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Biomedical subjects

C E Lewis

Publications and source records attributed to C E Lewis.

At least 163 records · Page 9Linked to original sources
PubMed1987

The influence of domestic position on health status.

Data from the Robert Wood Johnson Foundation 1982 survey of access to health care are used to examine the influence of household composition and members' domestic position--e.g. age, sex, marital status, and presence of children, on health status and use of health services. A hierarchical analysis was undertaken to sort groups of individuals and households having different domestic structures. The results of the analyses of use and access for these groups show that, after controlling for age, domestic position and household arrangements are significant explanatory variables. Ways to refine the approach are discussed.

Adolescent↗
PubMed1987

The antisocial and the nonantisocial alcoholic: clinical distinctions in men with major unipolar depression.

Depressed, alcoholic men were divided into those with and those without antisocial personality (ASP). The ASP alcoholics had a more severe, cross-sectional clinical picture; they had a higher rate of drug use disorder and more alcohol-related symptomatology. The medical complications of alcoholism were related to the duration of heavy drinking whereas the nonmedical complications (the psychosocial and pathologic-intake problems) were related to ASP, duration of heavy drinking, and their interaction.

Adult↗
PubMed1987

ACT-asthma control y tratamiento para niños: a progress report.

A randomized clinical trial is in progress to evaluate an asthma educational program for Latino children and their parents. The intervention, "ACT-Asma Control y Tratamiento Para Niños," was adapted from ACT for Kids, an asthma self-management program for English-speaking families. Results of a pilot study indicated that socioeconomic status was a critical variable to be considered in the design of such programs. Latino children and parents encounter significant barriers to access and continuity of medical care. Therefore, the intervention was redesigned to include "linkages" using a nurse to reduce barriers and to coordinate care. The lesson plans emphasize concrete, experimental learning experiences, with repetition of key points in each session.

Asthma↗
PubMed1987

AIDS-related competence of California's primary care physicians.

We conducted a telephone survey of a random sample of primary care physicians practicing throughout the State of California to determine their AIDS-related experiences and competencies. Interviews were completed early in 1986 with 1,000 family and general practitioners and internists, 60 per cent of those eligible. Data on practice experiences reflect the increased incidence of AIDS (acquired immunodeficiency syndrome) in Los Angeles and San Francisco. The proportion of practitioners in rural areas who evaluated possible cases (17 per cent), and counseled patients at risk (50 per cent) indicated the generalized nature of the problem. Compared to similar data obtained in 1984, levels of competency in diagnosing and counseling persons with AIDS-related disorders increased in Los Angeles. However, on a statewide basis, a majority of those interviewed lack the AIDS-related knowledge and skills required to carry out their roles in dealing with AIDS. Competency was associated with physicians' personal and professional characteristics and their level of discomfort in dealing with homosexuals.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Gender trends in the career patterns of recent dental graduates.

The gender composition of U.S. dental schools has changed dramatically over the past 25 years. While women represent less than 10 percent of the practicing dental population, the dramatic increase in dental school enrollment by women will be reflected in a much larger percentage of female dental practitioners in the near future. It is not clear how this trend will affect the structure and organization of the dental profession or the delivery of dental care. This study examined gender differences among recent dental graduates' professional commitment, choice of practice arrangements, and income. The data consist of a random sample of 1979, 1980, and 1981 graduates of U.S. dental schools with an adjusted response rate of 77.6 percent (n = 2,648 males and 346 females). Findings include statistically significant gender differences in mean annual income from private practice, administration, or teaching of dentistry; total family income before taxes; employment status in private practice; marital status, and the number of children under 18 years of age. A gender difference of fewer than four hours worked per week, while statistically significant, is less than previous reports in the literature. Gender remained as a statistically significant predictor of income when controlling for practice ownership, hours per week worked, background, and family/social variables. These findings have policy implications for dental resource planning, organized dentistry, dental education, and the delivery of dental care.

Career Choice↗
PubMed1987

Faculty development in general internal medicine. Perceptions concerning academic survival.

