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Biomedical subjects

E Weinstein

Publications and source records attributed to E Weinstein.

At least 19 recordsLinked to original sources

Religion, spirituality and the well-being of informal caregivers: a review, critique, and research prospectus.

The purpose of this article is to review and critique the published literature examining the relationships between religion/spirituality and caregiver well-being and to provide directions for future research. A systematic search was conducted using bibliographic databases, reference sections of articles, and by contacting experts in the field. Articles were reviewed for measurement, theoretical, and design limitations. Eighty-three studies were retrieved. Research on religion/spirituality and caregiver well-being is a burgeoning area of investigation; 37% of the articles were published in the last five years. Evidence for the effects of religion/spirituality were unclear; the preponderance (n = 71, 86%) of studies found no or a mixed association (i.e., a combination of positive, negative, or non-significant results) between religion/spirituality and well-being. These ambiguous results are a reflection of the multidimensionality of religion/spirituality and the diversity of well-being outcomes examined. They also partially reflect the frequent use of unrefined measures of religion/spirituality and of atheoretical approaches to studying this topic. Investigators have a fairly large number of studies on religion/spirituality and caregiver well-being on which to build. Future studies should be theory driven and utilize psychometrically sound measures of religion/spirituality. Suggestions are provided to help guide future work.

Caregivers↗

Nucleolar localization of BRCA1 protein in human breast cancer.

Both a rabbit polyclonal BRCA1 antibody, K-18, and a mouse monoclonal BRCA1 antibody, AP 16, produced nucleolar epithelial cell staining on frozen tissue sections of human infiltrating mammary carcinomas. There was much less BRCA1 antibody staining in normal tissues; however, 2 intraductal tumors and a papilloma, found in proximity to the carcinomas showed considerable nucleolar immunoreactivity. MCF-7 cells fixed in methanol and immunostained with the same two antibodies also revealed nucleolar staining, however, after 4% paraformaldehyde fixation for three minutes, there were many fewer nuclei stained. Antigen retrieval methods on formalin-fixed, paraffin-embedded specimens produced tumor cell cytoplasmic staining with AP 16 and nuclear staining in both tumor and normal epithelial cells with another BRCA1 monoclonal antibody, SG 11.

Adult↗

Baker's cysts mimicking the symptoms of deep vein thrombosis: diagnosis with venous duplex scanning.

PURPOSE: The purpose of this study was to determine the incidence and characteristics of Baker's cysts discovered during venous duplex examinations to rule out deep vein thrombosis (DVT). METHODS: We reviewed the vascular laboratory charts of patients found to have Baker's cysts during venous duplex studies to rule out DVT from October 1988 through December 1995. RESULTS: Ninety-five (3.1%) of 3072 patients who underwent venous duplex studies were found to have 111 Baker's cysts. Seven of the 95 had coexistent DVT. Ten patients had ruptured cysts, whereas six patients had cysts that compressed the popliteal vein. CONCLUSION: The presentation of DVT and that of a Baker's cyst are similar enough to be difficult to distinguish by clinical examination. Careful examination of the popliteal fossa should be performed during venous duplex examinations regardless of the indication for the study.

Adult↗

Role of venous duplex scanning in patients with suspected pulmonary embolism.

PURPOSE: We examined the use of venous duplex scanning (VDS) in the diagnosis of pulmonary embolism (PE) at our institution. METHODS: Patients undergoing lower extremity VDS from October 1988 through June 1995 were cross-referenced with those who underwent ventilation perfusion (V/Q) scans and pulmonary angiography (PA) for PE. RESULTS: A total of 664 of 3534 VDS were for "rule out PE." Deep venous thrombosis was found in 13%. A total of 256 VDS were in conjunction with V/Q scans in 249 patients, with only 8% undergoing PA. Deep venous thrombosis was present in 18% for those with both V/Q and VDS compared with 10% (p < 0.01) for those with VDS as the sole study. The order in which V/Q, VDS, and PA were obtained and the relationship of positive studies was examined. CONCLUSION: We found no pattern to the sequence of tests ordered. V/Q scan rather than VDS should be the first study in the evaluation of PE. PE was diagnosed or excluded in nearly one third of patients based on V/Q as the initial study. A total of 29% of VDS could have been avoided. Treatment could be determined on the basis of VDS as the initial study in only 13%. We found only 14% incidence of positive PA in patients with nondiagnostic V/Q scans. We advocate judicious use of diagnostic tests in a stepwise fashion to appropriately treat patients with suspected PE.

