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Biomedical subjects

D M Becker

Publications and source records attributed to D M Becker.

At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

Heart, body, and soul: impact of church-based smoking cessation interventions on readiness to quit.

BACKGROUND: Given the relatively low spontaneous quit rates and poor treatment outcomes among African American smokers, this study was designed to evaluate the effects of a multimodal culturally relevant intervention for smoking behavior change compared with a self-help strategy among urban African Americans in Baltimore churches. METHOD: This randomized controlled trial in urban African American churches used the stages of change model to compare the effectiveness of two interventions in moving smokers along a continuum toward smoking cessation. Twenty-two churches were randomly assigned to either an intensive culturally specific intervention or a minimal self-help intervention. Smokers were interviewed at baseline church health fairs and at a 1-year follow-up. Self-reported quitters at follow-up were evaluated using saliva cotinine and exhaled carbon monoxide levels (CO). Stages of change were measured by applying a standardized stages of change instrument to individual interview response sequences. Analysis compared the two intervention groups at 1-year follow-up with baseline stages. Outcomes included quit rates and positive progress along the stages of change. RESULTS: Multiple logistic regression results, controlling for intrachurch correlation and demographic and baseline smoking characteristics, showed that the multimodal cultural intervention group was more likely to make positive progress along the stages of change continuum, compared with self-help intervention group (OR = 1.68; P = 0.04). Church denomination and intervention status interacted in the multivariate model; Baptists in the intensive intervention were three times (OR = 3.23; P = 0.010) more likely to make progress than all the other denomination groups. CONCLUSION: The multimodal culturally relevant intervention was more likely than a self-help intervention to positively influence smoking behavior. This is the first community-based intervention study to report progress along the stages of change as a process-oriented measure of success. It is notable that a spiritually based model focusing on environmental sanctions was more likely than a standard church disseminated self-help intervention to positively influence smoking behavior in an urban African American population.

Adult↗
PubMedDate not supplied

A patient-based system for describing ambulatory medicine practices using diagnosis clusters.

OBJECTIVE: To develop a patient-based classification system to describe the clinical content of ambulatory medicine practices. DESIGN: A system of 100 diagnosis clusters was developed based on retrospective review of computerized problem lists of patients from a university practice, and then applied to the problem lists of patients in a community practice. Chart review of a 5% random sample (n = 184) of university practice patients who had problem lists was carried out to assess the accuracy of the computerized problem lists. SETTING: A university ambulatory medicine practice and a community ambulatory medicine practice. PATIENTS/PARTICIPANTS: For the same one-year period, all 4,490 patients seen in the university practice and all 1,294 patients seen two or more times in the community practice. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of the 27,634 problems listed for university patients and the 5,648 problems listed for community patients, 22,629 (82%) and 4,924 (87%), respectively, were assigned to diagnosis clusters. For the university and community practices, the mean numbers of problems per patient were 6.1 (SD 5.4) and 4.4 (SD 3.7), and the mean numbers of diagnosis clusters per patient were 4.5 (SD 3.7) and 3.6 (SD 3.0), respectively. Among the ten most common diagnosis clusters in both practices were HYPERTENSION, SYMPTOM OR SIGN, OBESITY, and DIABETES. Only 18% (SD 3%) of patient problem lists in the university practice omitted one or more chronic, important medical problems (e.g., hypertension, dementia, COPD). CONCLUSIONS: This system of diagnosis clusters effectively and efficiently described the clinical content of two types of internal medicine practices, and has important applications in medical education, epidemiology, clinical and health services research, and public policy.

Ambulatory Care↗
PubMedDate not supplied

Suspected pulmonary embolism and lung scan interpretation: trial of a Bayesian reporting method.

