Search PubMed⌕ Search

Biomedical subjects

A M Stoddard

Publications and source records attributed to A M Stoddard.

At least 55 records · Page 3Linked to original sources
PubMed1988

Behavioral risk factors for HIV infection among homosexual men at a Boston community health center.

Social and behavioral factors associated with human immunodeficiency virus (HIV) infection were analyzed using cross-sectional data from homosexual and bisexual male clients of a Boston community health center. Partners from California, and a previous period of greater sexual activity (a "high period"), were independently associated with positive HIV antibody status, as were the frequency of receptive anogenital contact, both during the "high period" and during the last six months.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Effects of HIV antibody test knowledge on subsequent sexual behaviors in a cohort of homosexually active men.

This study assesses the effects of HIV (human immunodeficiency virus) antibody testing on subsequent (one year) sexual behavior among 270 homosexual men at a Boston community health center, 21 per cent of whom were unaware of their test result. Except for the number of steady partners, the levels of all sexual activities of all groups of study participants declined over time. No effects of test awareness of antibody status were found on protective behavior for receptive anogenital contact. Elimination of unprotected insertive anogenital contact (by elimination of the practice or by condom use) was reported somewhat more often among seropositive men who became aware of their test result. Increased negative emotional reactions were reported by HIV seropositive men who were aware of their test result. These results suggest some behavioral impact of HIV antibody test knowledge in this cohort, but may not be generalizable to other populations.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Do HMOs reduce hospitalization of terminal cancer patients?

The ability of health maintenance organizations to contain the costs of their members' health care, largely through reduced hospitalization, has been documented. There are, however, no studies to investigate whether HMOs realize cost savings specifically for their terminally ill members. In this study, we examined hospital utilization and costs in a matched-pair comparison of HMO members and nonmembers under the age of 65 in Monroe County, New York, who died of cancer during 1976-1982. We found that the HMO members used somewhat fewer hospital days and had lower hospital costs than nonmembers, but the differences were not statistically significant. We also found significantly greater variance in the costs of care for nonmembers than for HMO members.

Costs and Cost Analysis↗
PubMed1987

Correlation of enzyme-linked immunosorbent assays for serum human immunodeficiency virus antigen and antibodies to recombinant viral proteins with subsequent clinical outcomes in a cohort of asymptomatic homosexual men.

A cohort of asymptomatic homosexual men at a Boston community health center was screened for the presence of human immunodeficiency virus (HIV) serum antigen and antibodies to recombinant proteins containing portions of the envelope and the gag (core) gene products. Of 196 asymptomatic men screened, 149 were antigen-negative/antibody-negative, 41 were antigen-negative/antibody-positive, and six were antigen-positive/antibody-positive. All three men in whom the acquired immune deficiency syndrome (AIDS) developed over the next year were antigen-positive at enrollment. Although a larger portion of the men who were antigen-positive and did not demonstrate progression to AIDS after one year had thrush, zoster, or generalized lymphadenopathy, the associations were not statistically significant. Whereas all of the seropositive men had antibody to viral envelope antigens, about a quarter did not have detectable antibodies to recombinant core antigens. However, all of these men had detectable antibody to core antigens by Western blot. Titers to recombinant core and envelope antigens tended to be lower in the men with AIDS. HIV-infected persons who are more likely to have enhanced immuno-compromise may be identified by these newer tests, but further longitudinal studies will be necessary to fully understand their prognostic value.

AIDS-Related Complex↗
PubMed1987

Effects of an expanding home care program for the terminally ill.

This study was a quasi-experimental time series design to test the hypothesis that an expanded program of home care for the terminally ill would reduce hospital utilization and costs of care during the last month of life. The data base was derived by comparing cancer deaths in persons less than 65 years of age over a 7-year period from a regional tumor registry against Blue Cross enrollment and claims files, to form claims histories for the last 6 months of life for 1,874 decedents who had made at least one claim during this period. Forty-six percent (46%) of the decedents had used home-care services, and a subgroup of high-intensity users was identified from daily home care charges during the last month of life. As the home care program expanded to provide more intensive home-hospice services, a trend was observed of greater cost savings among home-care users than among nonusers. These savings among users were achieved by a reduction in hospital days, and by a reduction in the mean daily cost of hospitalization. Home-care users also showed significantly less variability in costs than nonusers.

