Search PubMed⌕ Search

Biomedical subjects

D M Siegel

Publications and source records attributed to D M Siegel.

At least 19 recordsLinked to original sources
PubMed1998

Early effects of a school-based human immunodeficiency virus infection and sexual risk prevention intervention.

OBJECTIVE: To determine the short-term effect of a middle and high school-based human immunodeficiency virus and sexuality intervention (Rochester AIDS Prevention Project for Youth [RAPP]) on knowledge, self-efficacy, and behavior intention. DESIGN: Nonrandomized intervention study with 2 intervention groups and 1 control group. SETTING: Middle and high school health classes in an urban, predominantly minority school district. PARTICIPANTS: Middle and high school students (N = 3635) enrolled in health classes in 9 schools; 50% African American, 16% Hispanic, 20% white, and 14% other. Less than 10% of students refused participation. INTERVENTION: There were 3 study conditions: (1) Control, usual health education curriculum taught by classroom teacher; (2) RAPP adult health educator, intervention curriculum implemented by ethnically diverse male-female pairs of highly trained health educators; and (3) RAPP peer educator, intervention implemented by male-female pairs of extensively trained high school students. Health classes within schools were assigned to 1 of the 3 conditions each semester, and simultaneous implementation of the control program with health educators or peer educators in the same school and during the same semester was not permitted. MAIN OUTCOME MEASURE: A confidential questionnaire administered to all study subjects before and immediately after the intervention, containing scales to measure knowledge, sexual self-efficacy, and safe behavior intention. RESULTS: Preintervention data indicated that the study population was involved in sexual activity and other risk behaviors at rates comparable to those of other urban adolescent populations. Examination of 3 outcome constructs as dependent variables (knowledge, sexual self-efficacy, and safe behavior intention) revealed that the health educators and peer educators increased students' knowledge significantly more than did the control condition for both middle (females, P<.01; males, P<.01) and high (females, P<.001; males, P<.001) school. Comparisons of self-efficacy changes across intervention groups did not reach statistical significance, and safe behavior intention changes differed significantly by intervention group for high school but not for middle school students. For all analyses, the preintervention scores for each outcome variable were the most powerful predictors of postintervention scores, and analysis of variance models predicted substantial overall variance. CONCLUSIONS: At short-term follow-up, the RAPP intervention had a powerful effect on knowledge for all students and a moderate effect on sexual self-efficacy and safe behavior intention, particularly for high school students. The peer educators were found to be equally and, for some variables, more effective than the highly trained adult educators. The substantial effect of the baseline scores and the high prevalence of risk behavior already evident by seventh grade indicate the importance of early implementation of school-based sexuality programs.

Adolescent↗
PubMed1998

Self-reported honesty among middle and high school students responding to a sexual behavior questionnaire.

PURPOSE: To determine self-reported honesty in completing a sexual and other risk behavior questionnaire among middle and high school students, and to relate honesty scores to sexual behavior item responses as a method to detect bias in reporting. METHODS: A self-administered questionnaire measuring overall honesty (7-point rating scale), sexual honesty (5-category scale), and selected sex behaviors was used. Urban, predominantly minority middle and high schools (Grades 7-12) were examined, and participants were 3144 male and female students in middle (mean age = 13.7 +/- 2.0) and high (17.3 +/- 1.6) school health classes. RESULTS: The majority of students stated that they had been very or completely honest in responding to items on the questionnaire. Seventy-eight percent of middle school males (lowest rate), and 94% of high school females (highest rate) reported honesty. Middle school males were most likely to declare dishonesty regarding sexual behavior items, overstating their actual behavior (14%), while middle school girls were most likely to understate (8%) their behavior. Self-reported sexual honesty and reports of behavior were most consistent for understaters. That is, those subjects who answered that their questionnaire responses underreported their true sexual behavior did, in fact, report lower sexual activity on selected survey items. CONCLUSION: Middle and late adolescents reported high levels of honesty in responding to a sexuality-related questionnaire. When interpreting such questionnaire data, correction for the tendency to overstate among middle school males and understate among middle school females should be considered; conclusions about self-reports of sexual behavior among young adolescents need to take into account degree of honesty. However, the presence of some overreported and some underreported behavior does not invalidate interpretation of the overall survey findings.

Adolescent↗
PubMed1998

Experimental rationale for treatment of high-risk human melanoma with zinc chloride fixative paste. Increased resistance to tumor challenge in murine melanoma model.

BACKGROUND: Fixed-tissue micrographic surgery (Mohs) of melanoma has been shown by retrospective analysis to improve 5-year survival. OBJECTIVES: To determine whether zinc chloride fixative paste acts as an immune adjuvant to increase host resistance to melanoma. METHODS: We performed a murine study using the poorly immunogenic B16 melanoma of C57Bl6J mice, and the more immunogenic K1735p melanoma of C3H/HeN mice. Tumors were treated with zinc chloride paste and excised 24 hours later (Group 1), or simply excised (Group 2). Mice were challenged 7 days later with injection of melanoma cells at a distant site, and tumor growth in this second site was followed. RESULTS: K1735p melanomas developed at the challenge site in 69% of mice treated with excision versus 32% of mice treated with zinc chloride fixation (P < 0.025). Development of B16 melanoma was not altered by zinc chloride fixation. CONCLUSION: Zinc chloride fixation of the more immunogenic K1735p melanoma increased resistance to subsequent tumor challenge, suggesting that zinc chloride fixative paste acts as an immune adjuvant.

