Biomedical subjects

David Levine

Publications and source records attributed to David Levine.

At least 19 recordsLinked to original sources

PubMed2005

Correlates of condom failure among adolescent males: an exploratory study.

OBJECTIVE: To identify the prevalence and correlates of condom failure (defined as breakage or slipping off in the past 90 days) among a sample of adolescent males (15 to 21 years of age). DESIGN: A cross-sectional study of 481 condom-using males residing in three US cities (Atlanta, GA, Providence RI, Miami FL). Data were collected, in the years 2000 and 2001, using audio computer-assisted self-interviewing technology. Prevalence ratios were used to determine the strength and significance of bivariate associations between ten assessed correlates and condom failure. Correlates achieving a screening level of significance were entered into a multivariate model that was used to calculate adjusted odds ratios (AOR). RESULTS: Recent condom failure was reported by 34.1%. Younger adolescents were about one-third less likely to report condom failure (AOR = 0.66; P = 0.4). Adolescents reporting multiple sex partners were about 80% more likely to report failure (AOR = 1.84; P = 0.09). Adolescents indicating they had sex with someone on the same day they met the person were about 80% more likely to report failure (AOR = 1.77; P = 0.02). Finally, adolescents indicating recent problems obtaining condoms were about 70% more likely to report failure (AOR = 1.69; P = 0.1). Failure was not less common among those reporting a history of STD infection or those ever impregnating a partner. CONCLUSION: Because adolescent males may commonly experience condom failure, targeted clinic- and community-based programs designed to reduce user error could be an important aspect of preventing pregnancy and the spread of STDs.

Adolescent↗

PubMed2005

Introduction to veterinary physical rehabilitation.

Physical therapy is a profession with an established scientific basis in human beings and companion animals. It has a large number of clinical applications in the restoration, maintenance, and promotion of optimal physical function. In providing physical therapy, the goal is to restore, maintain, and promote optimal function, optimal fitness, wellness, and quality of life as they relate to movement disorders and health. A major emphasis is to prevent or minimize the onset, clinical signs, and progression of impairments, functional limitations, and disabilities that may result from diseases, disorders, conditions, and injuries.

Animal Diseases↗

PubMed2005

Joint mobilization.

Therapeutic touch has been used in human beings to soothe aches and pains. Most dogs also seem to enjoy being touched. Manual therapy techniques are skilled hand movements intended to improve tissue extensibility; increase range of motion; induce relaxation; mobilize or manipulate soft tissue and joints; modulate pain; and reduce soft tissue swelling, inflammation, or restriction. The intent of this article is to provide an overview of the principles of manual therapy, followed by selected treatment techniques for the hip, stifle, elbow, shoulder, carpus.and thoracic and lumbar spine. The techniques of G.D. Maitland, an Australian physical therapist who developed a clinically based approach in the 1960s and 1970s, are emphasized.

Animals↗

PubMed2005

Physical agent modalities.

The purpose of this article is to review the use of cold, heat, therapeutic ultrasound, and electrical stimulation in small animal rehabilitation. The material in this article is a compilation from the veterinary and hu-man literature. Additional information is needed on how to adapt the techniques used in human beings to small animals and then to establish the efficacy of these techniques in animals.

Animals↗

PubMed2005

Rehabilitation and conditioning of sporting dogs.

Owners and trainers exercise sporting dogs to increase their fitness and optimize their conditioning and performance. Training is designed to in-crease strength, endurance, and agility and is sport-specific. Sporting dogs are susceptible to specific musculoskeletal injuries. The rehabilitation of sporting dogs after these injuries follows specific principles during the acute, subacute, and reconditioning periods.

Animals↗

PubMed2005

Assistive devices, orthotics, and prosthetics.

Deciding on which supportive device, orthotic, or prosthetic is best suited for a given patient is a complex process involving many different factors. The ability to manage biomechanical abnormalities successfully may be enhanced by an understanding of the properties of the various materials that comprise these devices, their effect on functional performance, and other associated patient factors. Veterinary health care providers are faced with the challenge of effectively addressing the physiologic and fiscal needs of the patient in a rapidly changing patient care environment.

Amputation, Surgical↗

PubMed2005

Condom failure among adolescents: implications for STD prevention.

