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Biomedical subjects

C E Lewis

Publications and source records attributed to C E Lewis.

At least 91 records · Page 5Linked to original sources
PubMed1996

Effects of gender and comorbidity on problem drinking in a community sample.

We investigated the influence of gender, comorbidity, drinking history, and age on the clinical manifestations of DSM-III alcohol abuse and/or dependence in men and women. The sample was drawn from the National Institute of Mental Health Epidemiologic Catchment Area study, a large-scale, multicenter survey to investigate psychiatric disorders in the community. The results showed that gender and comorbidity had independent effects on problem drinking after drinking history and age had been taken into account. Gender contributed to the age of onset of problem drinking and the rate of its development. Comorbidity, drinking history, and age contributed independently to its severity. The effects of these variables in this community sample paralleled those reported in treatment samples.

Adult↗
PubMed1996

Organizing the community to target poor Latino children with asthma.

A community-university partnership to improve outcomes of care for poor Latino children (aged 6-14 years) with asthma in East Los Angeles was based on development of a community infrastructure. A family-centered educational program involved over 500 families. The Association of Latinos with Asthma and Allergy Symptoms (ALAAS) was formed. Parents report reductions in hospitalizations, emergency room, and acute care visits. Survival of the infrastructure following the end of grant funds is unlikely unless other resources offset the costs of volunteerism among poor families. Block grants to community agencies from established fund-raising groups might reduce dependency-producing practices currently employed to "help" the poor.

Adolescent↗
PubMed1996

Assessing the expected outcomes of orthopedic surgical care for children.

A sample of 175 parents of children treated operatively for orthopedic problems were interviewed before surgery to ascertain their expectations with regard to specific functional changes postoperatively. They were interviewed about changes from 6 to 12 months after surgery. Medical records of a sample of this group were reviewed for any notes about functional status. Of this group, 54% said a specific function named preoperatively was "much better." Only a third of the parents from Mexico understood the nature of the procedure performed 6 to 12 months postoperatively, and only 40% of medical records contained notes about functional status pre- or postoperatively.

Adolescent↗
PubMed1996

AIDS-related experiences of primary care physicians in rural California, 1995.

A telephone survey was conducted of primary care physicians in nonmetropolitan counties of California. In a random sample of those counties reporting fewer than 30 cases of the acquired immunodeficiency syndrome (AIDS) as of December 1994, all physicians in practice were called; in counties reporting from 31 to 150 cases of AIDS as of the same date, a 30% random sample was selected for interviewing. Completion rates were 82% in the smallest counties and 70% in the larger counties (overall 72%). Two thirds of physicians reported that they had seen a patient positive for the human immunodeficiency virus and were providing continuing care for the disease. In all, 60% of physicians had seen a patient with AIDS. In these counties, there were 653 primary care physicians and 873 patients living with AIDS. The proportion of physicians providing care to persons with AIDS was twice that reported in previous surveys done in Los Angeles, California. In the interval (1985-1994), there was a 20-fold increase in the number of AIDS cases in California. In the nonmetropolitan areas, the number of AIDS cases in late 1994 was 290 times that reported in 1985.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Correlates and predictors of weight loss in young adults: the CARDIA study.

OBJECTIVE: To determine associations of sociodemographic characteristics, behaviors, attitudes and medical factors with weight loss in a population-based biracial cohort of young adults. DESIGN: Two-year longitudinal observation study. SUBJECTS: 4278 black and white men and women aged 18-30 years in 1985-1986. MEASUREMENTS: Weight, height, education, income, subscapular skinfold thickness, waist and hip circumferences, medical history, smoking, physical activity, dietary energy, fat and alcohol intake, physical fitness measured by treadmill testing, self-reported dieting, history of weight loss and regain, perception of body size and belief in health consequences of overweight. RESULTS: Weight loss, defined as reduction of 5% or more of baseline weight, occurred in 8.9% of the cohort, ranging from 4.9% among white men who were not overweight at baseline to 21.5% among white women who were overweight. Weight loss was more common in women than men and in overweight white women than overweight black women. Although findings differed among the four race-sex groups, weight loss was generally associated with greater baseline fatness, lower baseline physical fitness level, self-perception of being overweight, dieting and previous weight loss and regain. Greater baseline fatness, a perception of being overweight and dieting were also associated with weight gain. Among the overweight, low baseline fitness and an increase in physical activity were the factors most consistently associated with weight loss. CONCLUSION: Weight loss in young adults varies by race, sex and body weight and is associated with a variety of behaviors and attitudes, some of which are also associated with weight gain and, thus, may be associated with weight fluctuation.

