Biomedical subjects

William Gardner

Publications and source records attributed to William Gardner.

At least 19 recordsLinked to original sources

PubMed2006

The abuse-related beliefs questionnaire for survivors of childhood sexual abuse.

OBJECTIVE: To evaluate the psychometric properties of a new measure, the Abuse-Related Beliefs Questionnaire (ARBQ), designed to assess abuse-related beliefs among adult survivors of childhood sexual abuse (CSA). Study 1 examined the structure of the scale, and Study 2 evaluated its reliability and validity. METHOD: One hundred and seventy female CSA survivors recruited into a group psychotherapy intervention study were administered the ARBQ in Study 1. A subsample of 45 women completed the ARBQ again 12 months later. In Study 2, 70 women from a health maintenance organization who identified themselves as survivors of CSA completed the ARBQ along with the Trauma Symptom Checklist-40 (TSC-40) and the Symptom Checklist 90R (SCL-90-R). RESULTS: Three reliable ARBQ subscales emerged in Study 1: Guilt, Shame, and Resilience. Twelve-month test-retest reliability was high (r=.60-.64). The internal consistency of the subscales was further supported in Study 2, and validity was demonstrated by moderate to high correlations with the distress measures. CONCLUSIONS: The results indicate that the ARBQ has good psychometric characteristics, supporting the feasibility of its use in measuring abuse-related beliefs in research on survivors of CSA. A next step for validation of the ARBQ would be to evaluate its sensitivity in measuring changes in studies of interventions for treating CSA survivors.

Adolescent↗

PubMed2006

Women with antisocial behaviour: long-term health disability and help-seeking for emotional problems.

BACKGROUND: Previous studies have reported that women who display antisocial behaviour (ASB) as adults or adolescents are at increased risk of poor mental and physical health, but have not tested effects of sociodemographics, or used only incarcerated samples. AIMS: The authors sought first to test associations between ASB and emotional or physical health problems in non-incarcerated women, and second whether any such association could be explained by sociodemographic factors. METHOD: The sample was 1218 mothers, aged 22-59, of boys randomly selected from grades 1, 4 and 7 (aged about 7, 10 and 13 respectively) in US urban public schools in 1987 and 1988. The 30% of boys designated most antisocial on initial examination and a 30% random sample of the remainder entered the longitudinal study. Demographics for the mothers, data on their lifetime ASB, help-seeking for emotional and/or physical health problems were collected at interview with them. A history of adolescent conduct problems and/or lifetime police contacts led to classification as antisocial for this study. RESULTS: A total of 214 (17.6 %) of the mothers met our criteria for ASB. Compared with the women without such history, the women with ASB were younger, less well educated, of lower socioeconomic status, had a higher rate of unemployment and more of them were single mothers. They more often sought help for emotional problems and reported higher rates of long-term physical health problems, even when the effects of sociodemographic factors were taken into account. CONCLUSIONS: Although the findings rule out many sociodemographic factors as simple explanations for the association between ASB and poor emotional and physical health, more work is needed on the nature and extent of such disorder, and of temporal relationships between the key events: poor health and ASB.

Adolescent↗

PubMed2006

Adrenal androgen and gonadal hormone levels in adolescent girls with conduct disorder.

There are few data on the biological correlates of female antisocial behavior. This study compared adrenal androgen and gonadal hormone levels in adolescent girls with conduct disorder (CD) to girls without any psychiatric disorder (NC). We studied 87 girls, (47 CD; 36 NC), ages 15-17 years, obtaining three blood samples, drawn 20 min apart between 8 and 9 AM in the first 72 h of the onset of menstrual flow. Plasma was assayed for testosterone, estradiol, androstenedione, dehydroepiandrosterone (DHEA), dehydroepiandrosterone-sulfate (DHEA-S), sex hormone binding globulin (SHBG), and cortisol; area under the curve (AUC) for each of the three samples was used in the data analysis. We also calculated the Free Testosterone Index, Free Estrogen Index, Index of Hyperandrogenism and cortisol to DHEA ratio. In addition to receiving a full psychiatric interview, each girl completed a self-report questionnaire on general aggression. Main hormone analyses controlled for potentially confounding variables such as psychiatric comorbidity and race. Girls with CD had significantly lower cortisol to DHEA ratios, but did not differ from NC girls on any other hormone variable. Girls with symptoms of aggressive CD had significantly higher mean free testosterone indexes, lower SHBG levels, and lower cortisol to DHEA ratios than girls with non-aggressive CD. Girls with CD scored higher on the aggression questionnaire, but there was no association between general aggression and any hormone variable for the sample. Our data suggest that girls with CD, particularly aggressive CD, have lower cortisol to DHEA ratios, higher levels of free testosterone, and lower levels of SHBG. Clinical and research implications of these findings are discussed.

