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Biomedical subjects

S M Berman

Publications and source records attributed to S M Berman.

At least 19 recordsLinked to original sources
PubMed2005

Supraphysiological doses of levothyroxine alter regional cerebral metabolism and improve mood in bipolar depression.

Supplementation of standard treatment with high-dose levothyroxine (L-T(4)) is a novel approach for treatment-refractory bipolar disorders. This study tested for effects on brain function associated with mood alterations in bipolar depressed patients receiving high-dose L-T(4) treatment adjunctive to ongoing medication (antidepressants and mood stabilizers). Regional activity and whole-brain analyses were assessed with positron emission tomography and [(18)F]fluorodeoxyglucose in 10 euthyroid depressed women with bipolar disorder, before and after 7 weeks of open-label adjunctive treatment with supraphysiological doses of L-T(4) (mean dose 320 microg/day). Corresponding measurements were acquired in an age-matched comparison group of 10 healthy women without L-T(4) treatment. The primary biological measures were relative regional activity (with relative brain radioactivity taken as a surrogate index of glucose metabolism) in preselected brain regions and neuroendocrine markers of thyroid function. Treatment-associated changes in regional activity (relative to global activity) were tested against clinical response. Before L-T(4) treatment, the patients exhibited significantly higher activity in the right subgenual cingulate cortex, left thalamus, medial temporal lobe (right amygdala, right hippocampus), right ventral striatum, and cerebellar vermis; and had lower relative activity in the middle frontal gyri bilaterally. Significant behavioral and cerebral metabolic effects accompanied changes in thyroid hormone status. L-T(4) improved mood (remission in seven patients; partial response in three); and decreased relative activity in the right subgenual cingulate cortex, left thalamus, right amygdala, right hippocampus, right dorsal and ventral striatum, and cerebellar vermis. The decrease in relative activity of the left thalamus, left amygdala, left hippocampus, and left ventral striatum was significantly correlated with reduction in depression scores. Results of the whole-brain analyses were generally consistent with the volume of interest results. We conclude that bipolar depressed patients have abnormal function in prefrontal and limbic brain areas. L-T(4) may improve mood by affecting circuits involving these areas, which have been previously implicated in affective disorders.

Adult↗
PubMed2000

Impact of switching laboratory tests on reported trends in Chlamydia trachomatis infections.

Improvements in the sensitivity and specificity of laboratory testing methods for Chlamydia trachomatis infections in recent years have created potential problems with interpreting data on chlamydia prevalence trends. A switch to a more sensitive test can result in an increase in chlamydia positivity even with no increase in the true disease prevalence. To examine the impact of switching laboratory testing methods on chlamydia positivity trends among women, the authors analyzed data from chlamydia screening programs in family planning clinics in two geographic areas of the United States. Data from 7,287 tests performed in Philadelphia, Pennsylvania, indicated a 46% increase in positivity (from 4.1% to 6.0%) when the clinics switched from a nucleic acid probe assay to a ligase chain reaction test. Data from 35,306 tests performed in Oregon and Washington State laboratories showed a 21% increase in positivity (from 3.3% to 4.0%) when clinics switched from a direct immunofluorescent antibody testing procedure to an enzyme immunoassay with negative gray zone confirmation. These increases were within ranges consistent with the variability of the testing methods and occurred primarily in asymptomatic women and in women over age 20 years. Any switch in laboratory testing methods must be considered when interpreting data on chlamydial infection trends.

Adult↗
PubMed2000

A stochastic-covariate failure model with an application to case-control analysis.

A stochastic process X(t) is periodically stationary (and ergodic) if, for every k> or =1 and every (t(1),ellipsis,t(k)) in R(k), the sequence of random vectors (X(t(1)+n),ellipsis,X(t(k)+n))n=0,+1, ellipsis, is stationary (and ergodic). For such an ergodic process, let T be a positive random variable defined on the sample space of the process, representing a time of failure. The local failure-rate function is assumed to be of the form up(x),-infinity 0 is a small number, tending to 0; and, for each u,T=T(u) is the corresponding failure-time. It is shown that X(T(u)) and uT(u) have, for u-->0, a limiting joint distribution and are, in fact, asymptotically independent. The marginal distributions are explicitly given. Let Y be a random variable whose distribution is the limit of that of X(T(u)). Under the hypothesis that p(x) is unknown or of known functional form but with unknown parameters, it is shown how p(x) can be estimated on the basis of independent copies of the random variable Y. The results are applied to the analysis of a case-control study featuring a 'marker' process X(t) and an 'event-time' T. The event in the study is considered to be particularly rare, and this is reflected in the assumption u-->0. The control-distribution is identified with the average marginal distribution of the (periodically stationary) marker process X(t), and the case-distribution is identified with that of Y. The particular application is a biomedical trial to determine the risk of stroke in terms of the level of an anticoagulant in the blood of the patient.