Adolescent↗
PubMed1995

Lack of association of recreational cocaine and alcohol use with left ventricular mass in young adults. The Coronary Artery Risk Development in Young Adults (CARDIA) study.

OBJECTIVES: This study examined the associations of left ventricular mass with self-reported cocaine and alcohol use prevalent in the young adult population. BACKGROUND: Increased left ventricular mass has been associated with long-term use of cocaine and alcohol; however, few of the published studies have been population based. METHODS: Data from 3,446 black and white participants (mean age 29.9 years) in the Coronary Artery Risk Development in Young Adults (CARDIA) study were used to examine the associations between echocardiographically measured left ventricular mass obtained from 1990 to 1991 and self-reported cocaine and alcohol use. Categories of cocaine use were those who denied ever using cocaine (n = 2,122), experimental users who admitted to cocaine use only 1 to 10 times in their lifetime (n = 755) and recurrent users who admitted to cocaine use > 10 times in their lifetime (n = 568). For alcohol consumption, categories were abstainers who consistently denied any alcohol consumption in the year before each of the three CARDIA examinations (n = 275), occasional users who admitted consuming alcohol less than once a week or not at all during the year before the third examination (n = 1,322), moderate users who consumed 1 to 209 ml of alcohol/week during the year before the third examination (n = 1,524) and heavy users who consumed > or = 210 ml of alcohol/week during the year before the third examination (n = 323). Estimated power to detect a 10% difference in left ventricular mass between groups was > 80%. RESULTS: For white women, left ventricular mass was significantly higher among those who reported 1 to 10 lifetime uses of cocaine than in never-users (128.5 g [SE 2.0] vs. 122.7 g [SE 1.4], p = 0.002). There were no other significant differences in left ventricular mass among categories of cocaine or alcohol use in unadjusted analyses or among analyses controlling for age, body mass index, alcohol or cocaine use, physical activity, cigarette smoking status and systolic blood pressure. CONCLUSIONS: At the levels of consumption reported, neither cocaine nor alcohol use was associated with left ventricular mass in this cohort of healthy young adults.

Adolescent↗
PubMed1995

Cytokine regulation of angiogenesis in breast cancer: the role of tumor-associated macrophages.

Studies over the past 20 years have established that the development of new capillaries from an existing vascular network (a process called angiogenesis) is an essential component of tumor growth. Malignant tumors do not grow beyond 2-3 mm3 in size unless they stimulate the formation of new blood vessels and thus provide a route for the increased inflow of nutrients and oxygen and outflow of waste products. Tumor angiogenesis also provides an essential exit route for metastasizing tumor cells from the tumor to the bloodstream. Indeed, extensive neovascularization is a poor prognostic factor in several forms of human cancer. Angiogenesis is a complex, multistep process driven by many local signals within the tumor. This involves the degradation of the extracellular matrix around a local venule after the release of collagenases and proteases, the proliferation and migration of capillary endothelial cells, and their differentiation into functioning capillaries. Cytokines produced by various cell types present within the microenvironment of solid tumors form a complex, dynamic network in which they have multiple effects on tumor progression. Herein we review our work on the presence, and possible regulatory influence on tumor angiogenesis, of a number of these cytokines within invasive breast carcinomas. We have combined immunocytochemistry with a single cell cytokine release assay called the reverse hemolytic plaque assay to investigate the cellular sources of the key angiogenic cytokines, vascular endothelial growth factor, basic fibroblast growth factor, and tumor necrosis factor-alpha. Tumor-associated macrophages in the stromal compartment of these tumors and/or malignant epithelial cells were seen to be a major producer cell for these cytokines, whereas tumor necrosis factor-alpha receptors were expressed by leukocytes, malignant cells, and endothelial cells in tumor blood vessels.

