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Biomedical subjects

S J Schleifer

Publications and source records attributed to S J Schleifer.

At least 19 recordsLinked to original sources
PubMed1996

Human immunodeficiency virus-type 1 infection in an inner-city alcohol treatment program.

The human immunodeficiency virus (HIV) infection rate was examined in a selected cohort of healthy clients of an inner-city alcohol treatment center from 1990 through 1993. These subjects were also participating in a research protocol (n = 258) designed to assess immunity and HIV risk behaviors in inner city alcohol-dependent persons. Healthy alcohol-abusing heterosexual clients (165) had HIV testing conducted in an inner-city ambulatory alcohol treatment center between September 1990 and December 1993. Respondents were 93.9% African-American and 3.6% Hispanic; 72.1% were male. Anonymous HIV-1 antibody testing was conducted retrospectively for an additional 80 subjects who participated in the research protocol during the same interval, but for whom HIV-1 antibody testing was not conducted clinically at the time. HIV infection rate among the clinic-tested subjects (n = 165) was 4.4% for individuals who were exclusively alcohol-dependent, 1.4% for non-injecting drug use (IDU) mixed substance abusers, and 46.8% for clients with a history of IDU. Rates did not differ among cohorts tested in different years. Among non-injecting drug users tested in the clinic, all infected respondents (n = 3) were women (p = 0.03). Among those tested anonymously (n = 80), however, infection rate for exclusively alcohol-dependent persons was 16.7%, non-IDU mixed abusers 11.1%, and injecting drug users 48.3%, with seropositive males as well as females in each group. HIV infection rates for the pooled samples (n = 245) were 8.7% for exclusively alcohol-dependent persons, 5.1% for mixed abusers, and 54.5% for injecting drug users. Among non-injecting drug users, exclusively alcohol-dependent women had a significantly higher (p < 0.01) infection rate (20.0%) than the remaining females and males. Infection rates among exclusively alcohol-dependent males, male and female polysubstance non-IDU abusers, and injecting drug users were comparable with that seen in an earlier screening in the same clinic in 1989, with apparently little diffusion of infection from the IDU population to other substance abusers. An exception seemed to be exclusively alcohol-dependent females, who show substantially elevated rates. Age, housing, and other social differences may help segregated substance-abusing populations in the relatively small Newark metropolitan area, although not protecting exclusively alcohol-dependent females.

Adult↗
PubMed1996

Immunity in young adults with major depressive disorder.

OBJECTIVE: The authors previously found evidence for an age-related association between major depression and altered immunity. The present study was designed to assess a range of immune measures in young adults with major depression. METHOD: A homogeneous group of 21 unmedicated, ambulatory young adults with unipolar major depressive episode, as determined with the Structured Clinical Interview for DSM-III-R, were assessed in comparison with 21 matched nondepressed subjects. An extended battery of quantitative and functional immune measures was obtained on the same day from depressed and nondepressed subjects. RESULTS: Young adult subjects with major depression had more circulating leukocytes and granulocytes, fewer CD56+ (natural killer [NK]) cells, and, when the number of circulating NK cells was controlled, less NK cell activity. Mitogen responses, consistent with the authors' previous report, showed little difference between the young adults with and without major depression except for a possibly greater response at the highest dose of phytohemagglutinin. CONCLUSIONS: Major depression in young adults is associated with alterations in aspects of the immune system primarily involving NK cells. Some but not all these immune changes differ from those found in older depressed adults.

Adult↗
PubMed1994

Electrical stimulation of the dorsal midbrain periaqueductal gray suppresses peripheral blood natural killer cell activity.

This study examined the effects of dorsal midbrain periaqueductal gray (PAG) stimulation on both splenic and peripheral blood natural killer (NK) cell function as well as the proliferative response of lymphocytes to phytohemagglutinin mitogen. Male Sprague-Dawley rats were implanted with bipolar electrodes in the dorsal PAG. Following recovery, bipolar electrical stimulation eliciting a flight response was delivered at the rate of one/min for 30 min to freely moving rats. While dorsal PAG stimulation did not alter mitogen response or splenic NK activity, stimulation of this region of the PAG produced a marked decrease in peripheral blood NK response. In order to begin to explore a possible mechanism regulating suppression of peripheral blood NK activity, naltrexone (10 mg/kg) was administered prior to dorsal PAG stimulation. The results of this experiment replicated the findings that demonstrated suppression of peripheral blood NK following dorsal PAG stimulation. Naltrexone did not effect PAG induced suppression of peripheral blood NK. These findings point to the importance of the dorsal aspect of the PAG in the regulation of peripheral blood NK activity and further suggest that this phenomenon may not be opioid mediated.

