Susan Levenstein - Academia.edu (original) (raw)

Papers by Susan Levenstein

Digestive Diseases, 1993

Duodenal ulcer disease is a heterogenous condition characterized by episodes of recurrence and re... more Duodenal ulcer disease is a heterogenous condition characterized by episodes of recurrence and remission. Recurrences are often painful and may result in gross duodenal scarring and pyloric stenosis; bleeding and perforation can complicate the disease, requiring operative treatment and increasing mortality. Treatment should therefore maintain remission after ulcer healing, prevent possibly lethal complications, be safe and maintain efficacy over time. Maintenance treatment with H2 receptor antagonists reduces the rate of symptomatic relapse, but there is no evidence that it affects the complication rate. Tolerance develops in a subgroup of patients and seems to contribute to their poor response to long-term H2 antagonist therapy. It seems wise to prescribe maintenance treatment for 3 years following initial healing in patients with severe relapsing disease, or smokers with recurrent symptoms, and to continue it for life in selected individuals at increased risk of acute complications or of complication-related mortality.

Journal of Applied Developmental Psychology, 1998

National Centerfoir Mother-Child Home Program High school graduation is a major long-term goal of... more National Centerfoir Mother-Child Home Program High school graduation is a major long-term goal of cognitive programs for preschoolers at risk for educational disadvantage. One hundred twenty-three young adults who had been in five yearly cohorts of at-risk toddlers eligible for a replication of the Mother-Child Home Program, a play-filled and non-didactic home-based intervention promoting parent-toddler verbal interaction, were studied 16 to 20 years later for their high school performance. Subjects who had completed this program replication, the Pittsfield Parent-Child Home Program, as toddlers were significantly less likely than randomized controls to drop out of school (15.7% vs. 40.0%, p = 0.03). and more likely to have graduated (84.1% vs. 53.9% , p = 0.01). On an intention-to-treat basis, 76.9% of all subjects who enrolled in the program and 53.9% of controls graduated from high school @ = 0.07). With adjustment for baseline IQ scores the advantage of program subjects persisted (multivariate Odds Ratio 2.12, p = 0.28). The dropout rate of program enrollees was lower than the mean for all Pittsfield students, while program completers matched the national graduation rate for middle-income studentsThe results of this exploratory study suggest that long-term improvement in academic performance may be achieved by using the Mother-Child Home Program's approach; indicate the exportability of this program; and appear to justify further controlled long-term studies of the program.

Epidemiologia & Prevenzione, Jul 1, 2021

European Journal of Gastroenterology & Hepatology, Dec 1, 2004

ABSTRACT A subset of patients with inflammatory bowel disease have markedly impaired quality of l... more ABSTRACT A subset of patients with inflammatory bowel disease have markedly impaired quality of life. In this issue, Mussell et al. report that patients' self-rated health status and disease-related concerns were determined at least as strongly by their habitual use of depressive coping patterns as by their disease activity. Although past disease severity may have confounded these results, the finding that quality of life is better for patients armed with a positive approach to problem-handling suggests that psychologically oriented interventions could have far-reaching benefits for selected patients. Since evidence is accumulating that stress and distress can worsen tissue inflammation and clinical course in animal models and in clinical populations with inflammatory bowel disease, we may dare to hope that interventions aimed at improving patients' stress tolerance, depressive symptoms, and coping capacities might not only improve perceived quality of life but could potentially decrease bowel inflammation and reduce some patients' need for toxic medications or surgery. Designing, applying, and evaluating such interventions should be a major item on the agenda of psychosomatic medicine in gastroenterology, and biological reductionism should be replaced by the biopsychosocial model.

Journal of Clinical Gastroenterology, Sep 1, 1995

Psychosomatic Medicine, Mar 1, 2000

The American journal of gastroenterology, 1995

It is not known whether any link exists between life stress and disease activity in ulcerative co... more It is not known whether any link exists between life stress and disease activity in ulcerative colitis; attempts to demonstrate one have been complicated by recall bias, distressing psychological consequences of disease, psychogenic symptom exaggeration, and an irritable bowel component of inflammatory bowel disease symptoms. We therefore studied the relationship between psychological measures and two different aspects of ulcerative colitis activity. The relation of perceived stress, depression, state anxiety, trait anxiety, and life events with endoscopic appearance of the rectal mucosa was studied "blind" in 46 asymptomatic outpatients with known ulcerative colitis. The same measures were then examined in relation to subjective activity, comparing the group in clinical remission with 32 ulcerative colitis outpatients who reported symptoms. Among asymptomatic patients, the level of stress over the past 2 yr on the General Perceived Stress Questionnaire was higher in the 11 with mucosal abnormalities than in the 35 with a normal rectal mucosa (p = 0.004). Among the entire population, symptomatic patients were more likely to recall major life events in the previous 6 months than the asymptomatic group (p = .02). Adjustment for smoking and for duration of remission did not substantially alter these findings. Life stress is associated with both objective and subjective aspects of activity in ulcerative colitis. Although the association of life events with reported symptoms may be subject to recall bias, the association of perceived stress with rectal mucosal abnormalities in asymptomatic patients is strongly suggestive of a true link between psychological factors and ulcerative colitis activity.