Antigens, CD↗
PubMed1995

Giant cell reparative granuloma of the concha bullosa.

Giant cell reparative granuloma is a benign lesion occurring most commonly in the bones of the jaw and rarely in the paranasal sinuses. We present an unusual case of giant cell reparative granuloma arising within a concha bullosa. Complete excision was achieved using an endoscopic transnasal approach.

Female↗
PubMed1995

Predictors of mortality in alcoholic men: a 20-year follow-up study.

This study investigates the predictors of mortality in 156 male alcoholics who were psychiatrically hospitalized between 1967 and 1968 and followed for > 20 years. The findings showed that an older age, liver cirrhosis, and separation or divorce at intake were all associated with a shorter time to death. These results corroborate those of other follow-up studies that have identified age, health, and social support as independent correlates of mortality in alcoholics. From a therapeutic standpoint, the most alterable predictor is social support. Thus, the establishment of a salutary social network and social support system should be an integral part of the alcoholic's treatment plan.

Alcoholism↗
PubMed1995

Assessing gender interactions in the prediction of mortality in alcoholic men and women: a 20-year follow-up study.

This study investigates the predictors of mortality in 259 male and female alcoholics who were psychiatrically hospitalized between 1967 and 1968 and followed for > 20 years. The findings showed that, in addition to age, marital status, medical complications, and non-antisocial personality comorbidity were important independent predictors of time to death. Data pointed to gender interactions, in that marital disruption tended to be a stronger predictor of mortality in men, and delirium tremens tended to be a stronger predictor of mortality in women. Knowing and understanding that certain events and processes may differentially affect the survival of male and female alcoholics will allow for the development of more individualized and gender-specific therapeutic interventions.

Adult↗
PubMed1995

Fear of HIV contagion as workplace stress: behavioral consequences and buffers.

This article conceptualizes employees' fears for their health on the job as a form of stress with a collective, detrimental impact on work behavior. It tests a job-control of stress reduction that focuses on reducing uncertainty. Results indicate that fear levels are lower in organizations that have policies providing employees with certain types of information about the stressor. Analysis reveals that mechanisms conveying explicit information, rather than information that is indirect or implied, have the strongest association with lower fear levels. Hypotheses are tested in the context of nursing staff fears of contagion from HIV-infected patients, using data from 558 randomly selected hospitals nationwide. Implications for the policymaking dilemma of conflicting rights to privacy and disclosure are discussed.

American Hospital Association↗
PubMed1994

Longitudinal changes in adiposity associated with pregnancy. The CARDIA Study. Coronary Artery Risk Development in Young Adults Study.

OBJECTIVE: To examine the longitudinal associations between a pregnancy and persistent changes in adiposity in young black and white women. DESIGN: Prospective cohort study with 5 years of follow-up. SETTING: Participants recruited by community-based sampling (Birmingham, Ala; Chicago, Ill; and Minneapolis, Minn) and through the membership of a large prepaid health care plan (Oakland, Calif). PARTICIPANTS: A total of 2788 women (53% black) aged 18 through 30 years were assessed at baseline (1985 through 1986) and reassessed at examination 2 (91% retention; 1987 through 1988) and examination 3 (86% retention; 1990 through 1991). Women who remained nulliparous (n = 925) during the 5-year follow-up were compared with women who had a single pregnancy of 28 weeks' duration during that period and who were at least 12 months postpartum at follow-up (primiparas, n = 89; multiparas, n = 114). MAIN OUTCOME MEASURES: Change in body weight and in waist-to-hip ratio during the 5-year period. Analyses were adjusted for demographic factors (age and education), behavioral variables (smoking and physical activity), and baseline level of adiposity. RESULTS: Primiparas within both race groups gained 2 to 3 kg more weight during the 5-year period than did nulliparas in both adjusted and unadjusted analyses. Primiparas also had greater increases in waist-to-hip ratio that were independent of weight gain. Multiparas did not differ from nulliparas in adiposity change in either race group. At each level of parity, black women demonstrated greater adverse changes in adiposity than did white women. CONCLUSIONS: These data suggest that women experience modest but adverse increases in body weight and fat distribution after a first pregnancy and that these changes are persistent.

