Biomedical subjects

S J Shema

Publications and source records attributed to S J Shema.

32 records · Page 2Linked to original sources

PubMed1997

Does growing old increase the risk for depression?

OBJECTIVE: Most research examining age as a risk factor for depression has been based on cross-sectional data. To investigate the effect of aging on rates of depression prospectively, the authors used two waves of data from a panel study of community residents 50 years old and older. METHOD: Data on symptoms of major depressive episodes were examined for the 1994 and 1995 cohorts of the Alameda County Study. The authors examined age, gender, marital status, education, financial strain, chronic medical conditions, functional impairment, cognitive problems, life events, neighborhood problems, social isolation, and social support. Depression was measured with 12 items covering DSM-IV diagnostic criteria for major depressive episodes. RESULTS: Point prevalence of major depressive episodes was 8.7% in 1994 and 9.0% in 1995. Among the subjects 60 years old and older, there was a tendency toward higher prevalence in 1995. The highest prevalence rates in 1994 and in 1995 were among those 80 years old and older. Subjects who were depressed in 1994 were at greater risk for depression in 1995. When the effects of age and other psychosocial risk factors in 1994 were controlled, there were no significant age effects on depression in 1995. Multivariate analyses demonstrated that the initial age effects were due mainly to chronic health problems and functional impairment. Gender, chronic health conditions, problems with activities of daily living, cognitive problems, neighborhood problems, and social isolation in 1994 all were significant predictors of depression in 1995. CONCLUSIONS: Healthy, normally functioning older adults are at no greater risk for depression than younger adults. What seem to be age-related effects on depression are attributable to physical health problems and related disability.

Adult↗

PubMed1997

Frequent attendance at religious services and mortality over 28 years.

OBJECTIVES: This study analyzed the long-term association between religious attendance and mortality to determine whether the association is explained by improvements in health practices and social connections for frequent attenders. METHODS: The association between frequent attendance and mortality over 28 years for 5286 Alameda Country Study respondents was examined. Logistic regression models analyzed associations between attendance and subsequent improvements in health practices and social connections. RESULTS: Frequent attenders had lower mortality rates than infrequent attenders (relative hazard [RH] = 0.64;95% confidence interval [CI] = 0.53,0.77). Results were stronger for females. Health adjustments had little impact, but adjustments for social connections and health practices reduced the relationship (RH = 0.77; 95% CI = 0.64, 0.93). During follow-up, frequent attenders were more likely to stop smoking, increase exercising, increase social contacts, and stay married. CONCLUSIONS: Lower mortality rates for frequent religious attenders are partly explained by improved health practices, increased social contacts, and more stable marriages occurring in conjunction with attendance. The mechanisms by which these changes occur have broad intervention implications.

Alcohol Drinking↗

PubMed1996

Successful aging: predictors and associated activities.

Six-year predictors of successful aging were analyzed for 356 Alameda County Study men and women aged 65-95 years measured prospectively in 1984 and followed to 1990. Successful aging was defined as needing no assistance nor having difficulty on any of 13 activity/mobility measures plus little or no difficulty on five physical performance measures. After adjusting for baseline successful aging, sex, and age, the authors found that 1984 predictors of 1990 successful aging included income above the lowest quintile (odds ratio (OR) = 2.01, 95% confidence interval (CI) 0.99-4.11), > or = 12 years of education (OR = 1.67, 95% CI 0.98-2.84), white ethnicity (OR = 2.12, 95% CI 0.93-4.86), diabetes (OR = 0.10, 95% CI 0.01-0.79), chronic obstructive pulmonary disease (OR = 0.41, 95% CI 0.17-0.97), arthritis (OR = 0.43, 95% CI 0.26-0.71), and hearing problems (OR = 0.48, 95% CI 0.25-0.89). Adjusting for all variables, the authors found that behavioral and psychosocial predictors included the absence of depression (OR = 1.94, 95% CI 1.10-3.42), having close personal contacts (OR = 1.82, 95% CI 1.05-3.18), and often walks for exercise (OR = 1.77, 95% CI 1.00-3.12). Cross-sectional comparisons at follow-up revealed significantly higher community involvement, physical activity, and mental health for those aging successfully.

Activities of Daily Living↗

PubMed1996

Reproductive toxicity and growth effects in rats exposed to lead at different periods during development.