Adult↗
PubMed1986

Association of human T lymphotropic virus type III antibodies with sexual and other behaviors in a cohort of homosexual men from Boston with and without generalized lymphadenopathy.

Forty asymptomatic homosexually active men seen at a Boston community health center and 39 men with generalized lymphadenopathy were interviewed and filled out detailed epidemiologic questionnaires. Twenty percent of the asymptomatic men and 92 percent of those with lymphadenopathy had antibodies to human T lymphotropic virus type III (HTLV-III). None of the men have subsequently had the acquired immune deficiency syndrome (AIDS). Seropositivity was associated with receptive anal intercourse and oral exposure to ejaculate, a history of hepatitis B, anal gonorrhea, or intestinal parasites, but no other sexually transmitted diseases, and did not correlate with the use of recreational drugs. More of the seropositive men had multiple partners from New York City. An association with seropositivity was less evident in relation to the numbers of partners from San Francisco or Los Angeles, since the whole cohort generally had fewer contacts with partners from these cities. The data suggest that educational programs among homosexual men attempting to decrease AIDS risk should focus on decreasing the number of partners, receptive anal intercourse, oral exposure to ejaculate and other intimate rectal contact, and sexual contact with men from areas of increased HTLV-III seroprevalence.

Adult↗
PubMed1986

Human T-lymphotropic virus type III in high-risk, antibody-negative homosexual men.

A cohort of 215 asymptomatic homosexually active men from a Boston community health center are being prospectively followed to assess the natural history of the human T-lymphotropic virus type III (HTLV-III) infection. To determine if certain asymptomatic persons who are HTLV-III antibody negative may be viremic, an algorithm was developed that defined high-risk characteristics (a sexual partner with the acquired immunodeficiency syndrome [AIDS]; more than 100 homosexual partners; or leukopenia, lymphopenia, neutropenia, or thrombocytopenia). Of 33 asymptomatic homosexual men who did not have antibody to HTLV-III and whose cases have not been previously reported, 2 had HTLV-III recovered from their lymphocytes. Clinical, behavioral, and hematologic data from seronegative persons did not distinguish between those with negative or positive viral cultures. Asymptomatic carriage of HTLV-III in high-risk seronegative persons underscores the need to base preventive educational strategies and behavioral modification on the assessment of risk factors and not solely on the results of HTLV-III antibody screening.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Use of a surrogate for the Sickness Impact Profile.

The use of a surrogate Sickness Impact Profile (SIP) score was investigated in a sample of 66 chronically or terminally ill homebound patients and their caretakers. Statistically significant differences in category scores (P less than 0.05) were found in only two categories. Profile analysis revealed no systematic differences between patient and caretaker responses, and agreement was generally quite high. Agreement of a surrogate SIP was somewhat lower if the patient was suffering from a terminal condition, if the patient had lower educational attainment, or if the caretaker did not live in the same household as the patient. Agreement did not appear to be affected by a diagnosis of a neurologic or psychiatric condition, by the patient's age or degree of dysfunction, or by the relationship of the caretaker to the patient. Overall, the results of the study are encouraging with regard to use of surrogate SIP total and dimension scores for group-level analysis of chronically ill patients if the surrogate is a family member who is closely involved in the patient's care.

Activities of Daily Living↗
PubMed1979

Standardization of measures prior to cluster analysis.

A common problem in cluster analysis is the determination of a scale-free measure of distance between individuals. This paper presents a procedure for scaling measurements using a reference individual as a standard of comparison. The procedure is particularly useful in classification of the results of laboratory procedures, where a reference standard is routinely produced. An example is the clustering of patterns that result from crossed antigen-antibody electrophoresis for determining the phenotype of the serum protein alpha 1-antitrypsin. The procedure appears to remove extraneous variability while retaining the information necessary for classification.

Blood Protein Electrophoresis↗
PubMedDate not supplied

Automatic classification of biomedical information when classification error is unknown.

This paper describes a distribution-free method for the automatic classification of individuals by phenotype of the serum protein alpha 1-antitrypsin. This method achieved 74 per cent agreement and a Kappa value of 0.24 when compared to the conventional classification procedure on an independent testing sample. The methodology is appropriate for many classification problems, particularly when the true classes and the reliability of the conventional procedure are unknown.