OBJECTIVE: To determine whether a Bayesian method of lung scan (LS) reporting could influence the management of patients with suspected pulmonary embolism (PE). DESIGN: 1) A descriptive study of the diagnostic process for suspected PE using the new reporting method; 2) a non-experimental evaluation of the reporting method comparing prospective patients and historical controls; and 3) a survey of physicians' reactions to the reporting innovation. SETTING: University of Virginia Hospital. PATIENTS: Of 148 consecutive patients enrolled at the time of LS, 129 were completely evaluated; 75 patients scanned the previous year served as controls. INTERVENTION: The LS results of patients with suspected PE were reported as posttest probabilities of PE calculated from physician-provided pretest probabilities and the likelihood ratios for PE of LS interpretations. RESULTS: Despite the Bayesian intervention, the confirmation or exclusion of PE was often based on inconclusive evidence. PE was considered by the clinician to be ruled out in 98% of patients with posttest probabilities less than 25% and ruled in for 95% of patients with posttest probabilities greater than 75%. Prospective patients and historical controls were similar in terms of tests ordered after the LS (e.g., pulmonary angiography). Patients with intermediate or indeterminate lung scan results had the highest proportion of subsequent testing. Most physicians (80%) found the reporting innovation to be helpful, either because it confirmed clinical judgement (94 cases) or because it led to additional testing (7 cases). CONCLUSIONS: Despite the probabilistic guidance provided by the study, the diagnosis of PE was often neither clearly established nor excluded. While physicians appreciated the innovation and were not confused by the terminology, their clinical decision making was not clearly enhanced.

Adult↗
PubMedDate not supplied

Recognition and evaluation of red blood cell macrocytosis in the primary care setting.

OBJECTIVE: To investigate primary care physicians' recognition and evaluation of red blood cell (RBC) macrocytosis in adults. DESIGN: Retrospective chart review. Utilizing a computerized laboratory result system, all complete blood counts (CBCs) with RBC indices performed between May 1986 and May 1987 were retrieved. Patients having mean corpuscular volumes (MCVs) more than three standard deviations from the mean (greater than 98.5 fL) were selected for evaluation. SETTING: The primary care clinics of a public university hospital. PATIENTS: 138 (3.7%) of 3,805 adult outpatients had MCVs greater than 98.5 fL, and of these, 128 (93.4%) had medical charts available for review. RESULTS: 55 patients with elevated MCVs were not evaluated for this finding, and their mean MCV (100.6 fL) was significantly lower than that of the 73 patients who were evaluated (102.5 fL; p = 0.003). The investigation of macrocytosis included vitamin B12 and folate levels consistently, and the reticulocyte count and peripheral smear were examined infrequently. Five patients had vitamin B12 deficiency, and two had hypothyroidism. Macrocytosis was ascribed to alcohol abuse in 47 patients, six of whom had no laboratory evaluation. Nine alcoholic patients with macrocytosis had other causes for this finding. Among the 55 patients whose macrocytosis was not evaluated, 12 were anemic and one had a peripheral neuropathy. CONCLUSIONS: Clinically significant and treatable disease was often associated with macrocytosis in our study. Macrocytosis was common, and its recognition and evaluation were variable in this primary care outpatient setting.

Alcoholism↗
PubMedDate not supplied

Characterization of organic extracts from standard reference materials 1649, 'urban dust/organics,' and 1650, 'diesel particulate matter', using a microsuspension assay. A WHO/IPCS/CSCM study.

Mutagenicity associated with replicate organic extracts from standard reference materials 1649 'urban dust/organics' (air particles), and 1650, 'diesel particulate matter' (diesel particles), was determined using a Salmonella microsuspension assay. The results indicate that the mutagenicity of samples such as these can readily be determined using the microsuspension assay with only 5% of the mass required for the standard plate incorporation assay. In general, 80% of the variation in mutagenic activity was due to the bioassay procedure and 20% to the extraction process. Extracts from both samples had primarily direct-acting mutagenicity as there were no significant differences in responses with and without metabolic activation (S9). The TA98-S9 mean air particles mutagenic activities (C.V., %) based on mass of extractable organics or particles were 4.4 (4.7%) and 0.29 (3.6%) revertants/micrograms, respectively, and for the diesel particles were 66 (44%) and 12 (29%) revertants/microgram, respectively. More of the observed direct-acting mutagenicity in the diesel particles extracts was due to nitro-substituted compounds because there were significant reductions in activity with TA98NR (45% of TA98 -S9) and TA98-1,8-DNP6 (21% of TA98 -S9). In the air particles extracts, the TA98NR activities were not significantly different from TA98 -S9 but the TA98-1,8-DNP6 levels were.