The reproductive toxicity and growth effects of developmental lead exposure were assessed using a rat model in which 0.6% (w/v) lead acetate was administered in the drinking water ad libitum. Three series of experiments were conducted in which lead exposure was initiated beginning in utero, prepubertally, or postpubertally. Lead effects were measured on reproductive physiology and endocrinology, sexually dimorphic hepatic testosterone hydroxylation, and growth rates in both male and female animals. In male animals secondary sex organ weights were significantly decreased only in animals exposed prepubertally. In addition, serum testosterone levels were significantly suppressed, most severely in animals exposed from in utero (in the in utero group). Little effect was observed in adult female rats. However, in female animals exposed prepubertally, delayed vaginal opening and disrupted estrus cycling was observed. More severe reproductive disruption was accompanied by suppression of circulating estradiol in the in utero group. Effects on circulating sex steroids were accompanied by variable effects on circulating luteinizing hormone (LH) levels, pituitary LH, and pituitary LH beta mRNA, suggesting a dual site of lead action: (a) at the level of the hypothalamic pituitary unit, and (b) directly at the level of gonadal steroid biosynthesis. Prepubertal growth in both sexes was suppressed 25% in the in utero group. However, pubertal growth rates were significantly suppressed only in male animals and postpubertal growth was not significantly different from controls in any of the experiments, despite continued exposure to high lead levels in the drinking water. In addition, at age 85 days, male-specific hepatic hydroxylation of testosterone at positions 2 alpha and 16 alpha, which is catalyzed by a cytochrome P450 isozyme CYP 2C11, itself regulated by sexually dimorphic growth hormone secretion, was unaffected. This suggests that the growth effects of lead are possibly due to a delay in the development of sex-specific pituitary growth hormone secretion patterns rather than a persistent developmental defect. Thus, the reproductive and growth effects of lead are complex and sex-dependent, and appear to involve multiple sites on the hypothalamic-pituitary-gonadal axis.

Animals↗

PubMed1996

Behavioral descriptors that differentiate between seizure and nonseizure events in a pediatric population.

The diagnosis and treatment of epilepsy relies heavily on descriptions of behavioral changes noted during seizure episodes. A pilot study was completed to determine the frequency of occurrence of behaviors commonly associated with seizures in a pediatric population (n = 153). Caretakers of the children (ages = 4 months to 19 years) were asked to respond to a checklist containing 40 behavioral descriptors. Thirteen descriptors were found to differentiate between seizure and nonseizure events. Twelve of these behaviors were endorsed significantly more frequently by caretakers of children with seizures including the following: does not remember what happened, moves mouth funny, drools, jerking/twitching, becomes stiff, changes in breathing, stares off, bites or chews tongue, eyes look glassy, will not respond, mumbles or slurs words, and eyes or head turn to one side. One behavior, fidgets in seat, was significantly more associated with nonseizure episodes. The behavioral descriptors may be presented in a checklist format or incorporated within a clinical interview in primary care settings for initial screening of children with possible seizure disorders.

Adolescent↗

PubMed1995

Hyponatremia as the cause of seizures in infants: a retrospective analysis of incidence, severity, and clinical predictors.

STUDY OBJECTIVES: (1) To determine the incidence of hyponatremic seizures in infants, (2) to compare the severity and outcome of seizures in hyponatremic and normonatremic patients, and (3) to evaluate the utility of clinical predictors of hyponatremia. DESIGN: Retrospective chart review of infants who presented to an urban pediatric emergency department from 1988 through 1993. PARTICIPANTS: Patients who experienced seizures while in the ED. These patients were divided into hyponatremic and normonatremic groups. RESULTS: Hyponatremia was the cause of seizures in 70% of 47 infants younger than 6 months who lacked other findings suggesting a cause. Median seizure duration was longer in hyponatremic patients (30 versus 17 minutes; P = .007), with a greater incidence of status epilepticus (73% versus 36%; P = .02) and fewer patients with seizures lasting less than 10 minutes (9% versus 36%; P = .04). Emergency intubation was performed more often in hyponatremic patients (12% versus 0%; P = .009). The median temperature was lower in hyponatremic infants than in normonatremic patients (35.5 degrees C versus 37.2 degrees C; P = .0001). Exact logistic-regression methods identified temperature of 36.5 degrees C or less as the best predictor of hyponatremic seizures, with an OR of 64 (95% CI, 8 to 1,026). CONCLUSION: Hyponatremia should be strongly suspected in an infant less than 6 months old with seizures and a temperature of 36.5 degrees C or less.