Adolescent↗

PubMed2006

Substance use and community violence: a test of the relation at the daily level.

Prior research has consistently demonstrated an association between substance use and involvement in violence among individuals with mental illness. Yet little is known about the temporal quality of this relationship, largely because longitudinal data required to address this issue are not readily available. This study examined the relationship between substance use (alcohol, marijuana, and other drug use) and violence at the daily level within a sample of mentally ill individuals at high risk for frequent involvement in violence (N = 132). Results support the serial nature of substance use and violence, with an increased likelihood of violence on days following the use of alcohol or multiple drugs, but not the inverse relationship. Implications for the utility of substance use as a risk marker for the assessment of future violence are discussed.

Adult↗

PubMed2006

Psychiatric symptoms and community violence among high-risk patients: A test of the relationship at the weekly level.

Given the availability of violence risk assessment tools, clinicians are now better able to identify high-risk patients. Once these patients have been identified, clinicians must monitor risk state and intervene when necessary to prevent harm. Clinical practice is dominated by the assumption that increases in psychiatric symptoms elevate risk of imminent violence. This intensive study of patients (N = 132) at high risk for community violence is the first to evaluate prospectively the temporal relation between symptoms and violence. Symptoms were assessed with the Brief Symptom Inventory and threat/control override (TCO) scales. Results indicate that a high-risk patient with increased anger in 1 week is significantly more likely to be involved in serious violence in the following week. This was not true of other symptom constellations (anxiety, depression, TCO) or general psychological distress. The authors found no evidence that increases in the latter symptoms during 1 week provide an independent foundation for expecting violence during the following week.

Adolescent↗

PubMed2005

Use of clay mineral (montmorillonite) for reducing poultry litter leachate toxicity (EC50).

Poultry litter (PL) has useful nutrients and is therefore used as manure. In addition to N, P and K, PL also contains some heavy metals (As, Cd, Cu, Mn, Pb and Zn), antibiotics, antioxidants, mold inhibitors and other organic compounds. Poultry litter aqueous leachate (PLL) has been shown to be toxic to many organisms; PLL is more toxic than the aqueous leachate of other animal manures used on agricultural soils. Clayey soils are known to retain toxic heavy metals. The objective of this study was to measure the change in toxicity (EC50) of PLL on the addition of clay mineral--montmorillonite. A significant reduction (124%) in toxicity of the clay poultry litter leachate (CLL) after 7 days was observed compared to the toxicity of the PLL alone after 1 day. This indicates that some of the toxic components of the litter were adsorbed by the clay.

Adsorption↗

PubMed2005

A randomized trial to improve the quality of treatment for panic and generalized anxiety disorders in primary care.

CONTEXT: Panic disorder and generalized anxiety disorder are prevalent in primary care, associated with poor functional outcomes, and are often unrecognized and ineffectively treated by primary care physicians. OBJECTIVE: To examine whether telephone-based collaborative care for panic and generalized anxiety disorders improves clinical and functional outcomes more than the usual care provided by primary care physicians. DESIGN: Randomized controlled trial. SETTING: Four Pittsburgh area primary care practices linked by a common electronic medical record system. Patients A total of 191 adults aged 18 to 64 years with panic and/or generalized anxiety disorder who were recruited from July 2000 to April 2002. Intervention Patients were randomly assigned to a telephone-based care management intervention (n = 116) or to notification alone of the anxiety disorder to patients and their physicians (usual care, n = 75). The intervention involved non-mental health professionals who provided patients with psychoeducation, assessed preferences for guideline-based care, monitored treatment responses, and informed physicians of their patients' care preferences and progress via an electronic medical record system under the direction of study investigators. MAIN OUTCOME MEASURES: Independent blinded assessments of anxiety and depressive symptoms, mental health-related quality of life, and employment status at baseline, 2-, 4-, 8-, and 12-month follow-up. RESULTS: At 12-month follow-up, intervention patients reported reduced anxiety (effect size [ES], 0.33-0.38; 95% confidence interval [CI], 0.04 to 0.67; P</=.02) and depressive symptoms (ES, 0.35; 95% CI, 0.25-0.46; P = .03); improved mental health-related quality of life (ES, 0.39; 95% CI, 0.10 to 0.68; P = .01); and larger improvements relative to baseline in hours worked per week (5.7; 95% CI, 0.1 to 11.3; P = .05) and fewer work days absent in the past month (-2.6; 95% CI, - 4.8 to -0.3; P = .03) than usual care patients. If working at baseline, more intervention patients than usual care patients remained working at 12-month follow-up (94% vs 79% [15% absolute difference, 0.7%-28.6%]; P = .04). CONCLUSIONS: Telephone-based collaborative care for panic disorder and generalized anxiety disorder is more effective than usual care at improving anxiety symptoms, health-related quality of life, and work-related outcomes.

