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Biomedical subjects

G Wyshak

Publications and source records attributed to G Wyshak.

At least 55 records · Page 3Linked to original sources
PubMed1988

Nonpalpable breast lesions: recommendations for biopsy based on suspicion of carcinoma at mammography.

Carcinoma was found in 30% (119 of 400) of biopsy specimens obtained for mammographically suspicious but nonpalpable findings. The authors reviewed the mammograms of these 400 cases without knowledge of the biopsy results and placed each examination into one of four groups based on their suspicion for carcinoma: minimal (n = 82), slight (n = 91), moderate (n = 174), and high (n = 53). In 127 cases, mammograms showed either minimally suspicious calcifications (n = 33) or minimally (n = 49) or slightly (n = 45) suspicious masses. A 4.7% (six of 127) rate of carcinoma was found in these groups; five of the six cancers were in situ. Had follow-up mammography been done rather than biopsy for these 127 less suspicious lesions, it is probable that the delay in diagnosis would not have altered overall prognosis. In the remaining 273 patients, the positive predictive value of mammography for carcinoma would have risen from 30% (119 of 400) to 41% (113 of 273). The authors conclude that in the management of suspicious nonpalpable mammographic findings, the rate of carcinoma for lesions at biopsy can approximate 40%. This is almost double the rate of most published series.

Adult↗
PubMed1987

The psychosocial impact of war trauma and torture on Southeast Asian refugees.

More than 700,000 refugees from Southeast Asia have settled in the United States since 1975. Although many have suffered serious trauma, including torture, few clinical reports have described their trauma-related symptoms and psychosocial problems. The authors conducted a treatment study of 52 patients in a clinic for Indochinese. They found that these patients were a highly traumatized group; each had experienced a mean of 10 traumatic events and two torture experiences. Many of the patients had concurrent diagnoses of major affective disorder and posttraumatic stress disorder as well as medical and social disabilities associated with their history of trauma. The authors also found that Cambodian women without spouses demonstrated more serious psychiatric and social impairments than all other Indochinese patient groups.

Cambodia↗
PubMed1987

Indochinese versions of the Hopkins Symptom Checklist-25: a screening instrument for the psychiatric care of refugees.

The United States is accepting the largest number of displaced persons since World War II. Over 70% are Southeast Asians; many have suffered serious war trauma and torture. Cultural differences in health-seeking behavior and lack of specialized mental health services make the recognition of psychiatric distress in Southeast Asia refugees difficult for American health care providers. The authors describe the development and validation of Cambodian, Laotian, and Vietnamese versions of the Hopkins Symptom Checklist-25. This brief, simple, and reliable instrument is well received by refugee patients, offers an effective screening method for the psychiatric symptoms of anxiety and depression, and is especially helpful for evaluating trauma victims.

Anxiety↗
PubMed1987

Bone fractures among former college athletes compared with nonathletes in the menopausal and postmenopausal years.

Data are presented on the prevalence (lifetime occurrence) of bone fractures among 5398 college alumnae, 2622 former college athletes, and 2776 nonathletes, ranging in age from 21 to 80 years. As expected from increased physical activity, the former college athletes in each age decade from 20 to 70 years and over reported a higher lifetime occurrence (i.e., at any age up to the time of reporting) of bone fractures of all types, than that of nonathletes (40.5 versus 31.9%, P less than .001). However, when athletic activity was accounted for, the former college athletes were at no greater risk of fractures in the menopausal years than were nonathletes. Among women 60 years and over who were fracture-free up to age 40, the rate for any fracture at age 40 or over was 29% for former college athletes compared with 32% for nonathletes, a nonsignificant difference.

Adult↗
PubMed1986

Pregnancy during residency.

To identify possible barriers to women physicians who wish to combine parenting with medical careers, we studied 56 of 64 pregnancies from the past 10 years in 63 of 66 Harvard-affiliated residency programs. Pregnancies during residency were common (one in eight married women in 1983) and were usually planned (77 percent). Most institutions were unprepared for pregnancies among members of the house staff; four fifths of the programs had no maternity-leave policy. No one quit a residency program because of pregnancy, and pregnancy rarely affected achievement of board certification. Whether the pregnant women found pregnancy during residency a "pleasant" experience was determined largely by whether the program director was supportive, whether the issue of pregnancy was openly discussed within the program, and whether the woman was permitted to return to work on a part-time basis for the first weeks after maternity leave. We conclude that pregnancy within residency programs should be expected and planned for and that if proper arrangements are made, it need not be a major problem for either the training program or the pregnant resident.

Attitude of Health Personnel↗
PubMed1986

Hypochondriasis. An evaluation of the DSM-III criteria in medical outpatients.

