Showing papers by "Eric C. Seaberg published in 1997"

The relationship between self-rated health and depressive symptoms in an epidemiological sample of community-dwelling older adults.

Abstract: OBJECTIVE: To confirm the association between depression and self-rated general health, independent of demographics, functional disability, physical illness burden, and health services utilization. DESIGN: Logistic regression analyses of data obtained in a cross-sectional epidemiological survey. SETTING: The mid-Monongahela Valley, a rural, nonfarm, low SES community. PARTICIPANTS: Random sample of 880 subjects aged 65 and older. MEASUREMENTS: The dependent variable was self-rated overall health, categorized as excellent, good, fair, or poor. The independent variables were demographics (age, gender, education), number of depressive symptoms, number of impaired instrumental activities of daily living (IADLs), measures of physical illness burden (individual medical conditions, number of affected organ systems or disease processes, and number of prescription medications), and measures of health services utilization (number of visits to physicians, and acute hospitalization). RESULTS: Univariate analyses indicated that poorer self-rated health was associated with lesser education, higher numbers of depressive symptoms, impaired IADLs, prescription medications, physician visits, hospitalizations, and affected organ systems, and with the presence of several specific conditions. However, multiple logistic regression analyses revealed that only the following variables were associated independently with poorer self-rated health: age less than 75 years, education less than high school graduation, greater numbers of depressive symptoms, impaired IADLs, prescription medications, and physician visits. CONCLUSIONS: Even when controlling for physical illness and functional disability, subjective rating of overall health remains strongly and independently associated with depressive symptoms.

Over-the-counter medication use in an older rural community: The MoVIES project

Abstract: OBJECTIVE: To examine the self-reported use of over-the-counter (OTC) medications and the factors associated with OTC use in a rural older population. DESIGN: A cross-sectional study of an age-stratified random community sample. SETTING: The mid-Monongahela Valley, a rural area of Southwestern Pennsylvania. PARTICIPANTS: A total of 1059 older individuals with a mean age of 74.5 (± 5.5) years, 96.9% of whom were white and 57.3% of whom were women. MEASUREMENTS: Self-reported over-the-counter drug use and demographic information, and information about prescription drug use and recent use of health services. RESULTS: The majority (87.0%) of the sample were taking at least one OTC medication; 5.7% reported taking five or more OTCs. Women took significantly more OTCs than did men (P < .001). Individuals with more education took significantly more OTCs than those who had less (P = .018). The OTC category used most commonly was analgesics (66.3% overall), followed by vitamin and mineral supplements (38.1%), antacids (27.9%), and laxatives (9.7%). The use of analgesics decreased significantly (P = .018) with increasing age, whereas the use of laxatives increased significantly (P < .001). Women were more likely than men to be using each of these four major OTC groups. Unlike the associations with prescription drug use we reported previously in the same population, there were no significant associations for overall OTC use with age or with the use of health services. However, although vitamin use (as an example of an OTC drug taken for “preventive” purposes) was not associated with health services use, the use of laxatives (as an example of a “curative” OTC) was significantly associated (P ≤ .002) with a greater number of physician visits, emergency room visits, hospitalizations during the past 6 months, home health care service utilization, and number of prescription medications. CONCLUSIONS: A substantial proportion of our older sample reported using a variety of over-the-counter drugs. Analgesics and vitamin/mineral supplements were the most frequently used categories. Women and those with more education were taking more OTC drugs. OTC use was not related to age, but the use of analgesics decreased with age while laxative use increased with age. Unlike prescription drug use, overall OTC drug use was not associated with health services utilization.