Algorithms↗

Deployment technique and histopathological evaluation of an endoluminal vascular prosthesis used to repair an iliac artery aneurysm.

PURPOSE: To describe the deployment technique, function, and gross healing of an endoluminal vascular prosthesis deployed in a high-risk patient for treatment of a common iliac artery (CIA) aneurysm. METHODS: An 82-year-old, high-risk male with a 4-cm-diameter CIA aneurysm approximately 4.5 to 5 cm long was treated with endoluminal exclusion of the lesion using a 6-cm-long, 14-mm-internal diameter Dacron vascular prosthesis with Palmaz 308 stents sutured to either end of the graft. Intravascular ultrasound (IVUS) imaging facilitated sizing of the endograft and its accurate positioning so as to occlude both the aneurysm and the hypogastric artery, which was a potential source of retrograde flow to the aneurysm. Exclusion of the lesion and occlusion of the hypogastric artery were demonstrated on delayed angiographic images and contrast computed tomography scans obtained at 16 days postprocedure. Unfortunately, the patient died 67 days following implantation from a nonprocedure-related gastrointestinal complication. RESULTS: At autopsy, the aortoiliac segment was excised and examined grossly and histologically; the evaluation confirmed complete isolation of the aneurysm by the fully expanded endoluminal prosthesis. The surface of the vascular graft was covered by a glistening, thin, fibrinous membrane. The graft material was filled with hypocellular compact fibrinous material with no evidence of endothelialization. These observations confirm preliminary sealing and isolation of the iliac artery aneurysm as healing of the endograft progressed. CONCLUSIONS: The data acquired from the analysis of this specimen provide information regarding the utility and early healing of an endograft used for iliac artery aneurysm exclusion. This case also exemplifies the utility of IVUS in endograft deployment.

Aged↗

College students' sexual attitudes and behaviors: implications for sexuality education.

This study of sexual attitudes and behaviors of students in a large northeastern community college was undertaken in partial response to an outspoken community group's claims that the sexuality education courses being taught at the school were undermining the morality of its young adults and encouraging early sexual activity. Findings from 1,825 pretest respondents in human sexuality and general health courses indicated that more than 80% of the students had experienced sexual intercourse before they took the courses. In a posttest comparison with 1,456 of the same students, the authors found no significant changes in the number of students who were sexually active or in their attitudes about such issues as abortion and premarital, casual, or oral sex. Statistically significant changes did occur in human sexuality students' attitudes and behaviors about safer sex, having fewer sex partners, and using condoms and spermicides.

Abortion, Induced↗

Graduate health administration field experiences: a university and health service delivery systems partnership.

The importance of experiential components of education to professional preparation has been evidenced in the curricula of academic institutions in several disciplines. Graduate programs in health administration offer a variety of alternative residency, internship, and other field experiences for students to apply academic theory to practical phenomena. Using a case study approach, this article presents the advantages of field experience options to both students and health care delivery sites. Components of a model of experiential alternatives in a graduate health administration program are described.

Curriculum↗

Two-dimensional and Doppler echocardiography alone can adequately define preoperative anatomy and hemodynamic status before repair of complete atrioventricular septal defect in infants < 1 year old.