To understand the educational needs of faculty general internists in academic hospital environments, surveys of general internal medicine division chiefs, department of medicine chairmen, and members of the Society for Research and Education in Primary Care Internal Medicine were undertaken. Results indicated considerable interest in faculty development activities among all physicians sampled. Division chiefs and department chairmen viewed such activities as feasible, potentially effective, and were willing to assume considerable responsibility in providing educational opportunities to their faculty. Although some physicians viewed self-learning as a potentially effective educational method, the vast majority preferred learning in a small group taught by an expert. Specific content areas for faculty development were assessed, as were the skills thought to be essential for personal job satisfaction, academic promotion, and organizational effectiveness.

Attitude of Health Personnel↗
PubMed1987

The sexual history-taking and counseling practices of primary care physicians.

As part of a statewide survey of experiences related to the acquired immunodeficiency syndrome and competencies of a random sample of primary care physicians in California done in early 1986, we interviewed 1,000 internists, family and general practitioners about their sexual history-taking and counseling practices. Less than 4% have patients complete a history form that includes questions about sexual orientation or practices, and only 10% ask new patients questions specific enough to identify those at high risk of exposure to the human immunodeficiency virus. Internists, women and younger physicians and those expressing little discomfort in dealing with gay men more often took adequate sexual histories and gave appropriate advice. Among those physicians with patients at risk of becoming infected, only half recommended the use of condoms and 60% advised a reduction in the number of partners. More than 15% recommended abstention from sexual intercourse, and 8% suggested these patients should switch to a heterosexual life-style.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Comparison of respiratory triggering and gating techniques for the removal of respiratory artifacts in MR imaging.

Respiratory movement degrades magnetic resonance (MR) images of the chest and abdomen by increasing noise through the production of "ghost" artifacts and by decreasing edge sharpness in moving structures. Respiratory gating, which limits data acquisition to end-expiration, is successful in restoring edge sharpness and reducing ghosts but increases imaging time two to three times, which limits its use to sequences with short repetition times (TRs). To overcome this limitation, an alternative technique, respiratory triggering, was developed, which triggers the acquisition of an MR section at a fixed point on the respiratory cycle. This technique restores edge sharpness and reduces ghosts, but unlike gating, it can be used to produce an image at any phase of the respiratory cycle. Triggering requires long TRs since the TR is limited to the respiratory period (TP) or one-half of TP, depending on whether the same section is triggered once or twice during a single respiratory cycle. Gating and triggering were evaluated and compared for single-section and multi-section imaging of both volunteers and patients. The authors conclude that when a chest or abdominal survey is required, triggering takes less time than gating if TRs are required that exceed one-fifth of TP.

Abdomen↗
PubMed1986

Hyperprolactinemia induced by pituitary isografts suppresses the priming effect of LH-releasing hormone in normal and hypogonadal mice.

We have investigated the effects of hyperprolactinemia, produced by pituitary isografts under the kidney capsule (16-20 days), on the LH releasing action and priming effect of LH-releasing hormone (LHRH) in normal and hypogonadal (hpg) female mice. The pituitary grafts increased the plasma prolactin concentrations about 3-fold in normal intact mice and 4-fold in hpg mice. The extent of the graft-induced hyperprolactinemia was reduced by ovariectomy in normal mice, but was the same in grafted hpg compared with intact normal mice despite the absence in the hpg mice of functioning ovaries. The priming effect of LHRH could be elicited in both types of mice by giving two injections of LHRH separated by an interval of 60 min. Hyperprolactinemia did not reduce the amount of LH released in response to a first injection of LHRH, but did reduce significantly the amount of LH released (primed) in response to a second injection of LHRH. Ovariectomy significantly increased the magnitude of the releasing action of LHRH in normal mice and prevented the graft-induced reduction of LHRH priming. These results show that hyperprolactinemia in normal and hpg mice suppresses the magnitude of the priming effect of LHRH. This may be an important mechanism by which prolactin reduces gonadotropin secretion.

Animals↗
PubMed1986

Changes in the granule population of gonadotrophs of hypogonadal (hpg) and normal female mice associated with the priming effect of LH-releasing hormone in vitro.

