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Biomedical subjects

B Smith

Publications and source records attributed to B Smith.

At least 109 records · Page 6Linked to original sources
PubMed1999

An exploratory analysis of women and men within a self-help, communal-living recovery setting: a new beginning in a new house.

In the present exploratory study, women without children (n = 13) and women with children (n = 23) were compared to men (n = 35) on demographic and self-reported variables on entering a communal-living, self-help recovery program called Oxford House. Men were more often hospitalized for their addiction than either group of women, and men and women with children were older and had been previously hospitalized longer for their addiction than women without children. There were no significant differences among groups in terms of their codependency on others, and men felt a stronger sense of camaraderie with other residents than women with or without children. Men and women with children also tended to feel they shared more in the decisions within their house than did women without children. Further, with partial correlates (controlling for the number of children), women with children indicated that the greater their self-reported codependency, the less accepting they were of their children and the more depressed they were about their parenting abilities. Dysfunctional characteristics of the children also were related to negative characteristics in the children reported by their mothers. In short, men and women with and without children entering an Oxford House have similar profiles, yet women with children have additional stressors associated with parental responsibilities.

Adult↗
PubMed1999

Lay beliefs about the preventability of major health conditions.

Beliefs about the extent to which health problems can be prevented reflect an understanding that preventive measures can reduce adverse health events and the level of control individuals perceive that they hold over the factors that affect their health. A population survey of 1659 people conducted in 1995 in south western Sydney, Australia, found that only child drownings, tooth decay, skin cancer, and burns and scalds were considered all or mostly preventable by more than 50% of the sample. The majority of respondents did not believe that heart attacks, cervical cancer, high blood pressure, serious road injury, lung cancer and asthma deaths were all or mostly preventable. Logistic regression analysis showed that people born in an English speaking country, those with more than 10 years of education and men were significantly more likely to recognize a number of key conditions as highly preventable. The findings suggest that, in spite of the range of prevention efforts in Australia to date, these are not matched by strong beliefs within the community that prevention is possible. Communication of the opportunities and methods for prevention needs to be improved, particularly among certain population groups. The findings also indicate a need to examine social and environmental factors which are potentially reducing confidence, and subsequently and adoption of preventive behaviours.

Adolescent↗
PubMed1999

Family functioning, neurocognitive functioning, and behavior problems in children with sickle cell disease.

OBJECTIVE: To investigate the independent and combined contributions of neurocognitive and family functioning to mother-reported behavior problems in children with sickle cell disease (SCD) and evaluate the factor structure of the Family Environment Scale (FES) with African American families. METHOD: The study sample included 289 children enrolled in the multisite Cooperative Study of Sickle Cell Disease. The study protocol included neuropsychological evaluation and brain magnetic resonance imaging (MRI) of the children, and mothers completed the Child Behavior Checklist and Family Environment Scale. RESULTS: With child and maternal demographic parameters controlled, conflicted family functioning, but not neurocognitive functioning, accounted for a significant portion of the variance in mother-reported behavior problems. The factor structure of the FES for families of children with SCD was found to be similar to that for other families. CONCLUSIONS: Family functioning may be a salient target for fostering adaptation to chronic childhood illness.

Adaptation, Psychological↗
PubMed1999

Diagnosis and risk stratification of patients with anginal pain and non-diagnostic electrocardiograms.

Patients with acute chest pain suggestive of myocardial ischaemia, and normal or non-diagnostic electrocardiograms, form a difficult subgroup for diagnosis and early risk stratification. We prospectively evaluated the role of troponin T (cTnT), troponin I (cTnI), CKMB mass and myoglobin, in the diagnosis and risk stratification of 214 patients with acute chest pain of < or = 24 h and non-diagnostic or normal ECGs admitted directly to the Cardiac Unit of the Royal Victoria Hospital Belfast from the Mobile Coronary Care Unit or the Accident/Emergency Department. This was a single-centre prospective study, and follow-up (3 months) was complete for all patients. Blood was assessed for quantitative cTnT, cTnI, CKMB mass and myoglobin, and qualitative cTnT on admission and at 12 h. Diagnosis of index event and incidence of new cardiac events (death, non-fatal myocardial infarction, revascularization, or readmission for unstable angina) over 3 months were assessed. Based on standard criteria, myocardial infarction occurred in 37/214 (17%), and unstable angina in 72/214 (34%). At 12 h from admission, cardiac troponins had higher sensitivity for the diagnosis of acute coronary syndromes (myocardial infarction and unstable angina) than conventional markers (cTnI 48%, cTnT 38%, CKMB mass 30% or myoglobin 27%). At 3 months, a new cardiac event had occurred in 42/214 (20%). Significantly higher event rates occurred when any of the biochemical markers was elevated, but the statistical significance was highest for patients with elevated cTnI (p < 0.0001). Whilst gender, history of ischaemic heart disease (IHD), stress test response, cTnT, cTnI, CKMB mass and myoglobin were univariate predictors, cTnI at 12 h and stress test response were the only two independent significant predictors for a subsequent cardiac event at 3 months. Raised cTnI at 12 h after admission had the highest sensitivity for the diagnosis of acute coronary syndromes, and was independently associated with a 2-3 times increased risk of future cardiac events within 3 months among patients with acute chest pain suggestive of myocardial ischaemia but with normal or non-diagnostic ECGs.

