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Biomedical subjects

C Lewis

Publications and source records attributed to C Lewis.

At least 163 records · Page 9Linked to original sources
PubMed1994

Assessment of general practitioners' management of hyperlipidaemia. A study using personal visits and a scenario-based questionnaire.

In summary our study has looked at the current management practices of hyperlipidaemia by general practitioners in an innovative way. Our results suggest that most GPs are managing this condition appropriately. Where their management differs from current guidelines is mainly in introducing medication early. We obtained significantly lower participation rates in the metropolitan as compared with the regional and rural areas, but we found no significant differences in the overall assessment of appropriate management between the different geographical regions of Victoria.

Data Collection↗
PubMed1994

Evaluation of two AIDS education programs for impoverished Latina women.

This paper evaluates and contrasts the effectiveness of two culturally sensitive AIDS education programs developed by the UCLA AIDS Nursing Network and delivered to 213 impoverished Latina homeless or drug-addicted women in Los Angeles. The Comprehensive Health Seeking and Coping Paradigm guided the program, which was implemented by specially trained Latina nurses and outreach workers. A quasi-experimental design was employed where women were randomized by site into Specialized (N = 82) and Traditional (N = 131) programs. Repeated measures ANOVAS and log-linear models were used to evaluate improvement over a two-week period for women in both groups and to identify interactions with program type. Two-week posttest analyses were also conducted to assess program effectiveness, controlling for baseline values of the measure in question, nonequivalency between groups at baseline, and selected demographic characteristics, including acculturation. Results indicated that women in both AIDS education programs improved significantly in cognitive, behavioral, and psychologic outcomes.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Access to prenatal care following major Medicaid eligibility expansions.

OBJECTIVE: To determine whether lack of financial access was a significant barrier to prenatal care following major expansions of Medicaid eligibility in California. DESIGN: Retrospective analysis of birth certificates, assessing risks of inadequate prenatal care by insurance, controlling for maternal race/ethnicity, birthplace, age, parity, education, and marital status. SAMPLE: Singleton live births to California residents occurring in-state in 1990 (N = 593,510). OUTCOME MEASURES: Untimely initiation of care, two few visits, and no prenatal care. RESULTS: Despite major Medicaid expansions, nearly 11% of live births were uninsured for prenatal care. Being uninsured and having Medi-Cal were both risk factors of sizable magnitude, controlling for maternal characteristics. Compared with women who had private fee-for-service coverage, uninsured women were at elevated risk of untimely initiation (odds ratio [OR], 2.54; 95% confidence interval [CI], 2.47 to 2.60) and too few visits (OR, 2.49; 95% CI, 2.44 to 2.55). Women with Medi-Cal had a high risk of untimely care (OR, 3.33; 95% CI, 3.26 to 3.40); their risk of too few visits was also elevated (OR, 1.63; 95% CI, 1.60 to 1.66) but less than for the uninsured. Lack of private insurance was a strong risk factor for no care (OR, 6.70; 95% CI, 6.00 to 7.47). CONCLUSIONS: In spite of major Medicaid expansions, access to prenatal care was limited for women without private insurance. Medicaid was associated with untimely entry but with improved continuity. The findings suggest that financial barriers were salient even when controlling for many factors related to care-seeking behavior. Policy initiatives need to address continuing financial barriers along with other obstacles.

Adolescent↗
PubMed1993

Differences in the requirement of antigen-presenting cells for long-term growth among cytomegalovirus-specific Th clonotypes.