BMJ, Sep 22, 2009

ABSTRACT -

Journal of Consulting and Clinical Psychology, 2002

Over the past decade, while gastroenterologists' interest in mind-body interactions in organic di... more Over the past decade, while gastroenterologists' interest in mind-body interactions in organic disorders dwindled, stronger evidence has linked psychosocial factors with the incidence and recurrence of peptic ulcer and with the course of inflammatory bowel disease. Psychological-behavioral approaches to treatment continue to be disappointing. Psychosocial factors may affect ulcer by increasing duodenal acid load, altering local circulation or motility, intensifying Helicobacter pylori infection, stimulating corticosteroid secretion, and affecting health risk behaviors; possible mechanisms for inflammatory bowel disease include immune deregulation, gut permeability changes, and poor medication adherence. Both belong to the growing category of diseases thought to have an infectious component: for peptic ulcer the bacterium Helicobacter pylori, for inflammatory bowel disease an exaggerated immune response to gut bacteria. Peptic ulcer and inflammatory bowel disease, which present unique interactions among psychological, immunologic, endocrine, infectious, and behavioral factors, are splendid paradigms of the biopsychosocial model. Thanks to Phyllis Levenstein for her careful and constructive critique of a draft of this article.

Journal of Clinical Gastroenterology, Mar 1, 1996

... Author Information. From the Gastroenterology Division, Nuovo Regina Margherita Hospital, Rom... more ... Author Information. From the Gastroenterology Division, Nuovo Regina Margherita Hospital, Rome, Italy. Received May 2, 1995. ... This study was approved by the Ethics Committee of the NuovoRegina Margherita Hospital, and all patients gave written informed consent. ...

Scandinavian Journal of Gastroenterology, May 14, 2017

Objective: To examine whether mental vulnerability, an enduring personality characteristic, predi... more Objective: To examine whether mental vulnerability, an enduring personality characteristic, predicts incident hospital-diagnosed ulcer over three decades. Materials and methods: A population-based cohort study enrolled 3365 subjects with no ulcer history, ages 30-60, in 1982-3. Mental vulnerability, Helicobacter pylori IgG antibodies, socioeconomic status, and sleep duration were determined at baseline; non-steroidal antiinflammatory drug use, smoking, leisure time physical activity, and alcohol consumption both at baseline and in 1993-4. Hospital diagnoses of incident ulcer through 2011 were detected using the Danish National Patient Registry. Results: Ulcers were diagnosed in 166 subjects, including 83 complicated by bleeding or perforation. Age-, gender-, and socioeconomic status-adjusted associations were significant for mental vulnerability (Hazard Ratio (HR) 2.0, 95% Confidence Interval 1.4-2.8), Helicobacter pylori (HR 1.7, CI 1.2-2.3), smoking (HR 2.0, CI 1.3-3.1), heavy drinking (HR 1.6, CI 1.1-2.4), abstinence (HR 1.6, CI 1.1-2.5), non-steroidal antiinflammatory drugs (HR 2.1, CI 1.5-3.0), and sedentary lifestyle (HR 1.9, CI 1.4-2.7). Adjusted for all behavioral mediators, the HR for mental vulnerability was 1.5 (CI 1.0-2.2, p ¼ .04). Mental vulnerability raised risk in Helicobacter pylori seropositive subjects and those exposed to neither Helicobacter pylori nor non-steroidal antiinflammatory drugs; its impact was virtually unchanged when analysis was limited to complicated ulcers. Conclusions: A vulnerable personality raises risk for hospital-diagnosed peptic ulcer, in part because of an association with health risk behaviors. Its impact is seen in 'idiopathic' and Helicobacter pylori-associated ulcers, and in acute surgical cases.

International Journal of Epidemiology, Feb 1, 2002

While stress and diet can irritate an ulcer, they do not cause it. Ulcers are caused by the bacte... more While stress and diet can irritate an ulcer, they do not cause it. Ulcers are caused by the bacterium H. pylori.' Centers for Disease Control and Prevention 1 'Thus the dialectics of Hegel was placed upon its head; or rather, turned off its head, on which it was standing, and placed upon its feet.' Friedrich Engels 2

Journal of Clinical Gastroenterology, Apr 1, 1997

Archives of internal medicine, May 28, 2001

Journal of Applied Developmental Psychology, May 1, 2002

The Parent-Child Home Program (PCHP) is a 2-year home-based program for low-income parents and th... more The Parent-Child Home Program (PCHP) is a 2-year home-based program for low-income parents and their 2-and 3-year-old children at risk for educational disadvantage. To study the effects of a South Carolina PCHP replication on the school readiness of 84 former participants in four successive first grade cohorts (1997, 1998, 1999, and 2000), their scores on the Cognitive Skills Assessment Battery (CSAB) given to all South Carolina first graders were compared to scores statewide and in the school district. Scores indicating school readiness were achieved by 82.4% of first graders statewide and by 84.5% of all PCHP children (by 92.2% when seven PCHP children with severe developmental delay [SDD] were excluded). Among those receiving free lunch, 74.4% of statewide children but 93.2% of non-SDD PCHP children passed the CSAB school readiness score of 88 (p < .001). 75.6% of African American children passed the CSAB statewide, but 92.7% of non-SDD African American PCHP children did so (p < .01). Pass rates of non-SDD PCHP children were higher than those of at-risk non-PCHP children in the school district (.05 < p < .1). All parents invited into the PCHP accepted enrollment and 96.2% of those who remained in the district completed the 2-year program, at a cost of US$2000 per family. The PCHP is a feasible social program that normalized performance on a standardized educational test in at-risk first graders and eliminated the excess risk of inadequate school readiness associated with low income and African American ethnicity.

Journal of Clinical Gastroenterology, Oct 1, 1995

Inflammatory Bowel Diseases, Oct 1, 2008