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Biomedical subjects

J B Brown

Publications and source records attributed to J B Brown.

At least 73 records · Page 4Linked to original sources
PubMed1996

Cigarette smoking and urinary oestrogen excretion in premenopausal and post-menopausal women.

Cigarette smoking is associated with a reduction in the risk for endometrial cancer in post-menopausal women and it has been suggested that this is because smoking has an anti-oestrogenic effect. To investigate this, concentrations of oestrone, oestradiol and oestriol were measured in 24 h urine samples from 167 premenopausal women (53 smokers, 114 non-smokers) and 200 post-menopausal women (54 smokers, 146 non-smokers). Among premenopausal women there were no significant differences in oestrogen excretion between smokers and non-smokers. Among post-menopausal women, geometric mean excretion rates for oestrone and oestradiol did not differ significantly between groups, but oestriol excretion was 19% lower (95% confidence interval -34% to -1%) in smokers than in non-smokers. This may partly explain the reduced risk for endometrial cancer among post-menopausal smokers.

Adult↗
PubMed1996

Creating health with chronic illness.

Within the current context of health care, health promotion for individuals with chronic illness often reflects the priorities of disease-specific preventive care needs and related physical, social, emotional, and spiritual well-being. This article reports a phenomenological study of how older people with chronic illness experience health and health promotion and illuminates a different perspective of health resources and strategies. The findings have profound implications for nursing practice and theory, suggesting the need for restructuring work assignments and refocusing nursing care more clearly away from the medical model.

Adaptation, Psychological↗
PubMed1996

How family influences practice of obstetrics. Do married women family physicians make different choices?

PURPOSE: To examine the influence of family, past and current, on married women family physicians' and to understand why and how some women continue to practise obstetrics. PARTICIPANTS: Purposive sample of nine married women family physicians who currently practise obstetrics. METHOD: Qualitative in-depth interviews. FINDINGS: Analysis identified four main influences of family on participants' practice of obstetrics: family of origin, transitions in the life cycle, children, and the marital relationship. CONCLUSIONS: These women described how they combined the roles of wife, mother, daughter, sister, and doctor. Family was a powerful influence throughout their practice lives. Finding a balance between the demands of practice, particularly obstetrics, and family relationships was an ongoing process. The process was also influenced by transitions in the life cycle.

Adaptation, Psychological↗
PubMed1996

Development of the Woman Abuse Screening Tool for use in family practice.

BACKGROUND: This study developed a screening tool for use by family physicians to identify and assess women patients experiencing emotional and/or physical abuse by their partner. METHODS: An initial set of eight questions developed for the Woman Abuse Screening Tool (WAST) was completed by both abused and non-abused women. Participants were also asked to indicate their comfort in answering the questions in both research and family practice contexts. They also completed the Abuse Risk Inventory and a demographic questionnaire. Analysis of the WAST included 1) standard assessment of the validity and reliability of the measure and 2) examination of the efficacy of further reducing the number of questions on the WAST for screening purposes. RESULTS: The final samples of abused (n = 24) and non-abused women (n = 24) differed significantly on a number of demographic and abuse variables. After eliminating one of the original items, a strong single factor structure was identified for the WAST that accounted for 85% of the total variance in responses to the WAST items. The WAST was found to be a highly reliable measure; coefficient alpha was estimated at.95. The scale also demonstrated construct and discriminant validity. The abused women reported being less comfortable responding to the WAST questions, in both the research and family practice contexts, than the non-abused women. The two WAST questions the abused women reported being most comfortable with were used to construct the WAST-Short for initial screening purposes. The WAST-Short correctly classified 100% of the non-abused women and 91.7% of the abused women. CONCLUSIONS: The WAST demonstrated good reliability and validity and discriminated between abused and non-abused women. Development of the WAST-Short provides physicians with a relatively unobtrusive screening tool for assessing abuse. The use of additional WAST questions can be used to further explore the possibility that a woman patient is experiencing abuse by her partner. Further study includes field testing the WAST in the family practice setting.

Battered Women↗
PubMed1996

Retiree awareness of levels of blood pressure and cholesterol.

PURPOSE: Determine the level of awareness of cholesterol and blood pressure in a retiree population; assess factors indicating a higher risk for lack of awareness. METHODS: A cross-sectional survey was mailed to a random sample of 9.5% of the 7,400 retiree households served by an Army community hospital. Data analysis used descriptive statistics and t test for continuous data and chi-square for categorical data. RESULTS: Response rate was 71.4%. Overall, 45.8 and 37.9% of the respondents have accurate knowledge of the levels of their blood pressure and cholesterol, respectively. For those with documented hypertension and hyperlipidemia, the correct awareness levels are 78.5 and 63.4%, respectively. The only sociodemographic factor associated with correct awareness is age with cholesterol knowledge. CONCLUSIONS: This population meets the objectives set by Healthy People 2000 for cholesterol awareness, but not for blood pressure. The overall levels of awareness compare favorably to results from other studied populations. Physicians are not using all opportunities to educate patients about modifiable risk factors.