Functional and molecular studies of in vivo-activated T lymphocytes involved in normal and abnormal immune responses, i.e., cells infiltrating tissues affected by autoimmune processes, require their previous in vitro expansion. Problems such as unavailability of specific antigen(s) (Ag) and/or the requirement of large amounts of autologous peripheral blood mononuclear cells (PBMC) as feeders have prompted the development of alternative expansion methods that circumvent the use of antigen-presenting cells (APC) and/or Ag. We have previously shown that cytomegalovirus (CMV)-specific T cell lines and clones can be efficiently propagated in long-term cultures by stimulation with agonistic monoclonal antibodies (mAb) coated onto polystyrene particles in the absence of APC. However, this and other stimulation protocols may skew the repertoire of clonotypes that proliferate in response to nominal Ag and APC. Here we show that polyclonal populations of CMV-primed and interleukin-2 (IL-2)-stimulated PBMC undergo the same clonotypic selection when induced to grow both by continuous stimulation with CMV and an anti-CD3 mAb presented by APC. This selection, reproduced in three independent expansion experiments, involved the dominant growth of two CMV-specific, IL-2-secreting CD4+ clonotypes sharing J alpha, J beta, V alpha and V beta genes and highly homologous T cell receptor (TcR) junctional sequences. The dominant growth of these 2 clonotypes required a direct T cell/APC interaction since when coated onto polystyrene particles the same mAb induced the selective expansion of another IL-2-secreting CD4+ CMV-specific clonotype expressing a different, yet homologous, TcR heterodimer (used same V alpha and V beta genes), which was underrepresented before expansion (5 vs. 58%). T cell clones belonging to the subdominant clonotype proliferated significantly faster in response to stimulation with anti-CD3 mAb coated onto beads than in response to stimulation with CMV or anti-CD3 mAb presented by APC, possibly due to long-term expansion without APC or antigen. In contrast, neither the dominant clonotypes nor unprimed T cells were able to undergo CD3-mediated expansion in the absence of APC. We conclude that quantitative differences in growth competency among normal Ag-activated T-helper (Th) clonotypes in response to antigenic stimulation can be reproduced by stimulation through the TcR in the absence of TcR occupancy but only in the presence of APC and that certain clonotypes do not require APC for long-term growth in vitro. These data have practical implications for the isolation and repertoire characterization of in vivo-activated T cells from tissues affected by inflammatory, i.e. autoimmune, phenomena.

Amino Acid Sequence↗
PubMed1993

Outcomes of specialized and traditional AIDS counseling programs for impoverished women of color.

The efficacy and differential effects of specialized (S) and traditional (T) AIDS education programs on cognitive, behavioral, and psychological outcomes were investigated. The sample consisted of 858 impoverished African-American and Latina women (S = 448, T = 410). At baseline, women in the traditional group reported significantly higher distress, greater knowledge of AIDS, and less problem-focused coping. Significant improvements over the 2-week intervention interval were found for participants of both AIDS education programs for appraisal of threat, concerns, knowledge, and attitudes about AIDS, emotion-focused coping, number of sexual partners, IV and non-IV drug use, depression, and distress. However, multivariate analysis indicated that the traditional group had slightly better posttest scores on concerns, emotion-focused coping, knowledge of AIDS, and number of partners than the specialized group. The specialized group reported greater use of problem-focused coping. These differences do not detract from the substantial improvement found for both groups, but they do reinforce the conclusion that the specialized program was not more effective than its standard counterpart.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Sex and drugs and nuclear war: secular, developmental and type A influences upon adolescents' fears of the nuclear threat, AIDS and drug addiction.

Researchers are divided over the significance of teenagers' expressed fear of nuclear war. This study of 3556 secondary school pupils examined whether (1) fear of nuclear war remains a feature of adolescent concern during the current east-west détente; (2) the examination of responses in a large sample reveals age and sex differences in such expressed fears; (3) worry about 'real world' issues like nuclear war, AIDS and drug addiction relates more generally to Type A proneness in adolescents. The results suggest that fewer teenagers spontaneously raise fear of nuclear war than in previous "pre-Glasnost" research in Britain, that such concern is expressed differentially according to the child's age and sex and that secondary school pupils who express concern about nuclear war and AIDS are more likely to show significantly higher Type A identification.

Acquired Immunodeficiency Syndrome↗
PubMed1993

When is a mug not a mug? Effects of content, naming, and instructions on children's drawings.

Two hundred seventy 5-year-old children produced a copy drawing of a transparent glass mug with its handle turned away. In a factorial design three factors were manipulated to examine their additive or independent influence on the child's production of either view-specific or canonical (i.e., with the handle at the side) depictions: the content of the mug, the label used to describe it, and the explicitness of instruction. The results showed, first, that each of these variations in task demands exerted an influence on the canonicality/view-specificity of the children's drawings. Second, these influences were both facilitative and prohibitive. So, for example, general instructions prompted canonical drawings, while very explicit instructions elicited view-specific depictions. Third, each factor exerted an independent influence upon whether or not the handle was included--there were no interactions between factors on the production of the two types of picture. These results provide further evidence against simple associations between children's drawings and their cognitive abilities. They suggest that what children produce in studies of "drawing" may well simply inform us about the development of an understanding of adults' communicative intent.