Animals↗
PubMed1998

Fibromyalgia syndrome in children and adolescents: clinical features at presentation and status at follow-up.

OBJECTIVES: To 1) describe the characteristic features of fibromyalgia syndrome (FS) in a pediatric population, 2) note similarities and differences with FS in adults, and 3) determine outcome after treatment. SETTING AND DESIGN: The Pediatric Rheumatology Clinic at the University of Rochester Medical Center is staffed by two pediatric rheumatologists and serves as a regional subspecialty referral service with approximately 450 annual patient visits, of which approximately 120 are initial evaluations. A retrospective medical record review from 1989 to 1995 was used to identify and describe the study population, and a structured telephone interview served to determine current status and response to treatment. RESULTS: A total of 45 subjects were identified (41 female; 42 white; mean age, 13.3 years), of whom 33 were available for telephone interview at a mean of 2.6 years from initial diagnosis (0.1 to 7.6 years). Of a possible 15 symptoms associated with FS, subjects reported a mean of 8, with >90% experiencing diffuse pain and sleep disturbance. Less frequent were headaches (71%), general fatigue (62%), and morning stiffness (53%). The mean cumulative number of tender points summed over all visits was 9.7 (of 18). Telephone interviews showed improvement in most patients, with a mean positive change of 4.8 on a self-rating scale of 1 to 10 comparing current status to worst-ever condition. CONCLUSIONS: FS in patients referred to a pediatric rheumatology clinic is characterized by diffuse pain and sleep disturbance, the latter being more common than that in adults. The mean number of tender points summed over all visits is fewer than the criterion of 11 established for adults at a single visit. The majority of patients improved over 2 to 3 years of follow-up.

Adolescent↗
PubMed1996

Use of health services by urban youth: a school-based survey to assess differences by grade level, gender, and risk behavior.

PURPOSE: The purpose of this study was: (a) to describe reported access to health care among urban youth, and (b) to compare intention to seek care and risk behaviors for youth who did and did not seek care. METHODS: A cross-sectional survey measuring knowledge, attitudes, self-efficacy, and behavioral intentions related to sexuality and use of and access to health care was administered to 3,677 urban middle and high school students in health education classes. RESULTS: A total of 13% of students reported no established health care, whereas 25% reported no care within the past 6 months. A physical examination was the most common reason for seeking care. Younger teenagers, males, and those not under care were less aware of teen clinics, thought it more difficult to access care, and had less intention to seek care within the next year (P < .001). Older students had greater knowledge and self-efficacy concerning sexual matters, were less positive about abstinence, and higher life and sex risk scores (P < .001). Females reported greater self-efficacy regarding sexual matters, were more positive about abstinence, and had lower life risk scores (P < .001). Adolescents receiving care had higher knowledge and self-efficacy scores, were more positive about condoms, had greater intention to seek care, but had higher life and sex risk scores. CONCLUSIONS: Awareness and use of health care remain low for a sizable number of at risk urban youth, especially younger and male teenagers. The school is a setting in which adolescents not under care can be reached for provision of information about health care.

Adolescent↗
PubMed1995

The outcome of children referred to a pediatric rheumatology clinic with a positive antinuclear antibody test but without an autoimmune disease.

OBJECTIVE: To assess the diagnostic value of positive antinuclear antibody (ANA) test results in children with musculoskeletal or dermatologic problems but without autoimmune disease at presentation. DESIGN: Retrospective chart review. SETTING: Pediatric rheumatology clinic in a tertiary care center. PATIENTS: Five hundred charts reviewed, comprising all new patients seen, 1978 to 1993. RESULTS: Of 500 children seen, 113 had positive ANA test results available at referral. Of those 113 patients, 72 (64%) had an autoimmune condition diagnosed at initial clinic visit; another 10 (9%) were lost to follow-up. Thirty-one children (27%) had no autoimmune condition diagnosed at initial clinic visit and had clinical follow-up over a mean of 37 months. Nonspecific musculoskeletal complaints and hypermobility accounted for the majority of presentations. Routine hematology data were usually normal. Median ANA titer was 1:160; ANA patterns varied. On follow-up, 25 patients (81%) cleared their symptoms; five (16%) had significant improvement. One patient developed an autoimmune disease (autoimmune hepatitis). CONCLUSIONS: Based on our findings, the vast majority of children who have positive ANA test results but do not have autoimmune conditions at initial diagnosis will not develop an autoimmune condition. ANA testing of children who have musculoskeletal or dermatologic problems in the absence of autoimmune conditions does not reveal new diagnoses, and represents unnecessary laboratory time and expense. The prognosis of children who have positive ANA test results in the absence of autoimmune conditions is usually excellent.

