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Biomedical subjects

C B Taylor

Publications and source records attributed to C B Taylor.

At least 289 records · Page 16Linked to original sources
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Chronic disease management: treating the patient with disease(s) vs treating disease(s) in the patient.

The treatment of chronic disease is often complicated by the coexistence of multiple medical conditions and by the presence of social and psychological impediments. The needs posed by patients with chronic disease are overwhelming the capacity of the American health care system. Alternative disease management systems that rely on specially trained nurse case managers to implement detailed clinical protocols, including drug algorithms, have shown efficacy in managing chronic medical conditions, singly and in combination. By fostering integration of care across subspecialty and medical-social boundaries, such systems enable treatment of the patient with disease(s), not simply treatment of disease(s) in the patient. Working closely with primary care physicians, often by telephone-mediated interaction with patients, nurse case managers may take an expanded role in meeting the challenges posed by chronic disease.

Case Management↗
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The influence of gender and socioeconomic factors on Hispanic/white differences in body mass index.

BACKGROUND AND METHODS: This article examines the effects of gender and socioeconomic factors on ethnic differences in body mass index (BMI) using a matched-pairs design of 688 pairs of Hispanics (principally Mexican American) and whites. Subjects, ages 25-74, were drawn from five population-based surveys conducted from 1979 to 1990 in four northern California cities. RESULTS: Hispanic women and men both had significantly higher BMI levels than the white women and men with whom they were matched (P < 0.001). These ethnic differences persisted across every level of education for both women and men, with the magnitude of the difference ranging from 0.9 BMI units (between the most educated Hispanic and white men) to 2.9 BMI units (between the least educated Hispanic and white women). The highest prevalence of overweight was among the least educated Hispanic women (61.1%) and Hispanic men (48.4%). The higher BMI levels of Hispanic women and men relative to their white counterparts were not explained by age, gender, education, city of residence, time of survey, or language spoken in a multiple regression model. Hispanic women and men both reported higher desired body weight (height standardized) than white women and men, indicating a possible contribution of cultural factors to the ethnic differences in overweight. CONCLUSIONS: These findings provide insight into the greater prevalence of overweight in Hispanic relative to white populations as well as guidance for weight-loss interventions tailored to low socioeconomic groups.

Adult↗
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Predicting onset of drinking in a community sample of adolescents: the role of expectancy and temperament.

We report results of a prospective examination of the influence of outcome expectancy variables and inherited temperaments on the onset of drinking over a 12-month period in a sample of 1,164 high school students. While univariate prospective analysis indicated that drinkers and nondrinkers were different both on measures of outcome expectancy and temperament, multivariate analysis supported, most strongly, a social learning account of the processes influencing the onset and maintenance of drinking behavior in this sample. The multivariate analysis revealed that only expectancies for enhanced social behavior were consistently associated with the onset of drinking from baseline to 12-month follow-up (p < .001). Among all nondrinkers at baseline, those entertaining higher expectancies about the positive effects of alcohol on social interaction were more likely to begin drinking between baseline and follow-up. At present, few, if any, alcohol abuse prevention studies with adolescents have explicitly attempted to alter alcohol expectancies or to establish a link between expectancy and behavior change. Our results suggest that it may be useful to do so.

Adolescent↗
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Assessment and phenomenology of nonclinical panic attacks in adolescent girls.

Recent reviews of studies concerning panic attacks in adolescents have emphasized research limitations, noting problems of validity, reliability, and lack of normative data. To address some of these limitations we evaluated two methods of panic ascertainment (questionnaire versus interview), reliability of interview-determined panic, and clinical correlates of panic symptoms in a large sample (N = 1013) of early adolescent girls. The 5.4% of the sample who, when interviewed, reported ever experiencing a panic attack scored significantly higher on measures of depression, anxiety sensitivity, and alcohol use, but were not more avoidant than others. Using the interview as the standard, the questionnaire had a specificity of 81% and a sensitivity of 72%. Adolescents do experience panic attacks-whether identified by questionnaire or interview-although for many the attacks may not be salient. Longitudinal studies are required to determine those qualities of nonclinical panic (severity, context, interpretation/attribution), which render some episodes as clinically meaningful.

Adolescent↗
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Expected versus unexpected panic attacks: a naturalistic prospective study.

The purpose of this study was to identify factors that are associated with expectation of panic attacks as well as to validate the hypothesized tendency to identify false (panic) alarms in panic disorder. Ten women with panic disorder were assessed naturalistically using computer-assisted self-monitoring. This allowed for prospective assessment of expected versus unexpected panic attacks. Expectation of panic attacks was associated with panic occurrence, as well as elevated sense of threat or danger, anxiety, helplessness, avoidance, distress about physical symptoms, physical sensations, and catastrophic thoughts prior to the attack. In general, the state measured prior to unexpected attacks did not differ from ongoing nonpanic state. Furthermore, none of the variables measured during the attacks were able to distinguish unexpected attacks from expected attacks.

Adolescent↗
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Relaxation training for essential hypertension at the worksite: II. The poorly controlled hypertensive.