This study of 921 adolescents found condom failure (past 90 days) was experienced by at least one-third of the sample, regardless of gender. Frequency of condom failure was positively associated with STD diagnosis (AOR = 1.22, 95% CI = 1.01-1.48), with the odds of testing positive increasing 22% for each added event of failure.

Adolescent↗

PubMed2005

A healthcare revolution: Quebec's new model of healthcare.

Over the past two years as CEO of the Montreal Health Authority I have participated in the preparation and now the implementation of what I consider the first real reform in healthcare since the beginning of Medicare in 1970. In my opinion Quebec is undergoing a second "quiet revolution" in healthcare as important as the first one, a revolution not in structure but in the philosophy of how healthcare is provided to its population.

Delivery of Health Care↗

PubMed2004

Expression and purification of human tryptophan hydroxylase from Escherichia coli and Pichia pastoris.

Tryptophan hydroxylase (TPH) from several mammalian species has previously been cloned and expressed in bacteria. However, due to the instability of wild type TPH, most successful attempts have been limited to the truncated forms of this enzyme. We have expressed full-length human TPH in large amounts in Escherichia coli and Pichia pastoris and purified the enzyme using new purification protocols. When expressed as a fusion protein in E. coli, the maltose-binding protein-TPH (MBP-TPH) fusion protein was more soluble than native TPH and the other fusion proteins and had a 3-fold higher specific activity than the His-Patch-thioredoxin-TPH and 6xHis-TPH fusion proteins. The purified MBP-TPH had a V(max) of 296 nmol/min/mg and a K(m) for L-tryptophan of 7.5+/-0.7 microM, compared to 18+/-5 microM for the partially purified enzyme from P. pastoris. To overcome the unfavorable properties of TPH, the stabilizing effect of different agents was investigated. Both tryptophan and glycerol had a stabilizing effect, whereas dithiothreitol, (6R)-5,6,7,8,-tetrahydrobiopterin, and Fe(2+) inactivated the enzyme. Irrespective of expression conditions, both native TPH expressed in bacteria or yeast, or TPH fusion proteins expressed in bacteria exhibited a strong tendency to aggregate and precipitate during purification, indicating that this is an intrinsic property of this enzyme. This supports previous observations that the enzyme in vivo may be stabilized by additional interactions.

Enzyme Stability↗

PubMed2004

The impact of international medical graduate status on primary care physicians' choice of specialist.

BACKGROUND: Approximately one fourth of practicing physicians in the United States graduated from medical schools in other countries. It is unknown how the role of international medical graduate status affects physician decision-making. OBJECTIVE: The objective of this study was to determine whether a primary care physicians' knowledge of a specialist's international medical graduate status affects his or her decision to refer patients to that specialist. RESEARCH DESIGN AND SUBJECTS: We studied a national, cross-sectional study of primary care physicians who see adult patients. The sample was drawn from the American Medical Association Physician's Professional Data. Each physician received 2 clinical case vignettes describing a patient for whom referral to a specialist was considered necessary. Each vignette was followed by 5 vignette specialist descriptions with medical school graduate status varied randomly alongside other physician characteristics. MEASURE: We measured the decision to refer to an international versus U.S. medical graduate specialist. RESULTS: Of 1054 eligible physicians, 623 (59.1%) responded. Respondents were significantly more likely to refer to a U.S. medical graduate (USMG) compared with an international medical graduate (IMG) (63% vs. 54%, P <0.05). After adjustment for age, race, sex, and referral characteristics of the vignette specialists, a positive referral decision was noted in a higher proportion of vignettes in which the vignette specialist was described as a USMG versus an IMG (63% vs. 51%, P <0.05). CONCLUSION: With other factors being equal, vignette specialists described as IMGs versus USMGs were significantly less likely to be associated with a positive referral decision. Although specialist IMG status, relative to other factors, might not have a major effect on referral decisions, it is possible that negative views of international medical graduates could lead to suboptimal choices in referral decisions. Potentially, a patient could be referred to an USMG who happens to have inferior clinical skills than an IMG with superior clinical skills.

Adult↗

PubMed2004

Associations between sexually transmitted disease diagnosis and subsequent sexual risk and sexually transmitted disease incidence among adolescents.