Adult↗

PubMed2005

Gender and risk assessment accuracy: underestimating women's violence potential.

Understanding factors that contribute to mental health professionals' (MHPs') accuracy in assessing patients risk of violence can inform efforts to improve accuracy and to integrate risk assessment technology with practice. Based on a sample of 147 clinicians who assessed 680 patients in a psychiatric emergency room, this study investigates the influence of patient gender, MHP gender, and their potential interaction on MHPS' risk assessment accuracy. The results indicate that MHPs of both genders are particularly limited in their ability to assess female patients' risk of future violence. This finding was not limited to a particular professional group and was not attributable to gender-related differences in violence. Implications for future research on the judgment processes that may underlie MHPs' limited accuracy with women and for training programs in violence risk assessment are discussed.

Adult↗

PubMed2005

Authors' reports about research integrity problems in clinical trials.

BACKGROUND: There is little information about the prevalence of research integrity problems in the scientific literature. We sought to determine how frequently authors of published pharmaceutical clinical trials reported fabrication of data or misrepresentation of research. METHODS: We conducted a mail survey of 549 authors who had published reports of pharmaceutical clinical trials from 1998 to 2001 that appeared in the Cochrane Database of Systematic Reviews. We asked authors about fabricated data or misrepresentations of research in three contexts: the target study (the report from which their name was obtained), another study they had participated in, or a study that they personally knew about. RESULTS: We received replies from 64% of authors with valid addresses. Two authors (1%) reported that the target article misrepresented the research. Almost 5% reported fabrication or misrepresentation in a study they had participated in the last 10 years, and 17% of authors personally know about a case of fabrication or misrepresentation in the last 10 years from a source other than published accounts of research misconduct. CONCLUSIONS: Fraud and misrepresentation in clinical trials appear to be rare on a per-published report basis. However, they occur sufficiently frequently that scientists have a significant chance of participating in a project affected by fraud or misrepresentation during their research careers. These rates of exposure justify vigorous efforts to prevent research misconduct.

Adult↗

PubMed2005

What do clinicians expect? Comparing envisioned and reported violence for male and female patients.

Mental health professionals' (MHPs') accuracy in assessing the risk of violence in female patients is particularly limited. Based on assessments made by 205 MHPs of 605 patients in an emergency room, this study explored potential causes of MHPs' poorer accuracy in assessing women's potential for violence. The dimensions that underlie MHPs' envisioned violence in patients were identified and were compared with those that characterized patients' reported violence during a 6-month follow-up period. There were three key findings from their study. First, violence envisioned by MHPs differed depending on their professional role and varied in its congruence with patients' reported violence. Second, patients' violence was organized by dimensions of domesticity and substance relatedness; women's violent incidents were more domestic than were men's. Third, when MHPs envisioned violence that was highly conditional on psychiatric deterioration and medication noncompliance, violence often did not occur.

Adult↗

PubMed2005

A prediction rule to identify low-risk patients with heart failure.

OBJECTIVES: To derive a prediction rule using data available in the emergency department (ED) to identify a group of patients hospitalized for the treatment of heart failure who are at low risk of death and serious complications. METHODS: The authors analyzed data for all 33,533 patients with a primary hospital discharge diagnosis of heart failure in 1999 who were admitted from EDs in Pennsylvania. Candidate predictors were demographic and medical history variables and the most abnormal examination or diagnostic test values measured in the ED (vital signs only) or on the first day of hospitalization. The authors constructed classification trees to identify a subgroup of patients with an observed rate of death or serious medical complications before discharge < 2%; the tree that identified the subgroup with the lowest rate of this outcome and an inpatient mortality rate < 1% was chosen. RESULTS: Within the entire cohort, 4.5% of patients died and 6.8% survived to hospital discharge after experiencing a serious medical complication. The prediction rule used 21 prognostic factors to classify 17.2% of patients as low risk; 19 (0.3%) died and 59 (1.0%) survived to hospital discharge after experiencing a serious medical complication. CONCLUSIONS: This clinical prediction rule identified a group of patients hospitalized from the ED for the treatment of heart failure who were at low risk of adverse inpatient outcomes. Model performance needs to be examined in a cohort of patients with an ED diagnosis of heart failure and treated as outpatients or hospitalized.