Aged↗
PubMed1999

Clinical experience over 48 years with pheochromocytoma.

OBJECTIVE: To analyze the presentation, localization, surgical management, pathology, and long-term outcome of a large series of patients with pheochromocytomas. SUMMARY BACKGROUND DATA: There are several areas of controversy pertaining to pheochromocytomas. Although many studies report a higher rate of malignancy for extraadrenal pheochromocytomas than for adrenal pheochromocytomas, the number of patients with the former tumor are small and statistical analysis is lacking. There has also been recent debate as to whether microscopic features of the tumor may be predictive of future behavior. METHODS: From 1950 to 1998, the authors observed 108 pheochromocytomas in 104 patients. The outcome of these patients has been followed prospectively. The medical records of these patients were reviewed for data on the presentation, localization, surgical management, pathology, and outcome. Patient survival was analyzed using Kaplan-Meier survival distributions. RESULTS: This study included 66 female patients and 38 male patients. The average age at surgery was 42.3 years. Sporadic cases accounted for 84% of the patients; the other 16% had multiple endocrine neoplasia type 2, von Recklinghausen's disease, von Hippel-Lindau disease, or Carney's syndrome. Of 64 adrenal tumors, 55 were initially considered benign, 6 had microscopic malignant features, and 3 had malignant disease. Mean patient follow-up was 12.6 years. To date, in five additional patients (none with microscopic disease) malignant disease developed (13% overall rate of malignancy). Recurrence occurred as late as 15 years after resection. Of 26 extraadrenal pheochromocytomas, 14 were initially considered benign, 8 had microscopic malignant features, and 4 had malignant disease. Thus, 46% of patients had either malignant disease or tumors with malignant features. Mean patient follow-up was 11.5 years. In one patient with benign disease and in one patient with malignant features, malignant disease developed (23% overall rate of malignancy). The difference in the rate of malignancy was not statistically significant between adrenal and extraadrenal pheochromocytomas. Patients with adrenal and extraadrenal pheochromocytomas also had similar rates of survival (p = NS). CONCLUSIONS: The data suggest that patients with extraadrenal pheochromocytomas have the same risk of malignancy and the same overall survival as patients with adrenal pheochromocytomas. Lifelong follow-up of these patients is mandatory.

Adolescent↗
PubMed1999

Geographical influences upon physical activity participation: evidence of a 'coastal effect'.

OBJECTIVE: To examine the association between geographical proximity to the coast and physical activity participation levels. METHOD: Using stratified random sampling, a telephone survey was carried out in 1994 with 1,000 adults in each of the 16 health service regions in New South Wales (N = 16,178). Physical activity levels were measured through self-report of the frequency and duration of walking, moderate and vigorous activities in the two weeks preceding the survey. Logistic regression modelling was carried out to examine the association between physical activity and 'coastal' location of residence, adjusting for age, sex, employment status, education level and country of birth. RESULTS: After adjusting for other demographic factors, respondents who lived in a coastal postcode were 23% less likely to be classified as sedentary, 27% more likely to report levels of activity considered adequate for health, and 38% more likely to report high (vigorous) levels of physical activity than those who lived inland. Each of these associations was significant at the 0.05 level. CONCLUSIONS: Characteristics of the physical environment in coastal postcodes are related to physical activity participation. IMPLICATIONS: Physical environments may contribute to physical activity participation. Further efforts to conceptualise and measure these environmental influences is warranted. Public health efforts to promote physical activity should consider aspects of the physical environment as part of any intervention.

Adult↗
PubMed1999

Binding of rat and human surfactant proteins A and D to Aspergillus fumigatus conidia.

