burden of migraine. A review of cost to society.

Migraine is a common episodic disorder with considerable impact on individuals and society. Migraine occurs with the highest prevalence between the ages of 25 and 55 years, potentially the most productive period of life. Severe migraine can lead to disruption of work, family and social life, the long term consequences of which may affect quality of life. The direct costs of migraine (due to medical care) are small compared with the indirect costs caused by absence from work and reduced productivity. Population-based studies are required to assess incidence, prevalence and distribution of the disease. These studies also reveal that migraine is currently underdiagnosed and undertreated. The cumulative impact of migraine on individuals produces the burden of illness on society. Measuring the severity of migraine is important in understanding the extent of the burden of migraine on the individual and on society. Measures of severity may be useful as predictors of disability and healthcare use. These measures may also be useful in assessing the need for patient care and treatment and help target those more disabled by migraine. Identifying and treating appropriate patients should reduce the impact of migraine on the individual and the burden of migraine on society.

Age Factors↗
PubMed1994

Incidence of type I diabetes in people under 30 years of age in Barbados, West Indies, 1982-1991.

OBJECTIVE: To determine the incidence of type I diabetes among individuals < 30 years of age on the island of Barbados in the Caribbean. The population is predominantly African in origin but exhibits a relatively westernized lifestyle. RESEARCH DESIGN AND METHODS: Cases occurring during the years 1982-1991 were drawn from records at Queen Elizabeth Hospital and from physicians treating insulin-dependent diabetes mellitus (IDDM) patients. Patients using insulin and < 30 years of age at onset were included. Ascertainment was estimated at 94%. RESULTS: The average annual incidence of type I diabetes among Barbadians was 4.1/100,000 when age-adjusted to the world's population. There were 59 incident cases during this 10-year interval. The risk for males was 4.4 and for females 4.0/100,000. Among those 0-14 years of age, the risk was 5.0/100,000. Mean age at onset (+/- SD) was 14.7 +/- 6.9 for males and 12.5 +/- 5.7 for females. Males showed marked seasonal variation in risk and a more than threefold increase in annual incidence during 1984-1985. In contrast, females exhibited a stable pattern of IDDM risk during the 10-year interval. CONCLUSIONS: The incidence rate in Barbados falls near the lower limits of rates reported for Caribbean populations. There was a marked seasonal effect among males, even though the climate varies little throughout the year. This observation, and the incidence peak during 1984-1985, provide support for the role of environmental factors in the etiology of IDDM.

Adolescent↗