OBJECTIVES: We sought to assess the ability of two-dimensional and Doppler echocardiography alone, without cardiac catheterization, to evaluate infants < 1 year of age for complete open heart repair of complete balanced atrioventricular (AV) septal defect. BACKGROUND: Two-dimensional echocardiographic-Doppler examinations provide accurate anatomic detail in patients with AV septal defect. Lung biopsy data have shown that patients rarely develop significant inoperable pulmonary vascular disease before 7 months of age. Although calculated pulmonary arteriolar resistance is often elevated in young infants with this heart defect, this elevation rarely reflects significant pulmonary vascular changes in infants < 7 to 12 months of age. METHODS: We performed a retrospective review of 34 patients who underwent complete repair of AV septal defect at our institution between January 1, 1988 and September 1, 1992. Some patients had both catheterization and echocardiographic-Doppler studies (group I, n = 16); others had only echocardiographic-Doppler studies (group II, n = 18). RESULTS: The groups were comparable with regard to age at echocardiography and operation, days in the hospital, days with ventilatory and inotropic support and occurrence of postoperative pulmonary hypertension. One child (2.9%) died during the early postoperative period, and one child in each group (5.8%) died within the 1st year of life. Preoperative echocardiography allowed better detailing of anatomy, valve commitment and regurgitation than was possible with catheterization alone. Knowledge of preoperative pulmonary resistance did not alter the surgical decision or predict postoperative pulmonary hypertension. There was no apparent difference in mortality between the two groups (0 vs. 5.5%), but the small number of patients in each group provides for a very low power (beta = 0.04) calculation. This mortality rate is not different from that reported in recent studies. CONCLUSIONS: Patients with AV septal defect can safely undergo surgical correction of this defect on the basis of echocardiographic-Doppler data alone.

Echocardiography, Doppler↗

Angiographic evaluation of a carotid-subclavian bypass graft in a patient with subclavian artery stenosis and left internal mammary artery bypass graft.

The incidence of coronary subclavian steal syndrome is estimated to be 0.4%. When revascularization is necessary, the preferred technique is the carotid-subclavian bypass graft. Failure of a carotid-subclavian graft is rare. We present a patient with subclavian stenosis who required reevaluation of both the carotid subclavian conduit and the left internal mammary bypass graft. A combined femoral and left brachial approach is recommended for evaluating the carotid-subclavian graft and left internal mammary artery graft in patients with bypassed subclavian artery stenosis and prior myocardial revascularization.

Cerebral Revascularization↗

Preventing obesity in black women by targeting adolescents: a literature review.

Obesity is a critical problem in black women. Black women have been found to have twice the rate of obesity of white women, and the origins of obesity appear to be in adolescence. To date, few obesity prevention and treatment programs have been designed specifically for black female adolescents and black women. In this review, the biopsychosocial factors surrounding obesity in the black female population are discussed, including the significance of body fat distribution for the development of diseases common to the black population, such as diabetes and hypertension; the cultural tolerance for overweight and obesity in black women; and the importance of family and social networks in the dissemination of health information. Programs that stress early intervention during adolescence are identified as having the most potential to make an impact on obesity in black women and, ultimately, to reduce chronic disease. However, such interventions must be sensitive to cultural belief systems and values. The need to eliminate a predominantly white, Anglo-Saxon, ethnocentric viewpoint to prevent and treat obesity in black female adolescents is stressed.

Adolescent↗

Decreasing sex bias through education for parenthood or prevention of adolescent pregnancy: a developmental model with integrative strategies.

This paper identifies the need for more research, education, and services for males about adolescent pregnancy and parenthood to augment their social and familial learning experiences. A case is made for more participation by schools in achieving a better balance between males and females in preparing for parenthood or prevention of pregnancy. Developmentally appropriate educational concepts and strategies that are integrated into the curriculum are described.

Adolescent↗

Torture: psychiatric sequelae and phenomenology.