Age Factors↗

PubMed1994

Phase I study of escalating targeted doses of carboplatin combined with ifosfamide and etoposide in treatment of newly diagnosed pediatric solid tumors.

BACKGROUND: The combination of carboplatin, ifosfamide, and etoposide has shown promising activity in a variety of relapsed childhood solid tumors but has not been studied in newly diagnosed patients. PURPOSE: The tolerance for and activity of escalating targeted doses of carboplatin combined with ifosfamide and etoposide (ICE) were assessed in children with advanced germ cell tumors or other rare solid tumors for which no standard therapy exists. METHODS: Fifteen children with newly diagnosed solid tumors received ICE chemotherapy. Individualized carboplatin doses were calculated to achieve a target area under the concentration x time curve (AUC) and adjusted for the glomerular filtration rate (estimated by 99mTc-labeled diethylene-triamine pentaacetic acid clearance). Cohorts of at least three patients received carboplatin at an initial target AUC of 6 mg.min/mL, with escalations of 2 mg.min/mL in subsequent cohorts. Carboplatin was given on day 1, followed by ifosfamide at 2 g/m2 per day and etoposide at 100 mg/m2 per day on days 2 through 4. All patients received at least two courses of therapy in the absence of progressive disease, and as many as eight courses could be given. RESULTS: The 15 patients received a total of 46 assessable courses of ICE. Myelosuppression was the dominant toxicity; 30 courses (67%) resulted in hospitalization for febrile neutropenia. Neutropenia was dose limiting at the carboplatin target AUC of 12 mg.min/mL. One complete and eight partial responses were seen in the 14 assessable patients; two additional patients had at least partial responses documented at surgery or autopsy. Six patients are without evidence of disease at a median of 548 days after diagnosis. CONCLUSION: ICE chemotherapy, with the carboplatin dose based on a target AUC of 10 mg.min/mL, is tolerable and has significant activity in a variety of rare malignancies, including extragonadal germ cell tumors. IMPLICATIONS: The combination of carboplatin, etoposide, and ifosfamide holds promise in the treatment of rare pediatric malignancies.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1994

Failure of granulocyte-macrophage colony-stimulating factor to reduce febrile neutropenia in children with recurrent solid tumors treated with ifosfamide, carboplatin, and etoposide chemotherapy.

Ifosfamide, carboplatin, and etoposide (ICE) chemotherapy has promising activity against various solid tumors but produces significant myelotoxicity that might be ameliorated by hematopoietic growth factors. Twelve patients with relapsed solid tumors were treated with ICE chemotherapy. Carboplatin was given on day 1 at a targeted area under the concentration-time curve (AUC) of 8 mg/mL x min (adjusted for each patient's glomerular filtration rate), followed by ifosfamide 2 g/m2 and etoposide 100 mg/m2 on days 2 through 4. Granulocyte-macrophage colony-stimulating factor (GM-CSF), 1,000 micrograms/m2/day, was started 24 hours after each course and given for 17 days or until the absolute neutrophil count (ANC) reached 10 x 10(9)/L. Myelotoxicity and responses in these patients were compared to those of eight patients who received the same therapy without GM-CSF. Patients received a median of three courses (range, 1-8). All 20 patients developed grade 4 neutropenia and grade 3 or 4 thrombocytopenia. The median duration of neutropenia was significantly shorter in patients who received GM-CSF (16.75 vs. 10 days, P = 0.005). However, the two groups did not differ in the proportion of courses associated with hospitalization for febrile neutropenia, the duration of hospitalization, or the median duration of thrombocytopenia. There were two complete, four partial, and three objective responses in the 12 patients treated with ICE plus GM-CSF, and two partial and three objective responses in the 8 patients treated with ICE only. GM-CSF did not reduce the occurrence of febrile neutropenia or the duration of thrombocytopenia associated with ICE chemotherapy. Studies of other hematopoietic growth factors in conjunction with this promising combination are merited.

Adolescent↗

PubMed1994

Pseudomonas aeruginosa bacteremia in immunocompromised children: analysis of factors associated with a poor outcome.

