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Biomedical subjects

D Fleming

Publications and source records attributed to D Fleming.

At least 37 records · Page 2Linked to original sources
PubMed1998

Sudden infant death syndrome rates subsequent to the American Academy of Pediatrics supine sleep position.

OBJECTIVES: In April 1992, the American Academy of Pediatrics (AAP) recommended that healthy infants be positioned for sleep on their side or back to reduce the risk of Sudden Infant Death Syndrome (SIDS). The authors hypothesized three different forms of the intervention to examine the impact of the recommendation according to theory such as technology diffusion. Seasonality was included in the models to control its effect when testing. METHODS: Box and Tiao time-series intervention methodology was used to examine the effect of the AAP recommendation on SIDS rates. Sudden Infant Death Syndrome mortality data from Philadelphia and Chicago were examined separately for white and nonwhite populations over 32 quarters. RESULTS: Overall SIDS rates dropped significantly according to an abrupt effect from the intervention. However, the effect appeared to be gradually declining in Philadelphia but permanent in Chicago. In Philadelphia, a decline of 62.3% was estimated in whites in the first quarter after the intervention but decreased to only 5% in the last quarter of 1994. A decline of 35.8% was estimated in nonwhites in the first quarter after the intervention but decreased to only 9.4% in the last quarter of 1994. An abrupt and permanent decrease of 26.7% and 16.5% was found in Chicago for whites and nonwhites, respectively. CONCLUSIONS: Evidence of an abrupt adoption of the recommendation can be explained by the authority innovation decision made by the AAP. Some evidence was found that the effect is temporary, perhaps because physicians are reversing earlier decisions. The demonstrated methodology provides a powerful way to test naturally occurring interventions from quasiexperimental designs to test the impact of policy guidelines.

Chicago↗
PubMed1997

Trends in HIV counseling and testing of clients attending a public sexually transmitted disease clinic in Portland, Oregon, 1989-1995.

To assess the trend in acceptance of human immunodeficiency virus counseling and testing (HIV-CT) among clients attending a public sexually transmitted disease (STD) clinic, 13,139 clients who visited the largest STD clinic in Oregon at least once from 1989 through 1995 were investigated. Overall, 6236 (47.5%) of the clients accepted HIV-CT, and 98 (0.7%) clients reported having previously tested positive for HIV infection. The proportion of clients accepting HIV-CT increased from 28.2% in 1989 to 60.1% in 1995 (trend: p < 0.001). Among those who had never tested for HIV, acceptance of HIV-CT increased from 28.4% in 1989 to 60.9% in 1995 among HIV-uninfected clients (trend: p < 0.001) and from 20.6% in 1989 to 43.8% in 1995 among HIV-infected clients (trend: p = 0.13). The proportion increased from 25.9% in 1989 to 59.4% in 1995 (trend: p < 0.001) among those who previously tested negative for HIV and from 8.3% in 1989 to 25.0% in 1995 (trend: p = 0.03) among those who previously tested positive for HIV. Increases were seen in both sexes across all age and racial or ethnic groups. Acceptance of HIV testing increased among gay or bisexual men from 29% in 1989 to 57% in 1995 (trend: p < 0.001), and among IDUs from 49.5% to 78.8% (trend: p < 0.001). We conclude that HIV-CT is becoming more acceptable among public STD clinic clients, although extra efforts must be made to reach the clients who know they carry the virus but continue to practice unsafe sex.

Adolescent↗
PubMed1996

The response of injection drug users to free treatment on demand: implications for HIV control.

Injection drug use is a major risk factor for human immunodeficiency virus (HIV) infection and drug treatment is widely recognized as a core component of the public health effort to limit the spread of HIV. The assumption is frequently made that lack of immediate access to treatment is a significant barrier to the success of this effort. However, little empirical data exist to support this belief. We conducted a trial of no-cost outpatient drug-free treatment made available on demand to a cohort of out-of-treatment injection drug users (IDUs) in Portland, Oregon, through a coupon program. Of 824 IDUs, 272 (33%) expressed an interest in treatment, 225 (27%) accepted a coupon, 66 (8%) redeemed a coupon, and 9 (1%) remained in treatment for 6 months. These numbers indicate that simply enhancing access is not adequate. Additional strategies to increase motivation to enter and remain in treatment are needed if drug treatment is to play an important role in reducing the spread of HIV among injection drug users, their sexual partners, and their infants.

