PubMed Health⌕ Search

Biomedical subjects

R S Stern

Publications and source records attributed to R S Stern.

At least 181 records · Page 10Linked to original sources
PubMed1981

The separation of susceptibility to psoriasis from age at onset.

The prevalence of psoriasis among first-degree relatives of 1209 patients with severe psoriasis was studied by means of a questionnaire survey. Siblings of patients with an affected parent were more than 4 times as likely to have psoriasis as siblings of patients without an affected parent. Siblings of patients with onset before age 15 were more than 3 times as likely to have psoriasis as siblings of patients with onset after age 30. The increased prevalence associated with each factor was independent of the other factor. This relation suggests that determinants of susceptibility to psoriasis are separate from factors that influence age at onset in those who are susceptible. This separation is important because the genetics and biochemistry of susceptibility may be less complex than for age at onset. Prevalence among offspring was less than age-adjusted prevalence among siblings with an affected parent which suggests the major determinant of susceptibility is not a single dominant allele.

Adolescent↗
PubMed1981

Guided mourning for morbid grief: a controlled study.

During 2 weeks on a waiting list 12 patients with morbid grief did not improve significantly. They were then randomly allocated either to guided mourning treatment, in which they were encouraged to face cues concerning their bereavement, or to control treatment in which they were asked to avoid such cues. Each treatment comprised six 1 1/2 hour sessions over 2 weeks. At week 4 guided mourning patients had improved significantly more than had controls on 3 measures, with a supportive trend on 4 measures. Improvement, though modest, was maintained to 10-28 weeks follow-up. Control patients did not improve significantly or show any trend to do so.

Adult↗
PubMed1980

Skin carcinoma in patients with psoriasis treated with topical tar and artificial ultraviolet radiation.

A case-control study, consisting of 59 skin cancer patients with severe psoriasis, was conducted to evaluate the effect of treatment with tar and/or artificial ultraviolet radiation on the risk of developing cutaneous carcinoma. Using 924 unmatched controls, we estimated that the crude rate of skin cancer was 2.4-fold for patients with high exposure to tar and ultraviolet radiation, compared with those lacking high exposure. Using a control series of 126 patients matched for age, skin type, region of residence, sex, history of exposure to ionising radiation, and number of 8-methoxypsoralen photochemotherapy treatments, we observed a stronger association (relative rate = 4.7, 95% confidence limits = 2.2 to 10.0). The magnitude of the relative rates argues for continued surveillance for tumours among patients with psoriasis who receive long-term tar or artificial ultraviolet radiation therapy.

Dose-Response Relationship, Drug↗
PubMed1980

Clomipramine and exposure for obsessive-compulsive rituals: i.

Forty chronic obsessive-compulsive ritualizers were randomly assigned to treatment with oral clomipramine or placebo for 8 months. During weeks 4 to 7 these two groups were each randomly split into treatment by relaxation or by exposure in vivo, and during weeks 7 to 10 all patients had exposure in vivo. Double blind assessments were made at weeks 4, 7, 10, 18, 36, 62 and 114. Results are reported to one year. Clomipramine produced significant improvement in rituals, mood and social adjustment, but only in those patients who initially had depressed mood. The clomipramine effect was maximum from weeks 10 to 18 and diminished thereafter. On stopping clomipramine patients often relapsed and improved again on restarting the drug. Relaxation produced little change. Exposure produced significant lasting improvement in rituals, but less change in mood; improvement generalized to social adjustment at follow-up. Clomipramine plus exposure had a slight additive but not interactional effect. Clomipramine enhanced compliance both with exposure and with relaxation. Clomipramine is useful for compulsive ritualizers with depressed mood, but may need continuation for over a year and combination with exposure in vivo. Exposure in vivo remains the treatment of choice for rituals without depressed mood.

Adolescent↗
PubMed1980

Clomipramine and exposure for compulsive rituals: II. Plasma levels, side effects and outcome.

Forty obsessive-compulsive ritualizers received nightly placebo or clomipramine up to 225 mgs nocte for 8 months, and received behavioural treatment (exposure to vivo) from weeks 4 to 10. Plasma concentrations of clomipramine and its primary metabolite N-desmethylclomipramine steadily increased over the first 4 weeks of treatment after which they remained relatively steady. Plasma levels correlated significantly with dose and with outcome but not with side effects. Patients with plasma clomipramine levels in the range 100-250 ng/ml and N-desmethylclomipramine levels between 230-550 ng/ml were found to improve significantly more than patients outside these ranges, thus suggesting a therapeutic window for clomipramine and its primary metabolite.

Clomipramine↗
PubMed1980

Phototoxic reactions to photoactive drugs in patients treated with PUVA.

To determine the potentially adverse effects of photoactive medications taken in conjunction with oral methoxsalen photochemotherapy (PUVA) for psoriasis, we studied the incidence of phototoxic reactions in 1,125 patients treated with PUVA at 15 centers. During the initial (clearing) phase of PUVA therapy, patients using photoactive medications were no more likely to have diffuse delayed erythema than patients who did not use such medications. After clearing, patients 45 years of age or older who used photoactive drugs were 2.3 times as likely to discontinue PUVA therapy for at least one month owing to problems related to UV-induced burns than were those who did not use such drugs. Only 6% of patients older than 45 years who took photoactive medications had problems with phototoxicity sufficiently severe to contribute to permanent discontinuation of PUVA therapy.