BACKGROUND: Empiric evidence is lacking in regard to the subsequent sexually transmitted disease (STD)-associated risk behaviors of adolescents diagnosed and treated for an STD. GOAL: The goal of this study was to prospectively identify associations between STD diagnosis and subsequent sexual risk and STD incidence among a sample of U.S. adolescents. STUDY DESIGN: A cohort of 455 adolescents (age 15-21 years) was followed for 3 months. Adolescents were recruited from primary care clinics and through outreach activities. RESULTS: A total of 10.8% were initially diagnosed with at least one STD. After adjusting for observed covariates, these adolescents (compared with those testing negative) were 2.8 times (P = 0.0001) more likely to be abstinent from sex and 2.2 times more likely to report always using condoms (P = 0.04). However, during the ensuing 3 months, they were approximately 2.4 times more likely to report having sex with multiple partners (P = 0.01), 8.9 times more likely to test positive for trichomonas (P = 0.009), and 3.0 times more likely to test positive for chlamydia (P = 0.04). CONCLUSIONS: Compared with those testing negative, adolescents diagnosed with an STD may subsequently adopt safer sex behaviors, including abstinence. However, perhaps in part as a result of having sex with multiple partners, they might fail to practice safer sex behaviors stringently enough to avoid subsequent STD acquisition.

Adolescent↗

PubMed2004

Effect of an Internet-based curriculum on postgraduate education. A multicenter intervention.

We hypothesized that the Internet could be used to disseminate and evaluate a curriculum in ambulatory care, and that internal medicine residency program directors would value features made possible by online dissemination. An Internet-based ambulatory care curriculum was developed and marketed to internal medicine residency program directors. Utilization and knowledge outcomes were tracked by the website; opinions of program directors were measured by paper surveys. Twenty-four programs enrolled with the online curriculum. The curriculum was rated favorably by all programs, test scores on curricular content improved significantly, and program directors rated highly features made possible by an Internet-based curriculum.

Ambulatory Care↗

PubMed2004

Regionalization: an opportunity for improving management.

Lewis and Kouri provide an excellent review of the status of regionalization across Canada. Their paper examines the potential benefits of regionalization and the factors increasing or decreasing potential impact, the state of regionalization in each province and regionalization's contribution to health reforms. Of the six goals mentioned in the potential benefits of regionalization, four focus on effectiveness and efficiency and two on accountability and public input. The political nature of healthcare is mentioned often, and the negative impact of end-runs to political authority if patients or providers are not satisfied is underlined.

Canada↗

PubMed2003

African American church participation and health care practices.

BACKGROUND: While religious involvement is associated with improvements in health, little is known about the relationship between church participation and health care practices. OBJECTIVES: To determine 1) the prevalence of church participation; 2) whether church participation influences positive health care practices; and 3) whether gender, age, insurance status, and levels of comorbidity modified these relationships. DESIGN: A cross-sectional analysis using survey data from 2196 residents of a low-income, African-American neighborhood. MEASUREMENTS: Our independent variable measured the frequency of church attendance. Dependent variables were: 1) Pap smear; 2) mammogram; and 3) dental visit-all taking place within 2 years; 4) blood pressure measurement within 1 year, 5) having a regular source of care, and 6) no perceived delays in care in the previous year. We controlled for socioeconomic factors and the number of comorbid conditions and also tested for interactions. RESULTS: Thirty-seven percent of community members went to church at least monthly. Church attendance was associated with increased likelihood of positive health care practices by 20% to 80%. In multivariate analyses, church attendance was related to dental visits (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.3 to 1.9) and blood pressure measurements (OR, 1.6; 95% CI, 1.2 to 2.1). Insurance status and number of comorbid conditions modified the relationship between church attendance and Pap smear, with increased practices noted for the uninsured (OR, 2.3; 95% CI, 1.2 to 4.1) and for women with 2 or more comorbid conditions (OR, 1.9; 95% CI, 1.1 to 3.5). CONCLUSION: Church attendance is an important correlate of positive health care practices, especially for the most vulnerable subgroups, the uninsured and chronically ill. Community- and faith-based organizations present additional opportunities to improve the health of low-income and minority populations.