Changes in the size and position of secretory granules in pituitary gonadotrophs have been studied in relationship to LH release and self-priming induced by LH-releasing hormone (LHRH) in pituitary glands from normal and hypogonadal (hpg) female mice. Hemipituitary glands were preincubated and then incubated for either 1 or 2 h in the absence or presence of LHRH (8.5 nmol/l). The glands were either processed for ultrastructural morphometry or homogenized for the determination of pituitary LH content. Morphometry was carried out on gonadotrophs identified by immunocytochemistry for LH beta using the thin/semi-thin section method. Pituitary LH content and the amount of LH released were determined by radioimmunoassay. The amount of LH released in response to the first and second hours of incubation with LHRH were similar in hpg and normal mice with a clear priming effect (three- to fourfold increase in pituitary responsiveness to LHRH) occurring in both strains. Despite a substantially reduced total number of granules (and amount of LH) in unstimulated hpg gonadotrophs, the number of granules in the outer 500 nm marginal zone of the cells was similar to that in normal mice. This could explain the similar amount of LH released from normal and hpg glands by the first LHRH challenge. The initial exposure to LHRH was also associated with a marked translocation of secretory granules from the central to the outer marginal region of cytoplasm subjacent to the gonadotroph plasmalemma, such that in 'primed' glands 60% of granules were found in this marginal zone compared with 40% (hpg) or 33% (normal) in unstimulated glands. The mean diameter of granules in the marginal zone was significantly less than that of granules in the central zone of the gonadotrophs of unstimulated glands from both normal and hpg animals. Exposure to LHRH for 1 h was associated with an increase in the number of small granules in the marginal zone and a significant decrease in the mean diameter of the gonadotroph granule population as a whole. After the primed release of LH, increased proportions of granules were still located in the marginal zone of gonadotrophs, indicating that granule migration continued during the second hour of exposure to LHRH in which primed release occurred. The primed release was associated with a detectable reduction in both the LH and granule content of gonadotrophs in normal, but not hpg glands.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1986

Multiple injections of LH-releasing hormone into hypogonadal (hpg) mice induce the appearance of two morphologically distinct populations of gonadotrophs.

We have investigated the effects of multiple 2-hourly injections of LH-releasing hormone (LHRH) on the number and size of the gonadotrophs and gonadotroph secretory granules, and the lipid content of gonadotrophs in the pituitary glands of intact and gonadectomized male and female hypogonadal (hpg) mice. Gonadotrophs were identified by immunocytochemistry for LH beta, and the size and secretory status of the gonadotrophs were assessed by quantitative ultrastructural analysis of immunoidentified gonadotrophs. The administration of 60 ng LHRH by subcutaneous injection every 2 h for 15 days resulted in an increase in the number, size and granule content of LH beta-immunoidentified gonadotrophs of hpg mice to values found in normal adult mice. Large lipid droplets accumulated in 30-40% of the gonadotrophs in both male and female LHRH-treated hpg mice. Although lipid-containing gonadotrophs were larger than lipid-free cells in all LHRH-treated groups irrespective of the presence or absence of gonads, a marked difference in the number, position within the cell, and size of the secretory granules between the lipid-containing and lipid-free cells was found only in the pituitary glands of intact LHRH-treated hpg females. These results demonstrate: (a) that the effects of multiple injections of LHRH on the morphology of the gonadotrophs of hpg mice is not dependent on the presence of functioning gonads, although ovarian factors are required for the full development of morphological, and hence possibly functional, heterogeneity in the gonadotroph population in female animals, and (b) that, although multiple injections of LHRH in hpg mice are more effective than single daily injections of LHRH in stimulating pituitary-gonadal function, there is no obvious difference in the morphologically recognizable effects that these two modes of administration have on the pituitary gonadotrophs.

Animals↗
PubMed1986

The practices of general and subspecialty internists in counseling about smoking and exercise.

We compared the practices of subspecialists and general internists in counseling about smoking and exercise, using data from a study of recent graduates of United States training programs in internal medicine. Information on the characteristics of physicians and their clinical practices was obtained from self-report questionnaires. The internists most likely to counsel smokers regardless of the presence or absence of diseases associated with smoking are cardiologists, pulmonary specialists, nephrologists, and generalists trained in a primary care residency funded by the Robert Wood Johnson Foundation or Health Resources Administration. Most internists practice tertiary prevention by counseling a high percentage of smokers with heart or lung disease. Rheumatologists counsel a higher percentage of all patients with poor exercise habits but a lower percentage of such patients with heart disease than do other internists. The differences in counseling related to training are not explained by different levels of involvement as a primary care physician. Rather, these differences appear to reflect training and subspecialty-specific priorities for counseling.

Adult↗