Biomedical subjects

Thomas TenHave

Publications and source records attributed to Thomas TenHave.

4 recordsLinked to original sources

PubMed2006

Simvastatin causes changes in affective processes in elderly volunteers.

OBJECTIVES: To test for simvastatin-induced changes in affect and affective processes in elderly volunteers. DESIGN: Randomized, clinical trial. SETTING: The Geriatric Behavioral Psychopharmacology Laboratory at the University of Pennsylvania. PARTICIPANTS: Eighty older volunteers, average age 70, with high normal/mildly elevated serum cholesterol. INTERVENTION: Simvastatin up to 20 mg/d or placebo for 15 weeks. MEASUREMENTS: Daily diary records of positive and negative affects and of events and biweekly measures of depressive symptoms. Affect ratings were obtained using the Lawton positive and negative affect scales; independent raters coded the valences of events. RESULTS: Thirty-one of 39 subjects assigned to placebo and 33 of 41 receiving simvastatin completed the study. During biweekly assessments, four subjects on simvastatin and one on placebo experienced depressive symptoms, as manifest by Center for Epidemiological Studies Depression scale scores greater than 16 (exact P=.36). Diary data demonstrated significant effects on affective processes. For positive affect, there was a significant medication-by-time interaction that reflected decreases in positive affect in subjects receiving simvastatin, greatest in those patients whose final total cholesterol levels were below 148 mg/dL. For negative affect, there were significant medication-by-event, and medication-by-event-by-time interactions, reflecting a time-limited increase in the apparent effect of negative events. CONCLUSION: Simvastatin has statistically significant effects on affect and affective processes in elderly volunteers. The decrease in positive affect may be significant clinically and relevant to the quality of life of many patients.

Affect↗

PubMed2004

Predicting adherence to colonoscopy or flexible sigmoidoscopy on the basis of physician appointment-keeping behavior.

BACKGROUND: Poor patient attendance to scheduled flexible sigmoidoscopy or colonoscopy may contribute to deficient colorectal cancer screening. OBJECTIVE: To examine the association of physician appointment-keeping behavior with attendance to scheduled endoscopic studies of the colon. DESIGN: Retrospective cohort. SETTING: 23 sites performing endoscopic procedures in a health care system. PATIENTS: 11 803 patients scheduled for a first colon study with 3 or more scheduled physician visits from June 1999 through November 2001. MEASUREMENT: 2 outcomes from health system computerized records: 1) attendance at the first scheduled colon study and 2) among nonattendees, attendance at the study rescheduled within 6 months. Physician visit adherence was defined as the proportion of physician visits kept, grouped by quartile. Adjusted associations were examined in conditional logistic regression. RESULTS: Of 11 803 patients, 62% attended the first colon study. Of the 4496 nonattendees, 2739 (61%) rescheduled and, of these, 64% kept that appointment. Compared with the highest quartile of physician visit adherence (>85%), the adjusted odds ratio of attending the first colon study decreased as physician visit adherence decreased: Adjusted odds ratios were 0.94 (95% CI, 0.89 to 1.00) for 76% to 85% adherence, 0.87 (CI, 0.81 to 0.92) for 66% to 75% adherence, and 0.79 (CI, 0.73 to 0.85) for adherence of 65% or less. Among nonattendees who rescheduled, the lowest quartile of physician visit adherence (< or =65%) was the only statistically significant predictor of attending the rescheduled study (adjusted odds ratio, 0.87 [CI, 0.78 to 0.98]). LIMITATIONS: The adherence measure applies only to patients with at least 3 scheduled visits. Persons having a colon study outside of the system could have been misclassified. CONCLUSION: Physician appointment-keeping behavior predicted attendance to colorectal endoscopic studies in this cohort and may help identify persons who need interventions to promote adherence.

Aged↗

PubMed2004

Treatment effects from UPBEAT: a randomized trial of care management for behavioral health problems in hospitalized elderly patients.

The purpose of this study was to examine the impact of the Unified Psychogeriatric Biopsychosocial Evaluation and Treatment (UPBEAT) Program, an interdisciplinary mental health care management program, on the behavioral health symptoms of elderly veterans. Participants, 60 years and older, included 2637 veterans recruited from medical/surgical units who screened positively for significant depressive or anxiety symptoms and/or at-risk alcohol drinking. Participants were randomized to UPBEAT or to usual care. Primary outcomes were measured at baseline and at 6, 12, and 24 months. Participant nonadherence to the protocol was common and is a major limitation. There were no differences between UPBEAT and usual care patients on symptom or functional outcomes at any follow-up point. Exploratory analyses suggested that among participants with more physical health problems, there were greater improvements in depressive symptoms in those assigned to UPBEAT care. Despite a theoretical and practically sound intervention, participation was low and treatment outcomes, while generally good, appeared unaffected by the addition of the program.

Aged↗

PubMed2002

Association between medical comorbidity and treatment outcomes in late-life depression.

OBJECTIVES: Previous studies have demonstrated an association between major depression and physical disability in late life. The objectives of this study were to examine the relationship between specific medical illnesses and the outcomes of treatment for late-life depression. DESIGN: The study was a longitudinal assessment of medical illness, depression, and disability. Patients were assessed during an initial inpatient psychiatric hospitalization and 3 months postdischarge. SETTING: All patients were initially evaluated after admission to one of 71 inpatient psychiatric treatment facilities. PARTICIPANTS: A sample of 671 older patients who received inpatient treatment for depression was evaluated at entry into the hospital and 3 months after discharge. MEASUREMENTS: Depressive symptoms were measured using the Geriatric Depression Scale. Disability was measured using the instrumental activities of daily living scale and the Medical Outcomes Study 36-item short form. Medical illness was assessed using the medical illness checklist. RESULTS: As previously reported, physical disability and the total number of medical illnesses were significantly related to change in depressive symptoms. In this study, we find that arthritis, circulatory problems, a speech disorder, or a skin problem, but not other general medical conditions, were related to a worse outcome with respect to depression symptoms. The effect of these problems was statistically and clinically significant. After controlling for pretreatment disability, arthritis and skin problems continued to predict a worse outcome. However, the apparent effect of each of these conditions was mediated by the residual disability after treatment. CONCLUSION: The results of this study support the hypothesis that certain somatic disorders play a role in the treatment response of late-life depression and suggest that the effect of specific illnesses on depression may be mediated by the presence of functional disability.

Activities of Daily Living↗