Aged↗

PubMed2004

Computerized adaptive measurement of depression: a simulation study.

BACKGROUND: Efficient, accurate instruments for measuring depression are increasingly important in clinical practice. We developed a computerized adaptive version of the Beck Depression Inventory (BDI). We examined its efficiency and its usefulness in identifying Major Depressive Episodes (MDE) and in measuring depression severity. METHODS: Subjects were 744 participants in research studies in which each subject completed both the BDI and the SCID. In addition, 285 patients completed the Hamilton Depression Rating Scale. RESULTS: The adaptive BDI had an AUC as an indicator of a SCID diagnosis of MDE of 88%, equivalent to the full BDI. The adaptive BDI asked fewer questions than the full BDI (5.6 versus 21 items). The adaptive latent depression score correlated r =.92 with the BDI total score and the latent depression score correlated more highly with the Hamilton (r =.74) than the BDI total score did (r =.70). CONCLUSIONS: Adaptive testing for depression may provide greatly increased efficiency without loss of accuracy in identifying MDE or in measuring depression severity.

Adult↗

PubMed2004

Follow-up care of children identified with ADHD by primary care clinicians: A prospective cohort study.

OBJECTIVE: To document follow-up care received by children identified with attention deficit hyperactivity disorder (ADHD) by primary care clinicians (PCCs). STUDY DESIGN: We surveyed families of children 4 to 15 years of age who had been diagnosed with ADHD. At an index office visit, parents and clinicians completed questionnaires. Six months after the index visit, parents completed a questionnaire (N = 659 returned surveys, 68% return rate). The main outcome measure was the number of visits with the patients' PCCs or mental health specialists during the 6 months after the index visit. RESULTS: Children had a median of one visit PCC over a period of 6 months. Children who had prescriptions for psychotropic medications (78%) did not differ from others in the number of visits. Follow-up visits with the child's own doctor were more common when the PCC had completed mental health training. Only 26% of patients saw a mental health specialist. Children who were black, on Medicaid, or with higher levels of internalizing symptoms were more likely to see a mental health specialist. CONCLUSIONS: Children treated for ADHD need more follow-up visits to permit adjustment of medication and support continuation of patients in treatment. Systematic quality improvement efforts are warranted.

Adolescent↗

PubMed2003

Neurobehavioral disinhibition in childhood predicts early age at onset of substance use disorder.

OBJECTIVE: This longitudinal study had three aims: 1) determine the extent to which boys at high average risk and low average risk for substance use disorder differ on a construct of neurobehavioral disinhibition, 2) evaluate the capacity of neurobehavioral disinhibition to predict substance use frequency at age 16, and 3) demonstrate the utility of neurobehavioral disinhibition in predicting substance use disorder. METHOD: The authors derived an index of neurobehavioral disinhibition from measures of affect, behavior, and cognition. The neurobehavioral disinhibition score was used to discriminate youth at high and low average risk for substance use disorder and to predict substance use frequency after 4-6 years and substance use disorder after 7-9 years. RESULTS: The neurobehavioral disorder score significantly discriminated boys at high average risk from those at low average risk at ages 10-12. Neurobehavioral disinhibition at age 16, in conjunction with substance use frequency and risk status group, predicted substance use disorder at age 19 with 85% accuracy and accounted for 50% of the variance in Drug Use Screening Inventory overall problem density score. Neurobehavioral disinhibition was a stronger predictor of substance use disorder (odds ratio=6.83) than substance consumption frequency (odds ratio=3.19). CONCLUSIONS: Cross-sectional and longitudinal analyses indicated that neurobehavioral disinhibition is a component of the liability to early age at onset of substance use disorder.

Adolescent↗

PubMed2002

Child sex differences in primary care clinicians' mental health care of children and adolescents.