Surfactant proteins A (SP-A) and D (SP-D) are thought to play important roles in pulmonary host defense. We investigated the interactions of rat and human SP-A and SP-D with Aspergillus fumigatus conidia. Rat SP-D but not rat SP-A bound the conidia, and the binding was inhibited by EDTA, mannose, glucose, maltose, and inositol. Binding studies using a mutant recombinant rat SP-D with altered carbohydrate recognition but normal structural organization clearly established a role for the carbohydrate recognition domain in binding to conidia. However, neither rat SP-A nor SP-D increased the association of fluorescein isothiocyanate-labeled conidia with rat alveolar macrophages as determined by flow cytometry. Both human SP-A (isolated from normal and alveolar proteinosis lungs) and SP-D (recombinant protein and protein isolated from alveolar proteinosis lungs) bound the conidia. These data indicate that important differences exist between rat and human SP-A in binding to certain fungi. Human SP-A and SP-D binding to conidia was also examined in the presence of hydrophobic surfactant components (HSC), containing both the phospholipid and hydrophobic proteins of surfactant. We found that HSC inhibited but did not eliminate human SP-A binding to Aspergillus conidia. In contrast, the SP-D binding to conidia was unaffected by HSC. These findings indicate that SP-D plays a major role in the recognition of Aspergillus conidia in alveolar fluid.

Animals↗
PubMed1999

Dynamics of human immunodeficiency virus type 1 replication in vertically infected infants.

Plasma human immunodeficiency virus type 1 (HIV-1) turnover and kinetics were studied in children aged 15 days to 2 years following the initiation of a triple antiretroviral drug regimen consisting of zidovudine, lamivudine, and nevirapine. HIV-1 turnover was at least as rapid as that previously described in adults; turnover rates were more rapid in infants and children aged 3 months to 2 years than in infants less than 3 months of age. These data confirm the central role of HIV-1 replication in the pathogenesis of vertical HIV-1 infection and reinforce the importance of early, potent combination therapies for the long-term control of HIV-1 replication.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Psychotropic drugs in mothers' milk: a comprehensive review of assay methods, pharmacokinetics and of safety of breast-feeding.

Many mentally ill women want to breast-feed their babies but, if they are taking psychotropic drugs, there is very little systematic data upon which to base decisions about whether or not it is safe to do so. We therefore attempt to provide a comprehensive and critical summary of existing case reports and of studies of breast-feeding in relation to commonly used psychotropic drugs. The literature review focuses on the following drugs: antidepressants: tricyclics and serotonin selective reuptake inhibitors (SSRIs); antipsychotic drugs: chlorpromazine, perphenazine, haloperidol and clozapine; mood stabilizers: lithium and carbamazepine; and benzodiazepines. The research literature consists mainly of single case reports and there have been very few attempts at controlled, longitudinal investigations. Findings are often difficult to compare because of differences in methods or because of lack of key information. Most data are available about the tricyclic antidepressants but even here we have found that the reports cover only a grand total of 66 mother-infant pairs. Dilemmas about whether or not to contraindicate breast-feeding arise most commonly in relation to postnatal depression. The findings to date suggest that provided that infants are healthy at the outset it is likely that the benefits of breast-feeding will outweigh potential hazards if their mothers are taking established tricyclic drugs at recommended dose levels. Much less is known about risks associated with SSRI antidepressants or about antipsychotic drugs such as phenothiazines and butyrophenones or mood stabilizers such as carbamazepine, all of which enter breast-milk. Safeguards are suggested for future single case studies, which, as they accumulate, will provide a platform for mounting controlled prospective studies properly to test for any acute toxic effects and for possible long-term adverse effects of such drugs on infants' development. Appendix 1 is a review of assay methods. Appendix 2 examines pharmacokinetic factors in newborn preterm and sick infants with special reference to contraindications to breast-feeding. Appendix 3 is a review of methods for assessing infant health and development.

Adult↗
PubMed1999

Sensorimotor and cognitive development of infants of mothers with schizophrenia.

BACKGROUND: The parenting environment provided by mothers with schizophrenia is likely to contribute to the cognitive impairment observed in their offspring. AIMS: To assess the relative contribution of maternal schizophrenia, obstetric factors and mothers' lifestyle to the cognitive development of infants in their first year. METHOD: The Bayley Scales of Infant Development were administered to 19 infants of mothers with schizophrenia, 34 with non-psychotic depression in the mother, 29 with affective psychosis in the mother and 24 normal controls when the babies were two and seven months of age. RESULTS: At two months, infants of mothers with schizophrenia and of those with affective psychosis had lower mental development index (MDI) scores than controls. At seven months, infants of mothers with schizophrenia had lower MDI scores than all other groups. When infant birth weight and mothers' social class were taken into account there was no effect of maternal schizophrenia on infants' MDI scores. CONCLUSIONS: Infants of mothers with schizophrenia are likely to have impaired cognitive development. This may be due in part to environmental factors such as the mother's lifestyle.

Adult↗
PubMed1999

Mid-third forearm fractures in children: an unorthodox treatment.