Anticoagulants↗
PubMed2000

Gonorrhea in male adolescents and young adults in Newark, New Jersey: implications of risk factors and patient preferences for prevention strategies.

BACKGROUND: Although the national rate of gonorrhea declined 68% from 1975 to 1995, rates remain high in many inner-city areas. In 1995, the gonorrhea rate in Newark, NJ, was five times the US rate. OBJECTIVE: To determine factors associated with acquisition of gonorrhea by men in Newark. STUDY DESIGN: A case-control study conducted at the sexually transmitted disease (STD) clinic in Newark, comparing males 15 to 29 years with culture-confirmed gonorrhea to controls with no STD. RESULTS: Compared with controls, males with gonorrhea more frequently reported at least 1 casual sex partner within the preceding month (adjusted odds ratio [OR], 3.2; 95% CI, 1.8-5.7), sex after using marijuana during the preceding month (OR, 2.4; 95% CI, 1.1-5.3), and a history of incarceration (OR, 2.1; 95% CI, 1.2-3.7). Of males with casual partners, having a new casual sexual relationship (onset within the past month) was particularly risky for gonorrhea (OR, 3.9; 95% CI, 1.2-12.7). Incorrect condom use was highly prevalent for both cases and controls. Many persons with gonorrhea reported that they were not willing to consistently use condoms or to have only one partner. CONCLUSIONS: Sex with casual partners is associated with gonorrhea in males, and may be a difficult practice to change. Condoms are often used incorrectly, if at all, in this population. Prevention strategies, in addition to the promotion of condom use and monogamy, may be necessary.

Adolescent↗
PubMed1999

Adherence of human immunodeficiency virus-infected patients to antiretroviral therapy.

The impact of demographic, psychosocial, and medical regimen-related variables on adherence of 123 human immunodeficiency virus (HIV)-infected patients to antiretroviral therapy was assessed by means of refill methodology. Satisfaction with social support (P = .029), problem-focused coping (P = .027), and active-behavioral coping (P = .011) correlated significantly with adherence, whereas loss of motivation (P = .006), hopelessness (P = .16), and avoidant coping (p = .015) correlated with nonadherence. At the 6-month follow-up, the mean CD4 cell count differed significantly among adherent versus nonadherent patients (a mean increase of 78/mm3 vs. a mean decrease of 5/mm3; P = .018). Adherence did not correlate with the number of antiretroviral medications consumed per day (mean, 3.0 vs. 2.5). Non-Caucasian patients were more likely to be nonadherent than Caucasian patients (relative risk, 2.5; 95% confidence interval, 1.2-5.3; P = .013); this difference was not explained by age, education, employment, income, history of intravenous drug use, or medical regimen. Non-Caucasian patients, however, were less satisfied with their social support (P = .04) and informational support (P = .016) and were more likely to utilize emotion-focused coping (P = .01). Thus, satisfaction with social support and coping style significantly impacted adherence and likely accounted for the observed racial difference in adherence among HIV-infected patients.

Adaptation, Psychological↗
PubMed1999

Patterns of recurrence and outcome for patients with clinical stage II non-small-cell lung cancer.