Adolescent↗
PubMed1995

Plasma transferrin receptor helps to predict iron deficiency in the anemia of chronic disease.

A recent study by Ahluwalia and colleagues used a discriminant statistical analysis approach to determine that a combination of serum ferritin, plasma transferrin receptor concentration, and erythrocyte sedimentation rate was the optimal set of variables for differentiating iron deficiency and the anemia associated with chronic disease in a group of elderly women. Iron deficiency was defined as a significant response in hemoglobin concentration after iron supplementation. The findings of this study suggest that iron deficiency can be relatively common among elderly anemic women with rheumatoid arthritis. Use of these three biochemical measures should be clinically useful to differentiate iron deficiency in the anemia of chronic disease.

Aged↗
PubMed1994

HLA-DPB1 polymorphisms in patients with hyperthyroid Graves' disease and early onset myasthenia gravis.

Using the technique of in vitro enzymatic DNA amplification and dot blot hybridization with sequence-specific oligonucleotide (SSO) probes, a study of genetic polymorphism of HLA-DPB1 was performed in 83 unrelated patients with Graves' disease (GD), 48 patients with early onset myasthenia gravis (EOMG) and 100 normal British caucasoid subjects who were also tissue typed for HLA-A, B and DR antigens. HLA-DPB1*0401 was the commonest allele in both patient and control groups with gene frequencies of 0.380, 0.333 and 0.445 for GD, EOMG and controls, respectively. No significant independent association was found with any HLA-DPB1 allele. As expected, HLA-DR17 is significantly associated with Graves' disease (pc < 8 x 10(-3), RR = 2.9), while both HLA-B8 and DR17 are significantly associated with EOMG (pc < 2 x 10(-7), RR = 10.3 and pc < 0.02, RR = 3.4, respectively)] HLA-DR2 is also significantly increased in EOMG patients who were negative for HLA-DR17 (pc < 0.02, RR = 6.4). In addition, the co-occurrence of HLA-B8 with DPB1*0402 was significantly commoner in patients with GD (p < 0.021, RR = 6.2) and EOMG (p < 0.0007, RR = 10.8) than in controls, although the HLA-DPB1*0402 by itself showed no significant increase.

Adult↗
PubMed1994

Relationship marketing in health care.

Building relationships with patients is critical to the success of many health care organizations. The authors profile the relationship marketing program for a hospital's cardiac center and discuss the key strategic aspects that account for its success: a focus on a specific hospital service, an integrated marketing communication strategy, a specially designed database, and the continuous tracking of results.

Advertising↗
PubMed1994

Comparison of intramuscular versus subcutaneous erythropoietin for the treatment of anemia in CAPD patients.

Recombinant human erythropoietin (rHuEpo) can be administered to continuous ambulatory peritoneal dialysis (CAPD) patients subcutaneously (SC), intravenously (IV), and intraperitoneally (IP). Subcutaneous rHuEpo is preferred in CAPD patients because of its ease of administration and favorable pharmacokinetics. The longer half-life of SC rHuEpo allows for one or two doses per week. Since SC rHuEpo can cause pain and local irritation at the injection site, the efficacy and safety of intramuscular (IM) rHuEpo were compared to SC rHuEpo in 6 random stable CAPD patients. The protocol in each subject consisted of a single weekly injection of IM rHuEpo for 3-6 months (period 1), crossover to SC rHuEpo for 3-6 months (period 2), and crossover to IM rHuEpo for 3-6 months (period 3). The rHuEpo dose was adjusted by protocol to achieve a target hematocrit of 30%-33%. Pain at the injection site was graded on a scale of 0-3. All patients preferred IM rHuEpo to SC rHuEpo because of less pain at the injection site. One patient tolerated IM rHuEpo for six months (period 1), then left the study after one month of SC rHuEpo because of ecchymoses and pain at the SC injection sites. In all patients, there was no significant difference in the dose of rHuEpo (U/kg/wk) during the three study periods.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Self-help groups: a key to HIV risk reduction for high-risk injection drug users?