Classification↗
PubMedDate not supplied

Underusers of mammogram screening: stage of adoption in five U.S. subpopulations. The NCI Breast Cancer Screening Consortium.

BACKGROUND: The purpose of this report is to describe the characteristics of women ages 50 to 80 who do not follow commonly accepted mammography screening guidelines. It provides unique understanding of the robustness of characteristics of underusers across five different U.S. subpopulations. METHODS: The data are from the baseline surveys of the five studies of the NCI Breast Cancer Screening Consortium. Stage of adoption of mammography screening and other characteristics of underusers are presented. Polytomous logistic regression analysis was used to explore multivariable associations with stage of adoption in each study site. RESULTS: The five samples studied by the Consortium range in size from 259 to 4,477 women (n = 11,292). The relationship of the perceptions of the pros and cons of mammography with stage of adoption was strikingly similar across the five samples. Other variables consistently associated with stage were a recent receipt of a breast physical examination and recommendation for mammography by a physician. CONCLUSIONS: The findings suggest a need to encourage regular screening through effective communication from a health care provider. Intervention messages should be designed to increase the pros of mammography, decrease the cons, and highlight these differentially according to the woman's stage of adoption.

Aged↗
PubMedDate not supplied

Use of condoms by heterosexually active drug abusers before and after AIDS education.

This study identified variables associated with increased condom use among drug abusers in a randomized trial of three AIDS educational programs in a short-term inpatient detoxification program. Participants (n = 301) completed baseline and follow-up interviews and were heterosexually active on both occasions. At baseline, 10% always, 24% sometimes, and 66% never used condoms, and this distribution changed only slightly at follow-up. Among the latter two groups, 21% increased their use. There was no differential intervention effect on changes in condom use. Women, but not men, were more likely to initiate condom use than to increase to consistent use with all partners, and to initiate use if they had multiple partners. Although beneficial attitudes and beliefs about condoms were more common among women at baseline, positive changes in these attitudes/beliefs were associated with increased condom use among men only. Among men, personal attitudes and beliefs were associated with increased condom use, while among women, perceptions of the attitudes of sexual partners were more important.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Social influences, social norms, social support, and smoking behavior among adolescent workers.

PURPOSE: To examine the relationships between worksite interpersonal influences and smoking and quitting behavior among adolescent workers. DESIGN: The cross-sectional survey assessed factors influencing tobacco use behavior. SETTING: During the fall of 1998, data were collected from 10 grocery stores in Massachusetts that were owned and managed by the same company. SUBJECTS: Eligible participants included 474 working adolescents ages 15 to 18. Eighty-three percent of workers (n = 379) completed the survey. MEASURES: The self-report questionnaire assessed social influences, social norms, social support, friendship networks, stage of smoking and quitting behavior, employment patterns, and demographic factors. RESULTS: Thirty-five percent of respondents were never smokers, 21% experimental, 5% occasional, 18% regular, and 23% former smokers. Using analysis of variance (ANOVA), results indicate that regular smokers were 30% more likely than experimental or occasional smokers to report coworker encouragement to quit (p = .0002). Compared with regular smokers, never smokers were 15% more likely to report greater nonacceptability of smoking (p = .01). chi 2 tests of association revealed no differences in friendship networks by stage of smoking. CONCLUSIONS: These data provide evidence for the need to further explore social factors inside and outside the work environment that influence smoking and quitting behavior among working teens. Interpretations of the data are limited because of cross-sectional and self-report data collection methods used in one segment of the retail sector.

Adolescent↗
PubMedDate not supplied

Impact of a physician intervention program to increase breast cancer screening.

In order to improve compliance with the National Cancer Institute's breast cancer screening guidelines, we developed a multifaceted intervention designed to alter physician screening practice. A pre-post test, two-community design was used. Primary care physicians in one community served as the control. Data were collected by two mailed surveys (1987 and 1990). Response rates were 61% and 64%, respectively. The physician intervention program consisted of a hospital-based continuing medical education program and an outreach component which focused on implementing a reminder system. Outcome measures were self-reported attitudinal, knowledge, and screening practices changes. In spite of an impressive change in comparison community physicians' practice, the difference in change over time in the intervention community physicians' ordering of annual mammography compared to the change in the comparison community physicians' ordering was significant (P = 0.04). The adjusted odds ratio is nearly 8. We conclude that our in-service continuing medical education program was successful in improving breast cancer screening practices among primary care physicians.