We identified 98 children and adolescents with cancer who were treated for Pseudomonas aeruginosa bacteremia over a 27-year period. The most common underlying disease was leukemia (lymphoblastic in 63 cases and myeloblastic in 17); in addition, 12 episodes were associated with solid tumors and 6 with other diagnoses. There were 29.5 episodes of P. aeruginosa bacteremia/1,000 cases of acute lymphoblastic leukemia, with a mortality of 27%, and 29.8 episodes/1,000 cases of acute myeloblastic leukemia, with a mortality of 24%; patients with solid tumors had an incidence of 5.0/1,000 cases and a mortality of 58% (P = .01 for mortality in leukemia vs. mortality in solid tumors, logistic regression analysis). Mortality was lower among children who developed bacteremia during remission therapy or induction therapy than among children who were being treated for relapse (P = .001). The majority (78%) of the 76 evaluated cases developed during periods when the absolute neutrophil count (ANC) was < 0.1 x 10(9)/L; mortality was higher among patients with such counts than among those with higher ANCs (36% vs. 14%, P = .04). Logistic regression analysis showed that perineal skin lesions were associated with higher mortality than were lesions at other sites of skin involvement (54% vs. 23%, P = .04).

Adolescent↗

PubMed1993

Brain metastases in osteosarcoma. Report of a long-term survivor and review of the St. Jude Children's Research Hospital experience.

BACKGROUND: Brain metastasis has been considered a rare event in osteosarcoma, although with prolonged survival an increasing incidence has been suggested. There have been no prior reports of long-term survivors among patients with this complication. METHODS: The authors describe a child treated for osteosarcoma who is alive and free of disease 8 years after the detection of brain metastases. Of 254 patients with primary osteosarcoma referred to St. Jude Children's Hospital between 1962 and 1989, 13 developed brain metastases, all after relapse or recurrence in another site. Concomitant active lung metastases were present in all of the patients except the one long-term survivor, whose pulmonary disease had responded to treatment with cisplatin and doxorubicin. Log-rank analyses were used to compare survival duration and the frequency of brain metastases among patients treated before and after 1982, when effective multiagent therapy was initiated. RESULTS: Log-rank analyses comparing patients treated before and after 1982 showed that the introduction of effective modern therapy improved survival among patients at risk for brain metastases (i.e., those with recurrent and progressive disease, P = 0.007) but was not associated with a statistically significant increase in the frequency of brain metastases (15.5% versus 4.5%, P = 0.125). CONCLUSIONS: Although the outlook for patients with this complication remains bleak, the resolution of brain metastases after eight courses of ifosfamide in the patient described in this article suggests that enrollment of selected patients in Phase II trials is merited.

Adolescent↗

PubMed1993

Phase I study of escalating targeted doses of carboplatin combined with ifosfamide and etoposide in children with relapsed solid tumors.

PURPOSE: The tolerance of escalating targeted doses of carboplatin combined with ifosfamide (IFOS)/etoposide (VP-16) (ICE) was assessed in children with recurrent solid tumors. PATIENTS AND METHODS: To reduce interpatient variability in carboplatin systemic exposure, 45 children were treated with doses individualized to a target area under the serum concentration versus time curve (AUC) based on renal function, using technetium 99-diethyl-enetriamine pentaacetic acid (99mTc-DTPA) clearance to estimate glomerular filtration rate (GFR). Cohorts of at least three patients received carboplatin at an initial target AUC of 2 mg/mL x min, with escalations of 1 mg/mL x min in subsequent cohorts. Courses consisted of carboplatin on day 1 followed by IFOS 2 g/m2 plus VP-16 100 mg/m2 on days 2 and 3. Patients received at least two courses, with a maximum of eight courses possible in the absence of progressive disease. When only moderate toxicity occurred after escalation to 5 mg/mL x min, a third dose of IFOS plus VP-16 was added. After three patients were treated at this level, carboplatin escalation proceeded. RESULTS: Neutropenia and thrombocytopenia were the dominant toxicities in the 43 assessable patients. At the target AUC of 8 mg/mL x min, 13 of 20 cycles were associated with febrile neutropenia. For phase II trials, we recommend a carboplatin target AUC of 6 mg/mL x min with three doses of IFOS and VP-16 for patients with prior craniospinal irradiation or high-dose cisplatin (CDDP)/VP-16, or 7 mg/mL x min for patients without such histories. There were two complete responses (CRs), 13 partial responses (PRs), and 17 objective responses (ORs). CONCLUSION: The ICE regimen shows promising activity in pediatric solid tumors. The clear relationship between hematologic toxicity and carboplatin systemic exposure supports the use of targeted dosing in further trials of ICE chemotherapy.