While recent studies indicate that injection drug users (IDUs) can change their behavior to reduce injection risk of HIV, it remains unclear which users are most likely to change and which mediating variables are most amenable to intervention. We report a study in which a cohort of high-risk IDUs was followed over time to determine which variables were associated with reduced injection risk of HIV. Of 317 IDUs who at baseline had shared a dirty needle in the previous 30 days, 234 (74%) were followed for 6 months. Of these, 107 (46%) reported reduced or eliminated injection risk between the baseline and follow-up interviews, 82 (35%) by not injecting and 25 (11%) by not sharing syringes. Those who attended self-help meetings between the two interviews were almost twice as likely to report reduced or eliminated risk as those who did not attend (OR = 1.92; p = 0.04). The findings suggest that, at least, IDUs in self-help groups comprise a population amenable to HIV interventions and, at most, that self-help groups may play an important role in reducing the risk of HIV in out-of-treatment populations.

Adult↗
PubMed1993

Recognizing illicit drug use by pregnant women: reports from Oregon birth attendants.

OBJECTIVES: This study was undertaken to determine the prevalence of recognized prenatal illicit substance abuse and the characteristics of women being identified as illicit drug users in a statewide population-based cohort. METHODS: During a 1-month period, birth attendants of all singleton births in Oregon (n = 3200) were surveyed regarding their knowledge of prenatal illicit drug use by women who gave birth. Birth certificates were linked to surveys after removal of personal identifiers. RESULTS: Illicit drug use was recognized in 5.2% of delivering women. Nearly half had used cocaine, methamphetamine, or heroin. Recognized users were significantly more likely than nonusers to be unwed and to have used tobacco or alcohol, have received inadequate prenatal care, and have public assistance as a source of payment. Drug use was recognized twice as frequently by practitioners who routinely questioned their patients about it compared with those who relied on clinical judgment or the occurrence of complications during pregnancy. Birth certificate reporting identified only 41% of recognized users. CONCLUSIONS: Oregon practitioners are identifying seven times as many drug-using women as can be accommodated by available treatment programs for this population. Increased efforts are needed to ensure the adequacy of resources necessary to cope with the problem as already recognized.

Adult↗
PubMed1993

Effects of increasing outpatient diagnosis on AIDS surveillance.

Using AIDS surveillance data, we analyzed trends and correlates of outpatients AIDS diagnosis in Oregon and Washington. The proportion of outpatient diagnoses rose from 24% of cases in 1987 to 51% in 1990. Case characteristics associated with outpatient diagnosis included white race, urban residence, and the exposure category of male homosexual/bisexual contact. AIDS-defining conditions associated with outpatient diagnosis included Kaposi's sarcoma, HIV wasting syndrome, and esophageal candidiasis. Completeness and timeliness of reporting was poorer for cases diagnosed as outpatients compared with inpatients. As outpatient diagnosis becomes more common, modified surveillance methods may be needed to ensure complete case finding and consequent reliability of AIDS surveillance information.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Eosinophilia-myalgia syndrome. Natural history in a population-based cohort.

BACKGROUND: To determine the natural history of eosinophilia-myalgia syndrome, we followed up all patients with eosinophilia-myalgia syndrome reported to the Oregon Health Division, Portland, during the recent epidemic caused by contaminated tryptophan. METHODS: Patients were interviewed by telephone from 1 to 5 months after illness onset and again at least 12 months after onset. Symptoms (type, onset, and duration), overall disability, treatment, and tryptophan lot and dose were assessed for each patient. RESULTS: Information was obtained for 55 (96%) of 57 case-patients: 53 patients completed interviews and two patients had died. For the 53 patients who were interviewed, symptoms with onset more commonly during the first 3 months of illness included severe myalgias, fatigue, generalized weakness, edema, and rash. Symptoms with later onset included paresthesias, muscle cramps, extremity weakness, and alopecia. At 12 months, 41 patients (77%) continued to report fatigue, 36 (68%) weakness, and 34 (64%) myalgias; 26 patients (49%) had difficulty climbing stairs, 23 (43%) had difficulty getting up from a chair, and 15 (28%) had difficulty holding a cup. Higher doses of tryptophan were correlated with more severe disability, both initially (rs = .33) and at follow-up (rs = .42). Although most patients reported improvement in symptoms at 12 months, only 14 (26%) patients reported that they were able to perform all normal daily activities. CONCLUSIONS: Most patients with eosinophilia-myalgia syndrome in this population-based cohort are still symptomatic 1 year after onset, primarily with the complaints reported early in the illness. The association between degree of disability and daily tryptophan dose suggests that ingestion of varying amounts of contaminant may be responsible, in part, for the severity of symptoms experienced by individual patients.

Activities of Daily Living↗