Adipose Tissue↗
PubMed1994

Non-isotopic in situ detection of mRNA for interleukin-4 in archival human tissue.

Non-isotopic in situ hybridisation (NISH) is a rapid and sensitive method currently used in molecular pathology to identify DNA in fresh and archival human biopsies. In this study we have extended NISH technology for mRNA detection to include the use of digoxigenin-labelled riboprobes to localise low abundance mRNA for interleukin-4 in paraffin embedded material (from active inflammatory bowel disease). As this methodological approach makes the retrospective study of cytokine gene expression in archival material possible for the first time, it could act as a prototype for studies of cytokine involvement in various human diseases.

Colitis, Ulcerative↗
PubMed1994

The termination of a randomized clinical trial for poor Hispanic children.

OBJECTIVE: To conduct a randomized clinical trial of the Spanish version of an educational program designed to be an adjuvant to adequate medical care of children with asthma. DESIGN: Randomized, clinical trial. SETTING: Los Angeles County, Calif. PARTICIPANTS: One hundred thirty-eight Hispanic children, ages 7 to 12 years, from disadvantaged families. All had used emergency facilities of major local hospitals in the previous year. MEASUREMENT/MAIN RESULTS: As the study proceeded, it became apparent that subjects were receiving inadequate medical and nursing care and had numerous barriers to applying knowledge and self-care skills gained from the program. Realizing this, we considered it unethical to allow the control children to suffer for the duration of the trial (1 year). Therefore, all children received "adequate" care from the research staff, and the randomized clinical trial, as originally designed, was ended. The emergency department/hospital use by both groups was significantly reduced compared with previous experience. CONCLUSION: Those researchers conducting randomized trials involving poor children should be aware of the potential ethical problems inherent in such ventures.

Asthma↗
PubMed1994

Associations of body mass and body fat distribution with parity among African-American and Caucasian women: The CARDIA Study.

Associations of parity with body fat and its distribution are poorly understood; therefore, we examined the relationships between parity and obesity in young adult women. Body mass index (BMI), skin-folds, and waist-hip ratio were compared in 1452 African-American and 1268 Caucasian nonpregnant women aged 18 to 30, adjusting for age (where no age-parity interactions were present), education, physical activity (assessed by questionnaire) and fitness (assessed by graded exercise test), dietary fat intake, alcohol and smoking. Adjusted mean BMI was significantly higher in African-American women aged 25-30 years with three or more children (28.5 kg/m2) than in those with two (27.0 kg/m2), one (26.2 kg/m2), or no children (26.3 kg/m2). Similar trends were found in Caucasians (BMI = 23.3, 23.4, 23.7, 25.0 kg/m2 for parity = 0, 1, 2, > or = 3, respectively), but the mean BMI was significantly higher in African Americans in each parity group. The association between BMI and parity was not present among women 18-24 years of age. Skinfolds were directly associated with parity in African Americans only. Waist-hip ratios were generally lower among nulliparous than parous women in both ethnic groups; race differences were present only among nulliparas. In conclusion, parity was associated with BMI in women aged 25 to 30 years but did not explain ethnicity-related differences in body mass.

Adipose Tissue↗
PubMed1994

Cytokine networks in solid human tumors: regulation of angiogenesis.

The isolation, purification, and molecular cloning of an increasing number of cytokines and their receptors have allowed major advances in our understanding of the relevance of these proteins to the pathobiology and treatment of such human diseases as neoplasia. Cytokines produced by the multiple cell types present within the microenvironment of solid tumors from a complex, dynamic network, in which they have overlapping properties, induce other cytokines and alter the expression of soluble and cell surface-bound cytokine receptors. A broad number of such intratumoral cytokines have multiple effects on tumor progression. These include direct and indirect effects both on tumor cell growth and metastatic behaviors and on such cells in the stromal compartment as fibroblasts, infiltrating immune cells, and endothelial cells in the microvasculature. Here, we review the sites of production and multifaceted role of several key cytokines in the stimulation of a new blood supply within growing neoplasms. The clinical implications and new therapeutic targets suggested by this rapidly emerging picture of the cellular and molecular mechanisms subserving tumor angiogenesis are also discussed.

Cytokines↗