Air Pollutants↗
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Genomic organization and sequence of T-cell receptor beta-chain constant- and joining-region genes.

The genomic structure of the joining (J) and constant (C) regions of the locus encoding the beta-chain of the murine T-cell receptor has been analysed. The gene segments are arranged tandemly (J-C/J-C) within a 15-kilobase region. The two constant-region genes are almost identical, differing by only four amino acids, all in carboxy-terminal portions. Each C region comprises four exons encoding an external globular domain, a small hinge-like region, a transmembrane region and a cytoplasmic tail plus 3'-untranslated region. The two clusters of J regions each contain 7 distinct elements, 12 of which may be functional.

Amino Acid Sequence↗
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A third type of murine T-cell receptor gene.

By subtractive cDNA hybridizations, we have isolated a new species of T-cell receptor cDNA clone whose predicted amino acid sequence has homology to variable, constant, joining and diversity segments of immunoglobulins and T-cell receptors. The corresponding genomic sequence is also rearranged in several T-cell DNAs. The four potential N-linked glycosylation sites, frequency of expression and predicted molecular weight (27,800) of this molecule make it a likely candidate for the alpha-chain of the T-cell receptor. Expression data also indicate that this gene may be activated at a later stage of T-cell differentiation than the beta-chain.

Amino Acid Sequence↗
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Variability and repertoire size of T-cell receptor V alpha gene segments.

The immune system of higher organisms is composed largely of two distinct cell types, B lymphocytes and T lymphocytes, each of which is independently capable of recognizing an enormous number of distinct entities through their antigen receptors; surface immunoglobulin in the case of the former, and the T-cell receptor (TCR) in the case of the latter. In both cell types, the genes encoding the antigen receptors consist of multiple gene segments which recombine during maturation to produce many possible peptides. One striking difference between B- and T-cell recognition that has not yet been resolved by the structural data is the fact that T cells generally require a major histocompatibility determinant together with an antigen whereas, in most cases, antibodies recognize antigen alone. Recently, we and others have found that a series of TCR V beta gene sequences show conservation of many of the same residues that are conserved between heavy- and light-chain immunoglobulin V regions, and these V beta sequences are predicted to have an immunoglobulin-like secondary structure. To extend these studies, we have isolated and sequenced eight additional alpha-chain complementary cDNA clones and compared them with published sequences. Analyses of these sequences, reported here, indicate that V alpha regions have many of the characteristics of V beta gene segments but differ in that they almost always occur as cross-hybridizing gene families. We conclude that there may be very different selective pressures operating on V alpha and V beta sequences and that the V alpha repertoire may be considerably larger than that of V beta.

Animals↗
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Impaired vibratory perception and diabetic foot ulceration.

We have studied risk factors for diabetic foot ulceration by comparing diabetic patients who had active foot ulcers (n = 86) with diabetic patients who had no history of foot ulcers (n = 49). Whereas there was a strong association of diabetic foot ulceration with abnormal vibratory perception (Odds Ratio = 10.77; p less than 0.001, which increased with worsening vibratory perception), there was little association with abnormality of the ankle-pressure index (Odds Ratio = 2.84, p = n.s.). Although foot ulceration and limited joint mobility were associated (Odds Ratio = 3.57, p less than 0.001), this relation was not significant when allowances for abnormal vibratory perception and diabetes duration were made. These data suggest that sensory neuropathy is of greater aetiological importance than peripheral vascular disease in the development of diabetic foot ulceration. The measurement of the vibratory perception threshold is clinically useful in identifying those diabetic patients at high risk of foot ulceration.

Diabetes Complications↗
PubMedDate not supplied

Racial differences in low-density lipoprotein particle size in families at high risk for premature coronary heart disease.