Adolescent↗

PubMed1992

Improved prognosis of children with osteosarcoma metastatic to the lung(s) at the time of diagnosis.

BACKGROUND: A poor outcome is traditionally ascribed to osteosarcoma metastatic to the lungs, but data have been unavailable regarding the outcome of such patients after systematic treatment on clinical trials. METHODS: The clinical course and outcome of 31 patients who had osteosarcoma metastatic to the lungs diagnosed between 1962 and 1990 at St. Jude Children's Research Hospital were reviewed to determine whether the use of increasingly aggressive multimodality therapy has improved their outcome. The patients were grouped by treatment eras, based on major changes in therapy (i.e., single-agent or two-agent era, 1962-1972; standard multiagent era, 1972-1982; and intensive multiagent era, 1982-1990). RESULTS: With increasingly intensive chemotherapy, more aggressive efforts to resect metastatic disease, and earlier detection of pulmonary metastases by computed tomography, the survival of these patients has improved significantly over the 28-year study period. Those treated since 1982 have a 50% estimated probability of survival at 3 years, whereas there were no survivors at 3 years in the two earlier eras. Survival for the former group reached a plateau of 30% at 4 years. CONCLUSIONS: The use of aggressive multimodality therapy, coupled with modern pediatric imaging techniques to detect pulmonary disease, has improved the traditionally dismal outlook in pediatric patients with osteosarcoma and synchronous pulmonary metastases.

Adolescent↗

PubMedDate not supplied

Prospective data on sleep complaints and associated risk factors in an older cohort.

OBJECTIVE: The purpose of this study is to provide data on the prevalence of insomnia and hypersomnia among older persons, the stability of these sleep complaints over time, and factors associated with disturbed sleep, in particular age. METHOD: Data on symptoms of insomnia and hypersomnia were examined for the 1994 to 1995 cohort of the Alameda County Study. In addition to age, the effects of gender, education, marital status, chronic medical conditions, functional impairment, life events, financial strain, and mood disturbance were examined using multiple logistic analyses. RESULTS: Prevalence in 1994 was 23.4% for insomnia and 6.8% for hypersomnia. There was moderate concordance between sleep complaints in 1994 and 1995 (kappa=.43). There was a tendency for insomnia and hypersomnia to increase with age in 1995, but not in 1994. Only gender, mood disturbance, and chronic health problems predicted insomnia. Life events, mood disturbance, and chronic conditions predicted hypersomnia. Age, net of the effects of other factors, was not associated with risk of either insomnia or hypersomnia. CONCLUSIONS: The results contribute to the expanding body of evidence concerning the important roles of psychological and somatic dysfunction in sleep disturbance. Age in and of itself is not a risk factor for insomnia or hypersomnia. That is, after adjustment for an array of putative risk factors for sleep problems, it seems the association between sleep difficulties and age is primarily due to depressed mood and physical health problems.

Age Distribution↗

PubMedDate not supplied

Analysis of paired Likert data: how to evaluate change and preference questions.

BACKGROUND AND OBJECTIVES: Likert scale data present unique analysis concerns that are often not recognized by nonstatistical researchers. Mean responses to a single question are frequently compared among two or more groups of moderate sample size using normal theory methods (t test, ANOVA). These tests are designed for continuous normally distributed data, but Likert responses are categorical, ordinal, and not normally distributed. The problems are further complicated when the paired nature of pre/post- or preference questioning is ignored. METHODS: Simulated data for a single five-point Likert scale question was used to illustrate the differing conclusions that may arise from single-question Likert scale data depending on whether pairing is modeled appropriately and which statistical procedure was applied (two sample: t test or Wilcoxon rank sum; paired samples; t test, Wilcoxon signed rank, or sign test). RESULTS: Cases are shown for which the paired responses are significantly different (indicated by the sign test), although the group mean responses to the two questions are identical (leading to nonsignificance with both paired t and signed rank tests). The sign test is shown to be appropriate and simple to apply in typical pre/post- or preference situations. CONCLUSIONS: Correctly identifying the question of interest is critical to selecting the appropriate statistical methodology.

Data Collection↗