Forty-six patients with pathologic clinical stage II non-small-cell lung carcinoma underwent resection with or without adjuvant radiotherapy from 1989 through 1994. These patients were analyzed to determine patterns of recurrence and survival. Surgery consisted of pneumonectomy for 11 patients, bilobectomy for two patients, lobectomy for 29 patients, and wedge or segmental resection for four patients. Adjuvant radiotherapy was delivered to 29 patients, and the median total dose was 54 Gy (range, 44-60 Gy). Median follow-up time was 23 months for all patients and 25 months for surviving patients. Twenty-six of 46 patients have had recurrence. The site of first recurrence was locoregional for 9 of 46 patients (20%) and distant for 17 of 46 patients (37%). The median time to locoregional recurrence was 18 months for patients treated with radiotherapy and 13 months for patients treated without radiotherapy. An isolated locoregional recurrence (with no simultaneous distant recurrence) was seen in 2 of 28 evaluable patients (7%) treated with radiotherapy compared with 3 of 17 patients (18%) not treated with radiotherapy. For all patients, the 3-year disease-free survival rate was 52%, and the overall survival rate was 52%. Among patients treated with radiotherapy, the 3-year disease-free survival and overall survival rates were 56% and 56%, respectively, compared with 46% and 43%, respectively, for patients who did not receive radiotherapy (p values were not significant). The locoregional recurrence rate was 33% for patients with adenocarcinoma and 15% for those with squamous cell carcinoma. The distant recurrence rates by histologic characteristic were 56% and 20%, respectively. For patients with clinical stage II non-small-cell lung cancer, postoperative radiotherapy appears to improve locoregional control. However, the preponderance of recurrences remains distant. Further study is warranted with special emphasis on control of systemic disease.

Adult↗
PubMed1999

An epidemic of congenital syphilis in Jefferson County, Texas, 1994-1995: inadequate prenatal syphilis testing after an outbreak in adults.

OBJECTIVES: After a syphilis epidemic in Jefferson County, Texas, in 1993 and 1994, congenital syphilis prevalence and risk factors were determined and local prenatal syphilis screening practices were assessed. METHODS: Medical records were reviewed, pregnant women with syphilis were interviewed, and prenatal care providers were surveyed. RESULTS: Of 91 women, 59 (65%) had infants with congenital syphilis. Among African Americans, the prevalence per 1000 live births was 24.1 in 1994 and 17.9 in 1995. Of the 50 women with at least 2 prenatal care visits who had infants with congenital syphilis, 15 (30%) had received inadequate testing. Only 16% of 31 providers obtained an early third-trimester syphilis test on all patients. CONCLUSIONS: Inadequate prenatal testing contributed to this outbreak of congenital syphilis.

Adolescent↗
PubMed1998

Total parenteral nutrition via multilumen catheters does not increase the risk of catheter-related sepsis: a randomized, prospective study.

The purpose of this study was to determine in a randomized, prospective manner whether administration of total parenteral nutrition (TPN) via multilumen catheters increases the risk of catheter-related sepsis (CRS). All patients receiving hyperalimentation during a 24-month period were randomized to receive either a double-lumen catheter (DLC) or a triple-lumen catheter (TLC). A total of 101 catheters were placed in 79 patients, of which 49 were DLCs and 52 were TLCs. The patients with DLCs received a total of 784 days of TPN, whereas patients with TLCs received a total of 754 days of TPN. CRS was associated with one (2.0%) of the 49 DLCs vs. one (1.9%) of the 52 TLCs. In comparison, the rate of CRS associated with single-lumen catheters (historical control) at our institution was 1.4% (P > .90). We conclude that the use of multilumen catheters in TPN therapy does not result in an increased risk of CRS.

Catheterization, Central Venous↗
PubMed1997

The D2 dopamine receptor (DRD2) gene and family stress; interactive effects on cognitive functions in children.

TaqI A D2 dopamine receptor (DRD2) alleles, family stress, and cognitive markers, including visuospatial ability (Benton's Line Orientation) and event-related potentials (P300 amplitude and latency), were obtained in preadolescent boys of alcoholic and nonalcoholic fathers. In the presence of the DRD2 minor allele (A1+), the Family Stress score negatively correlated with the Line Orientation score and P300 amplitude. No significant correlations were found in boys lacking this allele (A1-). The interaction of the A1+ allele and the Family Stress score produced significant regression coefficients for both Line Orientation score (p = .002) and P300 amplitude (p = .04). Together, these two cognitive markers account for 37% of the variance in the Family Stress score of 47 A1 allele boys (p = .0002) but less than 1% in 71 A1- allele boys (p > .9). This provides the first evidence of a specific gene-environment interaction involving human cognitive functioning.

Adolescent↗
PubMed1997

Trends in the prevalence of chlamydial infections. The impact of community-wide testing.