BACKGROUND: Sex differences in the medical and mental health care of adults are well established. OBJECTIVE: To study the effect of child patient's sex on whether primary care clinicians (PCCs), including pediatricians, family physicians, and nurse practitioners, found or treated mental health problems in primary care settings. DESIGN: The data were collected by clinicians and parents from 21 065 individual child visits (50.3% girls) in 204 primary care practices. METHODS: Each PCC enrolled a consecutive sample of approximately 55 children and adolescents aged 4 to 15 years. Parents filled out questionnaires, including the Pediatric Symptom Checklist, before seeing the clinician. Clinicians completed a survey after the visit about the psychosocial problems and recommended treatments, but they did not see the results of the Pediatric Symptom Checklist or any other data collected from the parents. RESULTS: Boys were more likely to be seen for a mental health-related visit and by a clinician who identified them as "my patient." Boys with parent-reported symptom profiles that were similar to those of girls were more likely to be identified as having attention-deficit/hyperactivity problems or behavior or conduct problems and less likely to be identified as having internalizing problems. Adjusting for parent-reported symptoms, PCCs were more likely to prescribe medications for boys. Child sex differences in referrals to mental health specialists and the provision of counseling to families were not statistically significant. CONCLUSION: There are substantial sex differences in the mental health care of children in the primary care system.

Adolescent↗

PubMed2002

Increased IgG 3:4 ratios in adolescent antisocial females: evidence of Th1/Th2 imbalance?

Female antisocial behavior in adolescence and late childhood has been associated with low basal cortisol levels. Because low cortisol has also been correlated with T helper cell Type 1 (Th1) predominance and suppression of T helper cell Type 2 (Th2), we investigated whether adolescent antisocial girls demonstrated this immunologic profile. Using plasma levels of IgG3 and IgG4 as markers for Th1 and Th2 activity, we studied IgG 3:4 ratios in 16-year-old girls with conduct disorder (CD) (n=42) or no psychiatric disorder (normal controls (NC)) (n=35). The mean IgG 3:4 ratio was higher in the CD group; this relationship remained significant after controlling for the effects of other variables. These data indicate that immunologic abnormalities are present in adolescent antisocial girls. Future studies should measure cytokine levels and investigate the clinical implications of these findings.

Adolescent↗

PubMed2002

Recurrent pain, emotional distress, and health service use in childhood.

OBJECTIVES: To determine the psychosocial correlates of recurrent pediatric pain and its relationship to health service use and medical presentations for "unexplained" symptoms in primary care. STUDY DESIGN: Children 4 to 15 years of age who complained frequently of aches and pains to parents were compared with those with infrequent or no pain on measures of demographics, psychopathology, school attendance and performance, perceived health, and service use. Univariate analysis was followed by logistic regression. RESULTS: Children who complained often of aches and pains used more health services, had more psychosocial problems, missed more school, and did worse academically. After controlling for health service use and demographics, recurrent pain was significantly associated with negative parental perceptions of child health and the presence of internalizing psychiatric symptoms. Higher levels of ambulatory health service use were associated with negative perceptions of child health, recurrent pain, visits for "unexplained" symptoms, and internalizing psychiatric symptoms. CONCLUSIONS: Pediatric recurrent pain challenges traditional service delivery models characterized by segregated systems of care for physical and mental disorders. Longitudinal and psychobiological studies of the relationship between recurrent pain, internalizing psychopathology, and health beliefs are warranted to direct future treatment efforts.

Adolescent↗

PubMed2002

Multidimensional adaptive testing for mental health problems in primary care.

OBJECTIVES: Efficient and accurate instruments for assessing child psychopathology are increasingly important in clinical practice and research. For example, screening in primary care settings can identify children and adolescents with disorders that may otherwise go undetected. However, primary care offices are notorious for the brevity of visits and screening must not burden patients or staff with long questionnaires. One solution is to shorten assessment instruments, but dropping questions typically makes an instrument less accurate. An alternative is adaptive testing, in which a computer selects the items to be asked of a patient based on the patient's previous responses. This research used a simulation to test a child mental health screen based on this technology. RESEARCH DESIGN: Using half of a large sample of data, a computerized version was developed of the Pediatric Symptom Checklist (PSC), a parental-report psychosocial problem screen. With the unused data, a simulation was conducted to determine whether the Adaptive PSC can reproduce the results of the full PSC with greater efficiency. SUBJECTS: PSCs were completed by parents on 21,150 children seen in a national sample of primary care practices. RESULTS: Four latent psychosocial problem dimensions were identified through factor analysis: internalizing problems, externalizing problems, attention problems, and school problems. A simulated adaptive test measuring these traits asked an average of 11.6 questions per patient, and asked five or fewer questions for 49% of the sample. There was high agreement between the adaptive test and the full (35-item) PSC: only 1.3% of screening decisions were discordant (kappa = 0.93). This agreement was higher than that obtained using a comparable length (12-item) short-form PSC (3.2% of decisions discordant; kappa = 0.84). CONCLUSIONS: Multidimensional adaptive testing may be an accurate and efficient technology for screening for mental health problems in primary care settings.

Adolescent↗