Age Factors↗
PubMed1993

Molecular heterogeneity of a Graves' thyroid-infiltrating T cell population rich in CD8+ and gamma delta+ T cells.

We report here on the isolation and repertoire characterization of a Graves' thyroid T cell population which, unlike most Graves' thyroid T cell isolates reported before, was rich in CD4-CD8- T cells (16%, all TcR gamma delta+) and CD8+ T cells (75%) [TcR alpha beta+ (59%) and TcR gamma delta+ (16%)]. Only 7% of the isolated T cells were CD4+. By contrast, < 2% of peripheral blood mononuclear cells from the same patient were gamma delta+ and < 14% were CD8+. Sequence analysis of 18 TcR delta cDNAs prepared from these cells indicated the presence of at least 17 different gamma delta+ T cell clonotypes with molecularly heterogeneous antigen-binding site sequences. As opposed to most peripheral blood gamma delta+ T cells (express V delta 2 TcRs), 13 of the 17 different TcR delta clonotypes used a V delta 1 gene, although PCR amplification of TcR gamma- and TcR delta-specific cDNAs with V delta- and V gamma-gene family-specific oligonucleotides confirmed usage of all 4 V gamma and all 6 V delta families. Sequence analysis of 21 TcR alpha cDNAs from a TcR alpha-specific cDNA library indicated the presence of at least 12 different clonotypes, using 8 different V alpha gene families and heterogeneous antigen-binding site sequences. These results are in contrast with the selective V alpha gene usage reported for other intrathyroidal T cell subpopulations in autoimmune thyroid disease.

Adolescent↗
PubMed1993

The first transplantation of the lung in a human revisited.

The first homotransplantation of the lung in a human was performed in early 1963, thirty years ago. It is the purpose of this review to evaluate the significance of this event and to determine its effects on the further development of lung transplantation.

History, 20th Century↗
PubMed1993

Validity of cardiovascular disease risk factors assessed by telephone survey: the Behavioral Risk Factor Survey.

The Behavioral Risk Factor Surveillance System (BRFSS) collects telephone interview data on behaviors for the leading causes of premature death and disability. Its validity has never been adequately studied. The authors replicated BRFSS methodology to validate self-reported cardiovascular disease (CVD) risk factors. Nine-hundred and eleven subjects from three upstate New York counties were interviewed between 1/89 and 5/90. Interviewees were offered physical examinations and laboratory testing for CVD risk factors; 282 men and 344 women participated. The authors studied validity by comparing objectively measured to self-reported CVD risk factors. Sensitivities for self-reported hypertension, hypercholesterolemia, obesity, smoking, and diabetes were: 43, 44, 74, 82 and 75%, respectively. Only smoking sensitivity differed by gender: men, 77%; women, 86%. Specificity was > 85% for all risk factors, except hypercholesterolemia in men (75%). Prevalence was underreported for hypertension, hypercholesterolemia, obesity, and smoking by 43, 50, 25 and 17%, respectively. Results suggest telephone survey research includes physiologic measurements for blood pressure, cholesterol, height, weight, and smoking to validate self-reported CVD risk factors. When this is impossible, results such as these can be used, in similar samples, to correct risk factor prevalence rates from telephone surveys for misclassifications.

Adult↗
PubMed1993

A phytoestrogen diet induces the premature anovulatory syndrome in lactationally exposed female rats.

The effects of a phytoestrogen diet on sexual differentiation were examined in lactationally exposed rat pups. Rat dams were provided a semipurified diet containing the isoflavonoid coumestrol at a concentration (0.01%) previously found to be uterotrophic. Coumestrol treatment did not significantly alter the time of vaginal opening, although vaginal opening did occur at a lighter body weight. By 132 days of age, 83% of coumestrol-treated females exhibited the cornified smears of a persistent estrous state. By contrast, 91% of control animals were cycling regularly at 132 days of age. Estradiol stimulation failed to elicit an LH elevation in the coumestrol-treated animals, suggesting the possibility of neuroendocrine impairments. These findings indicate that the female offspring of mothers fed a low-level phytoestrogen diet during lactation manifest early and nearly universal disruption of cyclicity of the persistent-estrus type.

Animals↗
PubMed1993

A cardiovascular health education program for rural schools.