We attempted to integrate the DSM-III criteria for hypochondriasis with the clinical literature and derived six positive and two negative diagnostic criteria. Seven of these were assessed in a random sample of 92 medical outpatients by means of a self-report questionnaire, structured interview, and medical record audit. The results are in accord with previous work: there appears to be considerable internal validity and consistency in the syndrome in that disease conviction, disease fear, bodily preoccupation, and somatic symptoms are significantly intercorrelated. The three hypochondriacal attitudes (conviction, fear, and preoccupation) were not statistically related to the number of medical diagnoses in the patients' medical records. Depressive symptoms, as measured by the Beck Depression Inventory, were highly correlated with the other hypochondriacal symptoms. The hypochondriacal syndrome in these patients appears to be consistent with the clinical disorder described in DSM-III.

Adult↗
PubMed1986

Medical and psychiatric determinants of outpatient medical utilization.

Ninety-two general medical outpatients were surveyed with an interview, questionnaires, and a medical record review to investigate the relationships among psychiatric disorder (depression and hypochondriasis), somatic symptoms, medical morbidity, and the utilization of ambulatory medical services. Medical utilization correlated with the number of somatic symptoms reported (r = 0.49, P = 0.0001), depressive symptoms (r = 0.34, P = 0.001), and the number of medical diagnoses in the medical record. Somatic symptoms were not significantly correlated with the number of medical diagnoses, but were related to hypochondriacal attitudes (r = 0.52, P = 0.0001) and depression (r = 0.51, P = 0.0001). In stepwise multiple regressions, the number of medical diagnoses accounted for 33% of the variance in medical utilization. Somatic symptoms were the second most powerful predictor, increasing R2 to 0.469. The next best predictors were two hypochondriacal attitudes and the presence of a major psychiatric diagnosis in the medical record. This five-step model explained 56% of the variance. Somatic symptoms are thus powerful determinants of medical utilization, even after controlling for medical morbidity. Depression, disease fear, and bodily preoccupation are also important predictors of utilization. Somatic symptoms are a final common pathway through which emotional disturbance, psychiatric disorder, and organ pathology all express themselves, and which prompt patients to visit doctors.

Adult↗
PubMed1986

Lower prevalence of diabetes in female former college athletes compared with nonathletes.

The prevalence rate of diabetes was determined for 5398 living college alumnae (2622 former college athletes and 2776 nonathletes) from data on medical history, athletic training, and diet. For all ages, the prevalence rate among the former athletes was 0.57% (15/2622) and among the nonathletes was 1.3% (37/2776). The former college athletes and the nonathletes had similar percentages in family history of diabetes, i.e., 12.0 and 13.5%, respectively. For cases occurring at age greater than or equal to 20 yr (thus assessing the effects of college athletic training), 0.5% (13/2622) of the former college athletes had diabetes compared to 1.2% (32/2776) of the nonathletes; the relative risk is 2.24 [95% confidence limits (CL), 1.19 and 4.74, respectively]. Omitting cases of gestational diabetes, the relative risk of diabetes in nonathletes versus athletes is 3.41 (95% CL, 1.33 and 8.70). The percentages of former athletes and nonathletes that are insulin-using, non-insulin-using, and gestational diabetics did not differ significantly. The athletes were leaner than the nonathletes at all ages up to 70 yr. Of the former college athletes, 82% had been on precollege teams, compared to 25% of the college nonathletes; 74% of the former athletes were exercising regularly, compared to 57% of the nonathletes. We conclude that long-term athletic training is associated with a lower risk of the development of diabetes.

Adult↗
PubMed1985

Lower prevalence of breast cancer and cancers of the reproductive system among former college athletes compared to non-athletes.

The prevalence (lifetime occurrence) rate of cancers of the reproductive system (uterus, ovary, cervix and vagina) and breast cancer was determined for 5,398 living alumnae, 2,622 of whom were former college athletes and 2,776 non-athletes, from data on medical and reproductive history, athletic training and diet. The former athletes had a significantly lower risk of cancer of the breast and reproductive system than did the non-athletes. The relative risk (RR), non-athletes/athletes, for cancers of the reproductive system was 2.53. 95% confidence limits (CL) (1.17, 5.47). The RR for breast cancer was 1.86, 95% CL (1.00, 3.47). The analysis controlled for potential confounding factors including age, family history of cancer, age of menarche, number of pregnancies, use of oral contraceptives, use of oestrogen in the menopausal period, smoking, and leanness. Of the college athletes, 82.4% had been on pre-college teams compared to 24.9% of the college non-athletes. We conclude that long term athletic training may lower the risk of breast cancer and cancers of the reproductive system.

Adult↗
PubMed1985

Shoulder arthrography: comparison of morbidity after use of various contrast media.