Torture has been defined by the United Nations (declaration of December 9, 1975) as "every act by which a public functionary (or another person at his instigation) intentionally inflicts on another person serious pain or suffering, ...physical or mental, with the object of obtaining information or of punishing him...or of intimidating that person or others." In Chile, from the 1973 military coup d'Etat up to the 1988 plebiscite, torture was practiced in a systematic way, as a method of interrogation and as a means of intimidation of detainees and, indirectly, of the population at large. In the beginning, torture was applied in military station units and in police stations, in the facilities of sport fields and prisoners' camps; but above all, in clandestine detention centers and prisons belonging to the secret police (Amnesty International 1977, 1983; CODEPU 1984, 1985, 1986; Lira and Weinstein 1987; Muñoz 1986; Rodríguez de Ruiz-Tagle 1978). In spite of the bloodshed of the 1973 coup d'Etat, the phenomenon of torture came as a total surprise for the detainees, who had very often voluntarily surrendered themselves to the new authorities, and who, given the civil traditions of the country, expected treatment in accordance with a society subject to the law. The military government regularly denied having undertaken the practice of torture. According to Lira and Weinstein (20), this denial of such an extreme experience or horror made it even more difficult to overcome the trauma and fostered the development of chronic psychiatric pathology.

Adult↗

Dental disease in the differential diagnosis of fever of unknown origin.

A patient with a one-year history of fever of unknown origin is presented. Extensive work-up failed to reveal the source of the fever. Treatment of periodontal infection resulted in complete cure, suggesting a cause-effect relationship. A possible role of Interleukin 1 (IL-1), universal pyrogen, in periodontal disease is suggested.

Adult↗

The development of adolescent sexual intimacy: implications for counseling.

This paper proposes a perspective for understanding the development of adolescent sexual intimacy. A "transitional stage" is described in which adolescents, driven by a variety of developmental needs influenced by external forces such as peers and family, experiment with sexual behaviors. The completion of the transitional stage results in the adolescent's ability to achieve "relational" sexual intimacy, which is also described. The problems and implications for counseling associated with the biophysiological and family dynamic influences on the development of adolescent sexual intimacy are discussed.

Adolescent↗

CORFs (comprehensive outpatient rehabilitation facilities): an emerging healthcare system for brain-injured patients.

This paper follows the development of Comprehensive Outpatient Rehabilitation Facilities (CORFs) as they emerged from the Day Hospital concept to a new healthcare delivery system. The structure, requirements for stature, reimbursement considerations and potential problems associated with CORFs are discussed. Issues relating to the care of patients with brain injuries are presented and an innovative model of an institute that individualizes a program of techniques to arouse comatose patients and trains and supports families during the process of arousal from coma, are described. The paper goes on to explore the problems and potentials for CORFs to serve as a cost effective, efficient health service delivery system for brain-injured patients with long-term rehabilitative needs.

Brain Injuries↗

The effect of stimulus significance on relatively sustained (tonic-like) and relatively transient (phasic-like) aspects of electrodermal, heart rate, and eyeblink response.

To examine the influence of stimulus significance on more sustained as well as transient aspects of electrodermal, cardiac (HR), and eyeblink response, a 21-sec tone was sounded in one ear or the other. A click occurred during many tones, and a light followed offset by 9 sec. Four groups were studied: one pressed a pedal immediately on hearing any click; another only on click during tone in a specified ear; a third also responded only to the specified ear, but withheld press until the light; a fourth listened without any response. Results confirmed the important role of stimulus significance in each system whether between- or within-subject comparisons were made. Sustained responses were seen only when a significant signal was sought, involving in each case sustained HR deceleration, slowed blink rate, and heightened electrodermal level. Transient response to click and light also appeared only when there were significant signals. Response to tone-onset gave more ambiguous results. ANOVAs of response magnitude suggested that onset of nonsignificant tones might have elicited ORs, while binomial tests indicated these were not elicited with better than random frequency anywhere but on those trials occurring more frequently at the experiment's onset. Interpretations consistent with both the significance hypothesis and with a distinction between automatic and voluntary ORs can be made only here. Motor response had no effect on electrodermal or eyeblink response, and on HR was associated only with increased acceleration 1-2 sec after pedal-press. Studies using small motor responses to establish stimulus significance are therefore not likely to be substantially biased by the response itself.

Acoustic Stimulation↗