Public understanding of cardiovascular disease (CVD) risk factors and primary prevention has increased, due in part to community prevention efforts. However, many segments of society are difficult to reach. Such groups still need public education to acquire the knowledge that can lead to behavior change. Community intervention programs in rural areas face the challenge of disseminating health information to widely scattered populations isolated by difficult terrain and weather, and restricted by the sparsity of channels for mass communication. School health promotion programs, because of the special role schools play in rural communities, can help reach rural populations. During a five-year period, the Otsego-Schoharie Healthy Heart Program, a state-funded community intervention program, provided presentations to 18% of the combined total population of two rural counties through its school-based component. It also helped promote other program initiatives by establishing linkages in the community. Schools provide an effective channel for health promotion efforts to reach rural populations.

Adolescent↗
PubMed1993

Measurement of serum arabinitol by gas-liquid chromatography: limitations for detection of systemic candida infections.

The measurement of serum arabinitol in the diagnosis of systemic candidosis was evaluated using a gas-liquid chromatography technique in a cohort of at risk patients. The prevalence of seropositivity was low and did not correlate with evidence of infection. This technique is unlikely to achieve acceptance because it does not discriminate between patients with and without infection; it requires specialised equipment and it is expensive.

Candidiasis↗
PubMed1993

Discriminant analysis of symptom pattern and serum antibody titres in humidifier related disease.

BACKGROUND: The heterogeneous patterns of symptoms among factory workers exposed to aerosols from contaminated air humidifiers were analysed to assess the association between specific symptoms and the serum IgG antibody response to the humidifier water contaminants, and to test the ability of specific symptoms to predict this antibody response. METHODS: Symptoms from 88 factory workers were surveyed by a doctor administered questionnaire and compared with their serum IgG antibody titres to humidifier water contaminants quantified by enzyme immunoassay. RESULTS: The strength of association between individual symptoms and antibody showed that fever, shivering or chills, influenza-like symptoms, or headache were individually significantly associated with the presence and higher titres of antibody. This was also true for those subjects whose symptoms were most pronounced during the first day of the working week. Within each subject's full symptom profile there were significant associations between the description of chest tightness, breathlessness, and wheeze; between headache and influenza like symptoms; between fever and shivering or chills; and between intermittent onset and general tiredness. Discriminant analysis of the full symptom profiles showed that there was maximum information content in five independent parameters, namely, the descriptions of fever, headache, and chest tightness, the timing of their onset, and the readiness to describe miscellaneous symptoms in addition to those in the questionnaire. On the basis of these criteria 72% of subjects could be classified according to their antibody state. Cluster analysis with these five independent parameters described four symptom clusters: one associated with high median antibody levels, one with low, and two with zero median levels. These were, respectively: (1) fever with headache and chest tightness; (2) either no or few symptoms; (3) chest tightness and headache with intermittent onset; (4) headache and miscellaneous symptoms with intermittent onset. CONCLUSIONS: The association between serum antibody titres and specific symptom patterns may identify different categories of disease which constitute the spectrum known as humidifier related disease, and strengthens the hypothesis that antibody may be involved in the pathogenesis of some components of the disease.

Antibodies↗
PubMed1993

AIDS-related knowledge, perceptions, and behaviors among impoverished minority women.

OBJECTIVES: The aims of this study were to (1) describe AIDS-related knowledge, perceptions, and risky behaviors of impoverished African-American and high- and low-acculturated Latina women; (2) delineate relationships involving high-risk behaviors; and (3) determine whether risky behaviors differ by race and levels of acculturation. METHODS: Survey instruments were administered to 1173 impoverished women of color residing in homeless shelters and drug recovery programs. RESULTS: Differences based on ethnicity and level of acculturation were found in AIDS-related knowledge, perceived risk of acquiring AIDS, and risky behaviors. Low-acculturated Latinas reported low perceived risk and were least likely to engage in illegal drug use and sexual activity with multiple partners. Intravenous drug use was most prevalent among high-acculturated Latinas, whereas nonintravenous drug use and high-risk sexual activity was most prevalent among African-American women. CONCLUSIONS: The data indicate the need for culturally sensitive AIDS prevention programs for women that deal with general issues of drug use and unprotected sex, and that include separate sessions for women of different ethnic backgrounds and acculturation levels to address specialized areas of concern.

Acculturation↗