Adolescent↗
PubMed1995

Uveitis.

Explore the source record for details and available documents.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1993

A comparison of self-perceived clinical competencies in primary care residency graduates.

One hundred seventy-eight graduates from four primary care residency training programs with common hospital sites (medicine/pediatrics, 72; family medicine, 29; pediatrics, 35; and internal medicine, 42) responded to a mailed survey questionnaire regarding distribution of professional time and self-perceived clinical competencies. Most of the internists, family physicians, and internist/pediatricians (MED/PED) were in primary care, and 57% of the pediatricians were subspecialists. Respondents rated each of 24 clinical vignettes as to their level of comfort in managing the patient problems presented. MED/PED and pediatricians responded similarly to all the infant, child, and adolescent cases. Family physicians were less comfortable in managing the complicated neonatal situations but more comfortable with adolescent health care than the MED/PED or pediatricians. MED/PED reported greater comfort than family physicians in complex internal medicine issues, but less than internists in intensive care and geriatric consultation. Significant differences in reported competency existed among these primary care practitioners despite substantially overlapping training backgrounds.

Adolescent↗
PubMed1993

Juvenile arthritis.

Juvenile arthritis encompasses a group of chronic arthritides in childhood with unclear etiologies. Careful clinical observation has led to categorization and nomenclature identifying three main subtypes of the disease, each with varying natural histories and prognoses. Management centers around antiinflammatory drugs, long-term disease-modifying agents, physical and occupational therapy, joint replacement, and ongoing psychosocial assessment and care. The majority of patients achieve reasonable control of their symptoms and are able to attain independent and satisfying adult lives.

Arthritis, Juvenile↗
PubMed1993

Consent and refusal of treatment.

Clearly, a multitude of potential consent problems can exist for the emergency physician. It is difficult at times to balance the concepts of patient autonomy with the desire to provide optimal medical care. Experienced emergency physicians should be able to individualize the type of consent needed in a particular situation, based on a clinical evaluation of the case. Some general principles apply, but no strict rules can guide the physician in every case. Documentation of consent and refusal of treatment are critical for quality of patient care and legal liability reasons. Principles of what is good, "appropriate" legal consent usually follow from good medical care and strict concern for the patient's health and rights.

Adult↗
PubMed1992

On the carcinogenicity of cadmium by the oral route.

Cadmium and cadmium compounds are carcinogenic both by inhalation and by injection. For purposes of risk assessment, a prudent public health approach has been that, if a chemical has been demonstrated to be carcinogenic by one route, it should be considered carcinogenic by all routes. This policy has been questioned for several toxic metals including cadmium. After reviewing the literature on cadmium carcinogenicity and genotoxicity, we think that cadmium should be considered noncarcinogenic by the oral route. The bases for this decision included: (1) a database for genotoxicity of cadmium with more negative test results than positive results and with most positive results in in vitro tests, indicating that cadmium has limited genotoxicity; (2) some epidemiologic evidence of respiratory tract cancer and prostatic cancer in people occupationally exposed to airborne cadmium but no reliable evidence of gastrointestinal tract cancers in workers; and (3) a large dietary oncogenicity study in rats of cadmium chloride at several dose levels, including a maximally tolerated dose (50 ppm) in males, which showed no increase of tumors due to cadmium ingestion in all of the 19 tissues examined. The conclusion that an agent, which has been shown to be carcinogenic by one route of exposure, is not carcinogenic by a second route should be made only in the presence of robust data which indicate the lack of effect via the second route of exposure.

Administration, Oral↗
PubMed1991

Comparative studies of the covalent binding of [14C]-2-chloro-4-acetotoluidide by liver and kidney slices of the starling.

In tissue slices of female starlings, binding of [14C]-2-chloro-4-acetotoluidide (CAT) radioactivity to liver proteins was almost five times greater than binding to kidney proteins after 2 h of incubation. Binding to protein of liver slices increased in a log linear fashion with increasing CAT concentrations. Binding to protein of kidney slices also increased with increasing concentrations but not in a log linear fashion. Mixed-function oxidase inhibitors, SKF 525-A and alpha-naphthoflavone, decreased binding to liver slices but did not affect binding to kidney slices. Anaerobic incubation conditions inhibited binding to both tissues. P-Hydroxymercuribenzoate and sodium cyanide did not affect the binding of radioactivity associated with [14C]-CAT to proteins of either liver or kidney slices. Diethyl maleate increased binding of the radioactivity to proteins of the kidney slices but not to liver slices. Cysteine also increased binding in kidney slices. Binding in liver slices did not increase significantly with cysteine. The cysteine-induced increase in protein binding in kidney slices did not appear to depend on the formation of sulfate from the metabolism of cysteine. There was no sex-dependent difference in starlings as to the binding of radioactivity in either liver or kidney slices. Male chicken kidney slices bound a much higher amount of radioactivity associated with [14C]-CAT than male starling kidney slices, while the liver slices bound comparable amounts. Male hamster liver slices bound much more radioactivity than did male starling liver slices. However, hamster kidney slices bound much less than did starling kidney slices.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