Animals↗
PubMed1993

Analysis of partial variance (APV) as a statistical approach to control day to day variation in immune assays.

The considerable day to day variability in some immunologic assays can obscure relationships among measures of interest and thereby complicate interpretation of findings when effect sizes are modest. Analysis of partial variance (APV) is a technique that utilizes data obtained from controls run in the laboratory on the day of each assay to control for day to day variance statistically. The application of this technique to permit detection of otherwise obscured effects for both larger and smaller samples is exemplified utilizing data from two studies in which subjects were assessed on multiple different dates. These included a study of the association of depression with in vitro immune measures in 296 adolescents and a longitudinal study of 20 spouses of patients admitted to a cardiac intensive care unit studied together with 20 matched controls. APV was most useful in analyses of mitogen-induced lymphocyte proliferation assays, which had considerable day to day variability. In general, multivariate studies with functional immune measures may benefit most from application of this technique.

Adolescent↗
PubMed1991

Predictors of physician nonadherence to chemotherapy regimens.

Physician nonadherence to cancer treatment regimens may diminish treatment efficacy and compromise clinical research. The influence of clinical, demographic, and psychosocial patient characteristics on physician adherence to breast cancer chemotherapy was investigated, as was the role of the clinician's attitudes concerning the chemotherapy. One hundred seven women recently diagnosed with breast cancer were followed for 26 weeks of treatment. Fifty-six (52%) of the patients experienced unjustified modification for at least one chemotherapeutic agent. Stepwise multiple regression revealed independent contributions of increased patient age, treatment setting (clinic versus academic or community private practice), and stage of disease to physician nonadherence. Regimen complexity, delay in seeking treatment, and presence of psychiatric disorder did not contribute, in general, to unjustified regimen modifications. Patient psychological and psychiatric factors, however, did influence prescribing behavior for vincristine. Physician awareness of factors contributing to unnecessary treatment modifications may reduce the frequency of such behaviors.

Age Factors↗
PubMed1991

Digitalis and beta-blocking agents: effects on depression following myocardial infarction.

Depression is frequently seen in patients following myocardial infarction (MI), many of whom are receiving digitalis glycosides, beta-blockers, or other agents that may exert central nervous system (CNS) effects. In a prospective study of the clinical significance of post-MI depression, 335 patients were assessed using a standardized diagnostic interview for depression at 8 to 10 days, and 190 were reinterviewed at 3 to 4 months. Patients prescribed digitalis, beta-blockers, or other cardioactive medications at hospital discharge were identified. Logistic regression analyses were performed to determine the contribution of these agents to depression at 3 to 4 months, controlling for medical and sociodemographic factors as well as for baseline depression. Treatment with digitalis predicted depression at 3 to 4 months (p less than 0.05); no other medications, including beta-blockers, predicted depression (p greater than 0.10). Digitalis may have CNS effects that contribute to depression post-MI and this finding should be considered in the differential diagnosis of depression in cardiac patients.

Adrenergic beta-Antagonists↗
PubMed1991

Depression in inner city adolescents attending an adolescent medicine clinic.

Interviews of 70 healthy inner city adolescents attending an adolescent medicine clinic, using the Diagnostic Interview for Children and Adolescents (DICA), revealed that 13% met criteria for current major depressive disorder. Lifetime diagnoses of major depression were found in 30% of the subjects, with many describing recurrent episodes and chronic residual symptoms. Depression in inner city adolescents represents a serious problem that may be best first detected in a medical setting.

Adolescent↗
PubMed1991

HIV-relevant sexual behavior among a healthy inner-city heterosexual adolescent population in an endemic area of HIV.