OBJECTIVE: Although small, dense low-density lipoprotein (LDL) has been implicated in atherogenesis and coronary heart disease (CHD) events, little is known about possible racial differences in LDL particle size. This study was designed to examine racial differences in the prevalence of small, dense LDL among 159 African-American and 477 White siblings of persons with premature (<60 years of age) CHD. METHODS AND RESULTS: This study examined fasting levels of total cholesterol, LDL cholesterol, high-density lipoprotein cholesterol, apolipoprotein B (ApoB), apolipoprotein A-1, and triglycerides, as well as factors known to be associated with small, dense LDL, including age, sex, obesity, hypertension, and diabetes. Relative LDL particle size was defined by the LDL cholesterol to ApoB ratio. Direct measurement of LDL particle size was obtained by proton NMR spectroscopy in a subset of 64 siblings. Despite similar levels of total and LDL cholesterol, White siblings were more likely to have low LDL cholesterol to ApoB ratios, indicative of atherogenic small, dense LDL, compared with African-American siblings. Multiple logistic regression analysis predicting the presence of LDL cholesterol/ApoB < or = 1.0 demonstrated that race (P = .009), triglyceride level (P = .0001), and diabetes (P = .02) were independent predictors, controlling for age and all other variables. Direct measurement of LDL particle size by NMR spectroscopy supported these findings. CONCLUSION: These findings provide the first known evidence that White individuals from a population at high risk for premature CHD have a greater probability of having a preponderance of small, dense LDL particles than do African Americans, independent of triglyceride levels, and despite comparable levels of total and LDL cholesterol.

Adult↗
PubMedDate not supplied

Narrowing the gap in health status of minority populations: a community-academic medical center partnership.

A major challenge in the United States is to narrow the gap in the excess morbidity and mortality rates of minority populations. This article presents a synthesis of the 15-year results of a collaborative program between the Johns Hopkins Medical Institutions and an African-American community with the highest rates of premature disease and death in Maryland. The program began with an efficacious disease prevention clinical trial with patients and ended with effective population approaches. We transferred key components to community ownership and formally trained community health workers who provided health promotion counseling, monitoring, linkage, and referral services. Results indicated significant decreases in morbidity and mortality as a result of improved control of hypertension. This program has begun to decrease the health status gap in an African-American population and has demonstrated long-term sustainability. Current joint activities are directed at several major causes of excess morbidity and mortality, including smoking, obesity, hyperlipidemia, and hypertension, and at plans for programs to control diabetes, substance abuse, and breast and cervical cancer.

Black or African American↗
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Improving preventive care at a medical clinic: how can the patient help?

We developed a comprehensive individualized preventive care reminder system and then tested the hypothesis that directly involving patients in the reminder process would lead to greater use of preventive services than involving physicians only. There were three experimental groups of 350 patients each: in group 1 physicians and patients received the reminder; in group 2 physicians only received the reminder; in group 3 neither physicians nor patients received the reminder. Nine preventive care services were studied: blood pressure measurement; dental exam; ocular pressure measurement; stool exam for occult blood; influenza, pneumococcal, and tetanus vaccinations; mammography; and Papanicolaou smears. Need for these services was determined by telephone interview and chart review. To determine whether services were obtained, charts were reviewed after four to eight months of follow-up. For overall compliance with preventive recommendations and for several individual services (stool exam for occult blood, tetanus vaccination, mammography), group 1 patients received significantly more preventive care than group 2. Likewise, group 2 patients received more preventive care than group 3. These data show that involving patients in reminder efforts is an effective means of raising the level of preventive services.

Adult↗
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Nursing practice and the National Cholesterol Education Program guidelines for detecting, evaluating, and treating high blood cholesterol in adults.

Recently published guidelines, The Report of the Adult Treatment Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, have tremendous implications for the practice of nursing. This paper presents key elements from that report and discusses how these guidelines can be used to enhance clinical practice among nurses treating and counseling patients with elevated blood cholesterol levels. In addition to discussing the major treatment modalities of diet and drugs, this paper considers implications for nurses working with Black patients.

Adult↗