Education, Medical, Continuing↗
PubMedDate not supplied

Physician compliance with mammography guidelines: barriers and enhancers.

BACKGROUND: Primary care physicians are increasingly the gatekeepers to clinical preventive services including mammography utilization. Moreover, lack of physician recommendation is a major reason for patient failure to obtain screening. A study was designed to examine the attitudes, beliefs, and practices with regard to breast cancer screening as self-reported by primary care physicians. The variables associated with compliance or lack of compliance with screening guidelines are emphasized. METHODS: One hundred sixteen primary care physicians practicing in two New England communities responded to a mailed survey. The survey included questions on attitudes and beliefs about breast cancer screening, as well as questions about perceived barriers and actual screening practices. RESULTS: Fifty-seven percent of the respondents reported ordering annual mammograms for their female patients aged 50 to 75 years. An additional 21 percent reported ordering biannual mammograms for women in this age group. Strongly associated with ordering annual mammograms were beliefs in the benefits of mammography and the perception of community consensus regarding breast cancer screening. A strong positive association of practicing in a group setting and mammography guideline compliance was documented. Middle-aged physicians in solo practice reported the poorest screening compliance. CONCLUSIONS: The level of physician compliance with the standard of annual mammography screening is low (57 percent). The three most important determinants of annual screening suggest ways to improve physician compliance: improve physician attitudes about the benefits of mammography, build further on the medical community's consensus regarding the appropriateness and importance of the annual guidelines, target the poorest compliers with special messages or programs.

Age Factors↗
PubMedDate not supplied

Reliability of self-reported sexual behavior risk factors for HIV infection in homosexual men.

This study was undertaken to determine the reliability of self-reported sexual behavior using the test and retest technique when used with self-reported sexual behavior. The subjects were 116 asymptomatic homosexual men who participated in another study (an examination of behavioral and demographic determinants of HIV antibody status). The subjects were asked to complete two questionnaires. The first contained demographic and sexual behavior questions. The second, administered an average of 6 weeks later, used a subset of the questions in the first questionnaire. The reliability of the test-retest procedure was measured by the Kappa statistic, which assesses the proportion of agreement between two data items, accounting for the amount of agreement expected by chance. The highest degree of reliability as measured by Kappa was found with demographic information, smoking history, and sexual orientation. Self-reported sexual behaviors for the previous 6 months generally had the next highest degree of reliability as measured by Kappa. Questions examining change over the previous 5 years had the lowest reliability. Behavior changes during the time between questionnaires, subjectivity of the answer categories, and social desirability of the answers are three factors that may result in a lack of reliability in this self-reported sexual behavior questionnaire. This raises methodological concerns about the measurement of behavioral risk factors for AIDS and the ability to assess meaningfully subjective reports of behavioral change.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

After Chernobyl--how U.S. physicians respond to radioactive fallout.

On April 26, 1986, a reactor unit at the Soviet Union's Chernobyl Power Station exploded, and substantial amounts of radioactive material were released. Fallout from this incident was deposited in the United States and elsewhere. Radioactive fallout is a major concern for obstetricians and pediatricians; their patients are the most vulnerable to the adverse effects of radiation. This study addresses the question: What are these physicians' perceptions and beliefs about fallout and its effects on their patients? A questionnaire was developed to measure these perceptions and beliefs. This instrument was mailed in November 1986 to all obstetricians and pediatricians listed in the telephone directory for western Massachusetts. A factor analysis of the physicians' responses yielded five factors: concern for patients, management of risk, effect of fallout, physicians' role in prevention, and guidance on advising patients. The physicians' responses to patients' inquiries were categorized as giving information, reassurance, and prescription. The authors recommend that the study be replicated with a more representative sample, that professional medical groups provide reliable information to members, and that physicians ask their professional organizations to address the issue of physician participation in the national planning process relevant to their concerns about radioactive fallout.

Accidents↗