This prospective study compares immediate and delayed patient discomfort in 177 patients following shoulder arthrography using intraarticular combinations of metrizamide, meglumine/sodium diatrizoate, meglumine diatrizoate, lidocaine, epinephrine, and air. Patients receiving conventional ionic monomeric positive contrast media had a 60% (90/150) incidence of moderate or severe delayed exacerbation of their baseline symptoms; only 14% (3/21) of patients receiving metrizamide, a nonionic contrast medium, had similar levels of postprocedural discomfort. Morbidity was somewhat diminished with the use of double-contrast (45%, 34/75) rather than single-contrast (75%, 56/75) examinations, and with avoidance of sodium-containing contrast agents or epinephrine. Nonionic or monovalent polymeric contrast media, despite their present high cost, may be the agents of choice if single-contrast arthrography is performed in joints (such as the shoulder, hip, and temporomandibular) associated with a high incidence of post-procedural pain.

Air↗
PubMed1984

Increased deaths due to endocrine system diseases and allergies among mothers of dizygotic twins.

To test the hypothesis that mothers of DZ twins, who seem to represent a separate population from mothers of singletons in terms of levels of pituitary gonadotropins, height and weight, and reproductive and menstrual characteristics, have different patterns of disease and mortality, causes of non-cancer deaths were examined. Study subjects were 3,982 mothers of unlike-sexed (DZ) twins and other polyzygous multiple births, and a matched comparison group of 3,982 mothers of singletons only. A significantly increased risk of death due to diseases in ICD Group III, Allergic Endocrine System, Metabolic and Nutritional Diseases, was found among mothers of DZ twins (relative risk (RR) = 2.4, exact two-tail P = 0.024, exact 95% confidence limits 1.11 to 5.62). Of the 24 deaths among mothers of DZ twins, 18 were due to diabetes, 2 to diseases of the adrenal glands, 1 to a thyroid gland and, 3 to asthma. Of the ten deaths in the comparison group, nine were due to diabetes and one to asthma. Excluding the asthmas, the RR for endocrine system diseases is 2.33, exact two-tail P = 0.042, exact 95% CL 1.02 to 5.79. These observations are consistent with evidence in the literature which shows an association between endocrine system diseases and twinning, and between gonadotropic hormones and diabetes.

Connecticut↗
PubMed1984

Health characteristics of mothers of twins.

Mothers of twins, as compared with mothers of singletons, are taller, and for a given height are heavier; they have slightly earlier menarche and menopause. Our recent studies have shown that mothers of DZ twins are at greater risk of cancer of the pancreas (but not for cancers of other sites), as well as of death due to diabetes, other endocrine diseases, and allergies. These findings are consistent with the clinical and epidemiological literature. We have also found that singleton siblings of twins are slightly heavier at birth than children born into sibships consisting of singletons only. The need for further research on the characteristics and long-term health of mothers of twins is indicated.

Birth Weight↗
PubMed1984

Patient-generated dysphoria in house officers.

Patients can induce intense emotions in physicians. Such feelings can become a source of stress for the physician and interfere adversely with patient care. The authors investigated patient illnesses and conditions that caused dysphoria among three specialty groups of house officers. Tragic, horrifying, or difficult patients produced intense dysphoria in all three groups. The characteristics of the patients producing the greatest dysphoria for each specialty group fell outside the traditional expertise of that group.

Emotions↗
PubMed1983

Health-promoting behavior among lawyers and judges.

This report compares the health-promoting behaviors of lawyers and judges and contrasts these behaviors with published data from nationwide surveys of the general population. Data were obtained from a self-administered questionnaire distributed to a random sample of Massachusetts lawyers and a group of judges attending an annual meeting of midwestern state municipal judges. Compared to the United States general population, lawyers and judges have more favorable health-promoting practices with respect to smoking, exercise, and use of seatbelts but are similar in terms of drinking habits and drinking problems, diet and weight consciousness, and the prevalence of tension, stress or pressure from their work.

Adult↗
PubMed1983

Cancer in mothers of dizygotic twins.

For the determination of whether mothers of dizygous (DZ) male-female twins or other polyzygous (unlike sexed) multiple births have cancer incidence different from that of controls, a cohort study was conducted with the use of the records of the Connecticut Twin Registry and the Connecticut Tumor Registry (CTR). A total of 3,982 women born between 1885 and 1935 who had borne DZ (male-female) twins or who had experienced other polyzygous multiple births in Connecticut during 1925-59 and a control group of 3,982 women, matched pairwise on year of childbirth, age, number of previous children, race, and national origin, were searched in the CTR for the incidence of cancer of all sites. Women who have DZ twins have a higher level of gonadotropins than women in the general population. A hypothesis that mothers of DZ twins may have a higher incidence of breast cancers than other women was investigated; the results did not support the hypothesis. There was, however, an excess incidence of cancer of the pancreas among mothers of twins. The relative risk was 3.2 (P = 0.026, exact two-tail probability) with exact 95% confidence limits (1.12, 11.16). These results are consistent with findings from autopsy data which suggested that among women but not among men with pancreatic duct cell carcinoma, there is excessive gonadotropic activity. These results are also consistent with early findings of high follicle-stimulating hormone (FSH) in the urine of diabetics and high FSH in the urine of postmenopausal women.

Adult↗