Adult↗

PubMed2003

Adjudication history and African American adolescents' risk for acquiring sexually transmitted diseases: an exploratory analysis.

BACKGROUND: Little is known about sexually transmitted disease (STD) risk behavior among adjudicated African American adolescents. GOAL: The goal of the study was to compare STD-associated risk profiles of African American adolescents reporting a history of adjudication and those not reporting adjudication. STUDY DESIGN: A cross-sectional survey of 304 African American adolescent males and females (aged 15-21 years) was conducted. Adolescents were recruited from primary care clinics and through outreach activities. RESULTS: Twenty-six percent of the adolescents reported adjudication. After adjusting for gender, adjudicated adolescents were about 3.6 and 4.5 times, respectively, more likely than nonadjudicated adolescents to report ever having one of three STDs (gonorrhea, chlamydia, and trichomoniasis) or to report having one of these in the past 90 days. Reporting recent sex with someone known or suspected of having an STD was about nine times more likely among adjudicated adolescents, and they were about 2.6 times more likely than their nonadjudicated counterparts to report using drugs or alcohol during their last sexual experience and 2.2 times more likely to report frequent sex in the past 90 days. CONCLUSIONS: African American adolescents with a history of adjudication may have greater risk for acquisition of STDs than their peers not reporting adjudication.

Adolescent↗

PubMed2002

Reliability of goniometry in Labrador Retrievers.

OBJECTIVE: To evaluate the reliability of goniometry by comparing goniometric measurements with radiographic measurements and evaluate the effects of sedation on range of joint motion. ANIMALS: 16 healthy adult Labrador Retrievers. PROCEDURE: 3 investigators blindly and independently measured range of motion of the carpus, elbow, shoulder, tarsus, stifle, and hip joints of 16 Labrador Retrievers in triplicate before and after dogs were sedated. Radiographs of all joints in maximal flexion and extension were made during under sedation. Goniometric measurements were compared with radiographic measurements. The influence of sedation and the intra- and intertester variability were evaluated; 95% confidence intervals for all ranges of motion were determined. RESULTS: Results of goniometric and radiographic measurements were not significantly different. Results of measurements made by the 3 investigators were not significantly different. Multiple measurements made by 1 investigator varied from 1 to 6 degrees (median, 3 degrees) depending on the joint. Sedation did not influence the range of motion of the evaluated joints. CONCLUSIONS AND CLINICAL RELEVANCE: Goniometry is a reliable and objective method for determining range of motion of joints in healthy Labrador Retrievers.

Animals↗

PubMed2002

Survey results of an interdisciplinary animal physical rehabilitation course for physical therapy and veterinary students.

Elon College and North Carolina State University co-organized an animal rehabilitation elective course given to 12 MPT and 12 DVM students and conducted a post-course survey of the participants. Changes in perceptions of the field of animal rehabilitation, in perceived practice patterns, in the DVM students' perception of the field of PT, and in knowledge of animal rehabilitation were present for 84-100% of students who answered the survey.

Animals↗

PubMed2002

Knowledge, attitudes, and behavior of homeless African-American adolescents: implications for HIV/AIDS prevention.

The purpose of this pilot study was to describe the knowledge of HIV/AIDS, attitudes about condom use, and the sexual behavior of African-American adolescents who reside in a children's emergency homeless shelter. The Attitudes Toward Condom Usage Questionnaire, the AIDS Knowledge and Attitude Survey, and a Perceived Risk of HIV/AIDS Scale were modified and administered to 37 African-American male and female adolescents who reside in an emergency shelter. HIV/AIDS knowledge and attitudes about condoms among these respondents were comparable to those of other adolescents described in the literature in that there was a strong knowledge of HIV/AIDS, although sexual behavior and attitudes toward condoms were not consistent with this knowledge. Significant differences between male and female respondents were only found on three items of the Attitudes Toward Condom Usage Questionnaire and on the Perceived Risk of HIV/AIDS Scale at the 0.05 level. The knowledge, attitudes, and sexual behavior of homeless, African-American adolescents should be examined to develop and implement appropriate programs to address the specific needs of this population. Further research should focus on this population and expand on this preliminary data.

Adolescent↗