This article reports the findings of a study designed to evaluate the long-term effectiveness of an industry-based relaxation training program in the treatment of hypertensives whose blood pressures were not well controlled by antihypertensive medication. Following a three-stage screening process, 137 participants were randomly allocated to either relaxation training (RT) or to blood pressure monitoring (BPM) at two worksites. Participants continued to receive medical care from their primary physicians during the course of the study. The advantage for participants receiving RT, in terms of mean blood pressure changes, was modest and of short duration. However, a larger proportion of participants in the RT group came into good control (blood pressures below 90 mm Hg) than in the BPM group following treatment (69.4% vs 41.5%, p less than 0.001). This advantage continued to 24 months' follow-up (63.9% vs 47.7%, p less than 0.05). At 30 months' follow-up there was no significant difference between the groups (75.0% vs 70.8%). Within-group analyses revealed that the BPM group also achieved significant blood pressure lowering which was maintained during the study. The largest initial difference between the two groups was for individuals whose entry diastolic blood pressures were most out of control despite several years of pharmacologic treatment. No difference was found between the two groups in the prescription of antihypertensive medication.

Adult↗
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Childhood sexual abuse, psychological distress, and medical use among women.

OBJECTIVE: This study examined the relationships between reported history of childhood sexual abuse (CSA), psychological distress, and medical utilization among women in a health maintenance organization (HMO) setting. METHODS: Participants were 206 women aged 20 to 63 years who were recruited from an HMO primary care clinic waiting area. Participants were classified, using screening questionnaires and the revised Symptom Checklist 90, as 1) CSA-distressed, 2) distressed only, 3) CSA only, or 4) control participants. Medical utilization rates were generated from the computerized database of the HMO for 1) nonpsychiatric outpatient, 2) psychiatric outpatient, 3) emergency room (ER), and 4) inpatient admissions. RESULTS: CSA-distressed and distressed only groups both used significantly more nonpsychiatric outpatient visits than CSA only and control participants but were not different from one another. CSA only and control participants did not differ on nonpsychiatric outpatient utilization. CSA-distressed participants used significantly more ER visits and were more likely to visit the ER for pain-related complaints than other participants. Among CSA-distressed participants, those who met criteria for physical abuse had significantly more ER visits than those who did not. There were no differences among the four groups in inpatient utilization rates. CONCLUSIONS: Psychological distress is associated with higher outpatient medical utilization, independent of CSA history. History of CSA with concomitant psychological distress is associated with significantly higher ER visits, particularly for those with a history of physical abuse. History of CSA without distress is not associated with elevated rates of medical utilization. Screening for psychological distress, CSA, and physical abuse may help to identify distinct subgroups with unique utilization patterns.

Adult↗
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The effect of a home-based, case-managed, multifactorial risk-reduction program on reducing psychological distress in patients with cardiovascular disease.

BACKGROUND: This study examined the effects of a nurse-case-managed, multifactorial, risk-reduction program on psychological distress among patients after myocardial infarction (MI). METHODS: Five hundred eighty-five men and women aged 70 years or younger, who were hospitalized for acute MI in one of five San Francisco Bay Area hospitals, were randomized to receive a nurse-managed, home-based, multifactorial risk-reduction program (n = 293) or usual care (n = 292). The program, which began in the hospital, included a brief screen for five areas of psychological distress with further evaluation if indicated, monitoring during the follow-up phone calls, and referral for mental health treatment if needed. Patients were assessed with single-item scales at baseline, and at 6 and 12 months. Separate analyses were performed for patients with moderate-to-severe levels on the psychological distress domains and for those with low levels. RESULTS: There was a significant reduction in the psychological distress variables for all patient groups between baseline and 12 months. The program had a significant effect on reducing anxiety in the patient group with low levels of anxiety and reducing anger in the patient group with frequent episodes of anger but, overall, the treatment and control groups showed equal levels of improvement. CONCLUSION: Among patients post-MI without complications, psychological distress decreases significantly during the 12 months after MI.

Aged↗
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Carcinoid tumour arising in a recurrent intradural spinal teratoma.

We report the case of a recurrent intradural spinal teratoma in a 44-year-old woman. Histological examination showed the lesion to be composed entirely of mature elements including an argyrophil carcinoid tumour. Electron microscopy showed the neoplastic cells to possess the ultrastructural features of a foregut type APUDoma. Gamma enolase, a marker of APUD cells, was demonstrated in the neoplasm by the peroxidase-antiperoxidase technique. This method was also used to demonstrate the presence of cytokeratins in the neoplastic cells and the squamous and columnar epithelia within the teratoma. These results are consistent with the suggestion that APUD cells of foregut type may be of endodermal rather than neuroectodermal origin.

Adult↗
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Monoclonal antibody to aldolase C: a selective marker for Purkinje cells in the human cerebellum.

A monoclonal antibody to the glycolytic enzyme aldolase C was used in an immunoperoxidase technique on unfixed and formalin-fixed paraffin-embedded tissues from the human central nervous system (CNS) and other tissues. No staining outside the CNS was detected. In the central nervous system the antibody gave a selective and intense staining of Purkinje cell perikarya, axons and dendrites in both fixed and unfixed tissues. In the human fetal brain, positive staining of Purkinje cells was seen from 35-36 weeks' gestation onwards. This coincides with the conversion of Purkinje cells to a tetraploid state, and may reflect increased glycolytic activity accompanying the rapid dendritic growth at this stage of development. Preliminary investigations on a variety of disease states suggest that this antibody may be useful in studies of ischaemic damage, congenital abnormalities and degenerative conditions affecting the cerebellum.

Adult↗