Twenty children with fractures of both bones in the middle third of the forearm were immobilized in extension after closed reduction. Unlike distal-third fractures, these fractures are prone to develop rotary and angular deformities that may lead to permanent functional impairment and visible deformity. Mid-third forearm fractures with the radius fracture proximal to the ulnar fracture are even more troublesome. Nineteen patients had no clinical deformity at cast removal, and by 1 year, there was no difference in forearm rotation. Extension casting can be used initially for proximal fractures or to salvage forearms that lost reduction in flexed elbow casts. Extension cast application is easy while the reduction is maintained, whereas the problems are often encountered while applying a flexed elbow cast. This unorthodox treatment is safe and effective and may alleviate the need for surgical intervention.

Casts, Surgical↗
PubMed1999

Colonic lymphocyte and plasma cell populations in dogs with lymphocytic-plasmacytic colitis.

OBJECTIVES: To quantitate immunoglobulin-containing cells (IgA, IgG, and IgM) and CD3+ T cells in colonic biopsy specimens obtained from dogs with lymphocytic-plasmacytic colitis (LPC), and to compare lymphocyte and plasma cell populations in dogs with LPC with those in healthy dogs. ANIMALS: 10 healthy dogs and 11 dogs with LPC. PROCEDURE: Colonic mucosal specimens obtained from healthy dogs and dogs with LPC were stained specifically for IgA-, IgG-, and IgM-containing cells and CD3+ T cells by use of immunoperoxidase techniques. Morphometric analyses were done to quantitate lymphocytes and plasma cells in standardized areas of colonic mucosa. Data analyses allowed determination of mean cell numbers in each dog group, and comparison of mean numbers of lymphocytes and plasma cells between dog groups. RESULTS: CD3+ T cells predominated in healthy dogs, whereas CD3+ T cells and IgA-containing cells were most numerous in dogs with LPC. In both dog groups, the IgG- and IgM-containing cells were considerably less numerous than the other 2 cell types. Comparison of cell populations between dog groups indicated that IgA- and IgG-containing cells and CD3+ T cells were significantly more numerous in the colonic mucosa of dogs with LPC. CONCLUSIONS: Dogs with LPC have significantly increased numbers of IgA- and IgG-containing cells and CD3+ T cells. These lymphocyte and plasma cell distributions indicate similarities to and differences from such distributions in human beings with inflammatory bowel disease. Results provide a basis for future correlation between histologic stage of disease activity and immunologic findings in dogs with LPC.

Animals↗
PubMed1999

Test-retest stability and short-term habituation of the N1 and gamma band response.

The gamma band response (GBR) is an exogenous, cortically generated, event-related potential that occurs between 20- and 170-msec post-stimulus onset. The auditory GBR is superimposed on the transient evoked middle and long latency cortical auditory evoked potentials and demonstrates a peak spectral frequency between 30 and 40 Hz. The present investigations were conducted to evaluate the test-retest stability and short-term habituation of the GBR. Both the GBR and N1 were recorded from six normal-hearing, neurologically intact subjects (Investigation 1, test-retest stability) and two subjects with intractable epilepsy with implanted subdural electrode grid arrays (Investigation 2, short-term habituation characteristics). For Investigation 1, the test-retest interval was 1 month. For Investigation 2, 300 samples were acquired per stimulus block (a 10-minute interval) and then subaveraged in blocks of 25 to 50 samples each. Results suggest that (1) like N1, the GBR shows high repeatability (qualitative) and test-retest stability (quantitative) and (2) the GBR does not demonstrate evidence of short-term habituation.

Adult↗
PubMed1998

The functional anatomy of sound intensity discrimination.

The human neuroanatomical substrate of sound intensity discrimination was investigated by combining psychoacoustics and functional neuroimaging. Seven normal subjects were trained to detect deviant sounds presented with a slightly higher intensity than a standard harmonic sound, using a Go/No Go paradigm. Individual psychometric curves were carefully assessed using a three-step psychoacoustic procedure. Subjects were scanned while passively listening to the standard sound and while discriminating changes in sound intensity at four different performance levels (d' = 1.5, 2.5, 3.5, and 4.5). Analysis of regional cerebral blood flow data outlined activation, during the discrimination conditions, of a right hemispheric frontoparietal network already reported in other studies of selective or sustained attention to sensory input, and in which activity appeared inversely proportional to intensity discriminability. Conversely, a right posterior temporal region included in secondary auditory cortex was activated during discrimination of sound intensity independently of performance level. These findings suggest that discrimination of sound intensity involves two different cortical networks: a supramodal right frontoparietal network responsible for allocation of sensory attentional resources, and a region of secondary auditory cortex specifically involved in sensory computation of sound intensity differences.

Adult↗