The AIDS crisis has devastated segments of the population including the gay community and those who use intravenous drugs. HIV has spread to other groups including prostitutes and those with other sexually transmitted diseases. We have been studying adolescents in a major Northeast city where there is a major HIV/AIDS epidemic. Despite high levels of AIDS related knowledge, these adolescents reported high levels of sex risk behaviors. In addition, our data suggests that even moderate alcohol or marijuana use predicts high risk sexual behaviors. These data indicate the urgent need to develop prevention strategies for the spread of HIV among inner-city youth based upon relevant predictors of risk behaviors. The coupling of HIV in inner-city populations with a high frequency of risk behaviors in adolescents demands an immediate public health response.

Adolescent↗
PubMed1990

Patient noncompliance with self-administered chemotherapy.

The contribution of patient factors to nonadherence with self-administered cancer chemotherapy along with its prevalence was studied. Fifty-one patients with breast cancer enrolled in protocols that included the orally administered medications Cytoxan (cyclophosphamide) and/or prednisone were interviewed and assessed at five points in time over a 6-month period. Two summary measures of patient nonadherence derived by self-report were developed: (1) dosage, the overall percentage of drug missed during 26 weeks of treatment; and (2) behavioral, the percentage of behavioral events or prescribing occasions on which a criterion level of drug was missed. Twenty-two patients (43%) met criteria for noncompliance according to both behavioral and dosage definitions. Univariate analyses showed more nonadherence in the clinic and private community settings than in the academic setting. Stepwise multiple logistic regression analyses assessed the contribution of patient demographic, psychologic, and physical symptom factors on patient noncompliance. In the regression analyses patient noncompliance was associated with (1) treatment location, more nonadherence in the private community-based treatment sector than in the academic setting; and (2) income, more nonadherence among those having lower incomes. In assessing total dose requirements in clinical research trials, rates of patient nonadherence need to be considered, and treatment location controlled.

Administration, Oral↗
PubMed1990

Facial pain, distress, and immune function.

Chronic facial pain syndromes are associated with high levels of distress and depression. Immune system measures were investigated in otherwise healthy patients suffering from chronic temporomandibular pain and dysfunction syndrome (TMPDS) and in matched controls. No mean differences were found between TMPDS patients and the controls on any of the immune measures; however, both ConA and PWM responses in TMPDS patients were decreased in relation to the level of demoralization (P less than 0.05). Cognitive symptoms such as low self-esteem and perceptions of helplessness/hopelessness were implicated in these effects. In addition, among patients pain severity was independently associated with decreased ConA response (P less than 0.05). The data suggest possible correlates of stress-induced changes in the immune system.

Adult↗
PubMed1989

Major depressive disorder and immunity. Role of age, sex, severity, and hospitalization.

An association between depression and altered immunity has been suggested but has not been consistently demonstrated. We have studied 91 patients with unipolar major depressive disorder, and no mean differences were found between the patients and concurrently studied matched controls in mitogen-induced lymphocyte proliferation, lymphocyte subsets, and natural killer cell activity. There were, however, significant age-related differences between the depressed patients and controls in mitogen responses and in the number of T4 lymphocytes. In contrast to age-related increases in mitogen response and in T4 cells in controls, depressed patients did not show increased lymphocyte responses or numbers of T4 lymphocytes with advancing age. Severity of depression and hospitalization status were also associated with immune system changes. Altered immunity does not appear to be a specific biologic correlate of major depressive disorder but may occur in subgroups of depressed patients.

Adolescent↗
PubMed1989

The nature and course of depression following myocardial infarction.

Two hundred eighty-three patients admitted to cardiac care units for myocardial infarction at two urban teaching hospitals were interviewed 8 to 10 days after infarction and 171 were reinterviewed 3 to 4 months later. Initially, 45% met diagnostic criteria for minor or major depression, including 18% with major depressive syndromes. Depression was not associated with the severity of cardiac illness but was associated with the presence of noncardiac medical illnesses. Three to 4 months after infarction, 33% of patients met criteria for minor or major depression. The large majority of patients who initially met criteria for major but not minor depression showed evidence of depression at 3 months and most patients with major depression had not returned to work by 3 months. Treatment of major depressive syndromes after myocardial infarction may reduce chronicity and disability, while minor depressive syndromes may be similar to normal grief and tend to be self-limited.

Aged↗