BACKGROUND: Evaluation of existing testing programs should guide the national effort to expand programs for the prevention of chlamydial infections. The Columbus (Ohio) Health Department instituted community-wide testing for Chlamydia trachomatis in 1988. GOALS: To assess trends in the prevalence of chlamydial infection, the coverage of screening, and concurrent trends in the prevalence of gonorrhea. STUDY DESIGN: This was a cross-sectional study of women 15 to 44 years of age tested for C. trachomatis at over 50 provider sites in Columbus, Ohio, from 1989 to 1992. RESULTS: The prevalence of chlamydial infection among all women tested decreased by 33% from 1989 to 1992. Prevalence decreased least (19%) among black women 15 to 19 years of age, the group with the highest initial prevalence (20.2%), even though 42% of this population in the city was tested. Prevalence did not decrease at all among prenatal patients 15 to 19 years of age. For women tested for both gonorrhea and chlamydia, gonorrhea decreased by 39% during the 4-year period. CONCLUSIONS: Screening appeared to have limited effect on the prevalence of chlamydial infection for groups with highest initial prevalence, despite the relatively high percentage of the population tested. Expanding screening programs to include men and instituting behavioral interventions may be necessary to reduce more rapidly the prevalence of chlamydia among these women.

Adolescent↗
PubMed1997

Screening women for gonorrhea: demographic screening criteria for general clinical use.

OBJECTIVES: The purpose of this analysis was to derive potential gonorrhea screening criteria for women. METHODS: Data corresponding to 44,366 gonorrhea cultures from women 15 through 44 years of age in Columbus, Ohio, were analyzed. RESULTS: Characteristics that were associated with gonococcal infection and were suitable for screening decisions included patient's age and marital status and previous prevalence of gonorrhea at provider site. Probabilities of infection ranged from .001 for married women 25 through 44 years of age at low-prevalence provider sites to .078 for unmarried women 15 through 19 years of age at high-prevalence sites. CONCLUSIONS: Patient's age and marital status and prevalence of gonorrhea at provider site can be used as indicators to ensure testing of high-prevalence groups.

Adolescent↗
PubMed1995

Reduced visuospatial performance in children with the D2 dopamine receptor A1 allele.

Previous studies suggest a reduced dopaminergic function in subjects with the A1 (minor) allele of the D2 dopamine receptor (DRD2) gene. To explore influences on visuospatial ability as a function of the DRD2 gene, 182 alcohol- and other drug-naive sons (age 10-14) of active alcoholic, recovered alcoholic, and nonalcoholic fathers were administered a visuospatial task (Benton's Judgment of Line Orientation Test) which makes minimal motoric/verbal demands. Visuospatial scores were lower for boys with the A1 allele and for sons of active alcoholics. A1-allele boys made more errors than A2 boys on all 11 of the template lines, with the effect being largest for the rightmost presentations. In contrast, the effect of family history for alcoholism was strongest on both right and left midquadrant presentations. Moreover, separate analyses of the two types of errors produced allele but not family history of alcoholism effects when the two lines were misjudged as farther apart than they actually were and family history but not allele effects where the two lines were misjudged as closer together. These results suggest that polymorphism of the DRD2 gene and family history of alcoholism are dissociable determinants of visuospatial ability and that visuospatial defects previously observed in alcoholics may, in part, be antecedent to their drinking behavior.

Adolescent↗
PubMed1995

Defense mechanisms and personality disorders: an empirical test of Millon's theory.

The purpose of this study was to investigate Millon's hypothesized relationships between particular personality disorders and specific defense mechanisms. One hundred thirty psychiatric inpatients and outpatients, all diagnosed with an Axis II personality disorder, completed the Millon Clinical Multiaxial Inventory-II (MCMI-II; Millon, 1987) and the Defense Mechanism Inventory (DMI; Ihilevich & Gleser, 1986). Analyses revealed strong corroborating evidence for a number of the hypothesized relationships, including significant correlations between antisocial traits and acting out, obsessive-compulsive traits and reaction formation, paranoid traits and projection, passive-aggressive traits and displacement, and self-defeating traits and devaluation. There was also a trend suggesting the presence of a relationship between dependent personality traits and introjection. A factor analysis was also performed that suggested that method variance may be responsible for either lowered correlations between the MCMI-II and DMI or lack of significance for some predicted relationships. Results are discussed in terms of existing theory and research, and implications for treatment and future research are briefly addressed.

Adult↗