Adult↗
PubMed1980

Clomipramine: plasma levels, side effects and outcome in obsessive-compulsive neurosis.

The relationship between plasma levels of clomipramine and desmethylclomipramine and clinical response was studied in a group of patients with obsessive-compulsive neurosis. In general the response was best in the middle range of plasma concentrations, showing the inverted U curve well recognized with nortriptyline. However, the results of this study suggest that the response of compulsive rituals correlates with levels of plasma clomipramine, while depression appears to correlate with plasma levels of desmethylclomipramine. The former relationship may be the stronger. There may also be some relationship between side effects and relative plasma levels of clomipramine and desmethylclomipramine.

Adolescent↗
PubMed1980

Plasma concentrations of clomipramine and desmethylclomipramine in obsessive-compulsive neurosis.

Patients suffering from chronic obsessive-compulsive states were treated with clomipramine up to 200 mg/day according to tolerance for periods up to 8 months and their plasma clomipramine and desmethylclomipramine concentrations determined weekly by a double radioisotope derivative technique. Plasma concentrations of both the parent compound and its metabolite rose with dose and within 7-14 days of constant dosage reached steady states. A strong positive correlation was found between clomipramine, and to a lesser extent desmethylclomipramine, and the daily dose of clomipramine. In almost all patients plasma desmethylclomipramine concentrations exceeded those of unchanged drug by a factor of two or three.

Adolescent↗
PubMed1979

Risk of cutaneous carcinoma in patients treated with oral methoxsalen photochemotherapy for psoriasis.

A 2.1-year prospective study of 1373 patients given oral 8-methoxypsoralen photochemotherapy for psoriasis revealed 30 patients with a total of 48 basal-cell and squamous-cell carcinomas. The observed incidence of cutaneous carcinoma was 2.63 (95 per cent confidence limits = 1.91 to 3.90) times that expected for an age, sex and geographically matched population. Relative risk to patients with history of ionizing radiation was 3.68 (99 per cent confidence limits, 2.42 to 8.69). Patients with a previous cutaneous carcinoma had a relative risk of 10.22 (99 per cent confidence limits, 4.78 to 37.08). A higher than expected proportion of squamous-cell carcinomas and an excess of squamous-cell carcinomas in areas not exposed to sun were seen. New patients with known histories of ionizing-radiation exposure or of skin tumors should be given 8-methyoxypsoralen photochemotherapy only if they understand the risks and have disabling psoriasis untreatable by other means.

Administration, Oral↗
PubMed1979

Antinuclear antibodies and oral methoxsalen photochemotherapy (PUVA) for psoriasis.

In view of theoretical concern that psoralen ultraviolet A radiation (PUVA) therapy might induce a systemic lupus erythematosus-like syndrome, we studied serum antinuclear antibodies (ANAs) in patients with psoriasis who received PUVA and are participating in a five-year prospective study. At 14 centers, 1,023 patients had two or more ANA determinations. When first and last tests were compared, the incidence of positive tests for ANAs was not significantly different (P greater than .2). In addition, there was no apparent relationship between the frequency of PUVA treatments and the probability of a positive test. Over a two-year period, there is no evidence to indicate that PUVA therapy for psoriasis has resulted in a significantly higher number of positive tests for ANAs within our population.

Adolescent↗
PubMed1978

Obsessive thoughts: the problem of therapy.

Eleven patients with obsessive thoughts were treated in two pilot studies. In the first of these patients were given thought-stopping, and this was contrasted with relaxation therapy. In the second study patients were treated by a technique described here as 'satiation', and this was followed by thought-stopping and finally a course of amitriptyline. The overall results were poor, but one type of obsessive thought responded well to satiation.

Amitriptyline↗
PubMed1977

Graduate education in primary care: an economic analysis.

To determine the financial requirements of an established primary-care educational program for house officers, we studied two prepaid and two fee-for-service Harvard Primary Care Program affiliated practices. Program-wide, each resident saw an average of 112 patients per month, with patient service costs of $2,580. With teaching and administrative expenses included, total monthly costs averaged $3,120 and $3,270 per trainee for prepaid and fee-for-service practices respectively. In fee-for-service practices, resident billings for patient services averaged $2,790, yielding revenues of $2,510 per month, which offset 77 per cent of total program costs. At current reimbursement rates, covering full program costs in the fee-for-service practices would require an increase of more than 40 per cent in resident-provided patient-care volume. By reducing time available for broad ambulatory experiences, such an increase would necessitate substantial program restructuring and limit opportunities for innovation in the Harvard Primary Care Program.

Costs and Cost Analysis↗
PubMed1977

Utilization of physician services for dermatologic complaints. The United States, 1974.

The National Ambulatory Medical Care Survey provides data on the "who," "for what complaint," and "to whom" for office visits to office-based physicians. In 1974, complaints referable to the skin accounted for 44 million physicians visits. This represents 7% of the 634 million visits to physician offices made during this period. Dermatologists accounted for 34% of all visits for skin complaints. General and family practitioners accounted for 40% of such encounters. Office visits prompted by dermatologic complaints were frequently less than 16 minutes long. Each office-based dermatologist accounted for an average of 5,600 patient visit per year. According to the dermatologist's diagnosis, 31% of these visits were prompted by acne; warts accounted for an additional 8%.

Acne Vulgaris↗