Prophylaxis of cytomegalovirus infection in liver transplantation: A randomized trial comparing a combination of ganciclovir and acyclovir to acyclovir

Abstract: Background The optimal prophylactic regimen to prevent cytomegalovirus (CMV) infection and disease in orthotopic liver-transplant patients remains to be established. We tested whether a combination of intravenous ganciclovir (GCV) followed by high dosages of oral acyclovir (ACV) for 4 months provided a higher degree of protection from CMV than oral ACV alone. Methods One hundred sixty-seven liver-transplant recipients were randomized to receive 120 days of antiviral treatment starting at the time of transplantation consisting of either ACV 800 mg orally four times daily (n=84) or 14 days of GCV 5 mg/kg intravenously every 12 hr followed by oral ACV 800 mg four times daily (n=83). Prospective laboratory and clinical surveillance was performed to determine primary endpoints (onset of CMV infection and CMV disease) and secondary endpoints (rates of fungal and bacterial infection, allograft rejection, and survival after transplantation). One-year event rates are presented as cumulative percentages. Results During the first year after transplantation, CMV infection developed in 57% of patients treated with ACV and in 37% of patients treated with GCV + ACV (P=0.001). CMV disease developed in 23% of patients treated with ACV and in 11% of patients treated with GCV + ACV (P=0.03). In seronegative recipients of allografts from CMV-seropositive donors (D+/R-), CMV disease developed in 58% of patients treated with ACV and in 25% of patients treated with GCV + ACV (P=0.04). In the D+/R- group, 54% of patients treated with ACV and 17% of patients treated with GCV + ACV developed infection with Candida albicans (P=0.05). Conclusions Prophylaxis of CMV infection in liver-transplant patients with 14 days of intravenous GCV followed by high-dosage oral ACV is more effective than high-dosage oral ACV alone at reducing CMV infection and disease, even for patients in the D+/R- CMV serological group.

Long-term patient and retransplantation-free survival by selected recipient and donor characteristics: an update from the Pitt-UNOS Liver Transplant Registry.

Abstract: Centers Between 1988 and 1996, the total number of liver transplantations performed in the United States more than doubled, and the number of centers performing liver transplantations increased from 58 to 106. The yearly net gain in number of centers has slowed substantially in recent years, and the reduced differences in volume per center reported previously has continued through 1996. Survival among pediatric recipients The estimated cumulative probability of a pediatric recipient surviving for 9 years following transplantation was .71, and surviving for 9 years without retransplantation was .58. In general, few deaths or retransplantations were observed more than 5 years following the initial transplantation. Factors independently associated with patient and retransplantation-free survival among children were year of transplantation, recipient age, location awaiting transplantation, primary liver disease, pre-LT serum creatinine, pre-LT bilirubin, and donor age. Recipient race and multiorgan transplantation were significantly associated with patient survival. Interestingly, of the 23 multi-organ recipients who survived at least 3 years, none died or required retransplantation. Survival among adult recipients The estimated cumulative probability of an adult recipient surviving for 9 years following transplantation was .55, and surviving for 9 years without retransplantation was .48. Though the one-year survival rate among adults was slightly better than among children, long-term survival was substantially worse. Factors independently associated with patient and retransplantation-free survival among adults were year of transplantation, recipient age, race, location awaiting transplantation, primary liver disease, pre-LT creatinine, pre-LT albumin, recipient HBsAg status, donor age, donor anti-CMV status, ABO match, and sex match. Pre-LT bilirubin was significantly associated with patient survival, and pre-LT prothrombin time was associated with retransplantation-free survival.

Adult Heart Transplantation Under Tacrolimus (FK506) Immunosuppression: Histopathologic Observations and Comparison to a Cyclosporine-based Regimen with Lympholytic (ATG) Induction

Abstract: Methods: We therefore reviewed 1145 endomyocardial biopsy specimens and eight autopsy results from 80 heart transplant recipients who received tacrolimus as baseline immunosuppression. These were compared with 619 endomyocardial biopsy specimens and four autopsy results from 51 patients treated with cyclosporine-based immunosuppression with lympholytic induction (eLI) by use of rabbit anti-thymocyte globulin. Twenty-one histologic features including the International Society for Heart and Lung Transplantation histopathologic grade were retrospectively assessed without knowledge of the treatment regimen. The lymphocyte growth index on biopsy specimens obtained from these patients was also compared. Results: In general, there were no qualitative differences in the histopathologic appearance of various allograft syndromes between tacrolimus- and eLI-treated patients. Thus histopathologic criteria used to diagnose various graft syndromes are applicable under tacrolimus immunosuppression. However, early (between 10 and 30 days) after transplantation, biopsy specimens from patients treated with tacrolimus showed a significantly higher percentage of inflamed fragments (p = 0.02), the