Adult↗
PubMed1995

Female family physicians in obstetrics: achieving personal balance.

OBJECTIVE: To describe the experiences of female family physicians who practise obstetrics in balancing professional obligations with personal and family needs, given the unique challenges that such practice poses for these physicians. DESIGN: Qualitative study. SETTING: Ontario. PARTICIPANTS: A purposefully selected sample of nine female family physicians who met the criteria of being married, having children and currently practising obstetrics. OUTCOME MEASURES: Experiences of female family physicians and their strategies in their personal, family and professional lives that enable them to continue practising obstetrics. RESULTS: All participants continued to practise obstetrics because of the pleasure they derived from it, despite the challenges of balancing the unpredictable demands of obstetrics with their personal and family needs. To continue in obstetrics, they needed to make changes in their lives, either through a gradual, evolutionary process or in response to a critical event. Alterations to work and family arrangements permitted them to meet the challenges and led to increased satisfaction. Changes included making supportive call-group arrangements, limiting work hours and the number of births attended and securing help with household duties. CONCLUSIONS: An in-depth examination, through the use of qualitative methods, showed the reasons why some female family physicians continue to practise obstetrics despite the stressful aspects of doing so. This knowledge may be useful for women who are residents or experienced clinicians and who are considering including obstetrics in their practice.

Adaptation, Psychological↗
PubMed1995

The paradox of guideline implementation: how AHCPR's depression guideline was adapted at Kaiser Permanente Northwest Region.

BACKGROUND: To ensure implementation, the Agency for Health Care Policy and Research's (AHCPR) Guideline for the Treatment of Depression in Primary Care was recently translated into a local document by a large health maintenance organization (HMO). The guideline revision process was studied on the basis of interviews with members of the guideline revision committee and others, observation of meetings, and documents and correspondence. WHY THE GUIDELINE WAS CHANGED: The HMO changed the AHCPR guideline for reasons of convenience, credibility, audience, purpose, and context. For example, in their roles as representative consumers, committee members perceived that the AHCPR guideline, although addressed to primary care clinicians, was actually written from a psychiatric perspective and based on a psychiatric literature not relevant to primary care. COMPARISON OF THE GUIDELINES: Although the guidelines differ dramatically in length and format, coverage, emphasis, and organizing principle, substantive conflict between the two guidelines' recommendations is minimal. For example, the emphasis on medication is greater in the adaptation, which adds considerable original material of a practical nature on drugs and drug use. In addition, the original guideline has a "research literature orientation." In contrast, the adaptation is described as "clinical decision oriented", identifying the key actions and decisions that a practicing clinician must make to treat depression. DISCUSSION AND IMPLICATION: Translation of science-oriented national guidelines into user-oriented documents tailored to local audiences and settings can add great value to the guideline development process without sacrificing science-derived integrity-and is probably essential to successful implementation.

Depressive Disorder↗
PubMed1995

Primary care HMO clinicians' opinions about clinical practice guidelines.

OBJECTIVE: To assess primary care clinicians' opinions about the principal goals that national guideline developers foresee for clinical practice guidelines, and about possible effects of guideline implementation that are known to concern practicing clinicians. DESIGN: Preintervention survey of attitudes conducted as part of a larger study to evaluate alternative strategies for implementing clinical practice guidelines. SETTING: Kaiser Permanente, Northwest Region, a large, group model HMO. PARTICIPANTS: Primary care clinicians (N = 211) with at least 1 year of work experience in the HMO. The response rate was 80% (N = 168). RESULTS: Clinicians' responses suggest they will not object to the implementation of specific practice guidelines in the HMO. Guidelines' information-synthesizing and consensus-building functions are likely to be welcomed. Increased guideline implementation is apparently not perceived as a threat to professional autonomy. CONCLUSIONS: Further research is recommended, using this measure, or refined versions of it, in diverse practice settings. In addition, studies are needed of the relationship between clinicians' general expectations about the effects of guidelines and their level of adherence to specific guidelines.

Adult↗
PubMed1994

A new perspective on threatened autonomy in elderly persons: the disempowering process.

This study explored factors other than medical condition and treatments which contributed to the discharge experiences of 12 rural and 9 urban patients. Interpretive research methodology included document review, observation and in-depth interviews of all key participants. The purposefully selected sample consisted of a total of 21 patients, 22 informal caregivers, and 117 professionals involved in the hospital and/or home setting. Findings document a new perspective on how patients and professionals together contribute to the patient's threatened autonomy. Lack of clarity about goals, aspirations, and purpose in life and a generally negative frame of mind in the elderly combine with professional practice approaches to create a disempowering process. Faced with the biomedical orientation and paternalism of professionals, patients with a positive mindset and sense of direction and purpose in life did not experience threat to their autonomy. The researchers conclude that empowerment strategies must encompass a patient-centred approach, which includes an understanding of the patient's mindset, goals, aspirations, and sense of purpose within a larger life context. This consideration is essential to enable elderly patients to maintain autonomy despite continued health care requirements.

Aged↗
PubMed1994

The relationship between the menstrual cycle and female sexual interest in women with PMS complaints and volunteers.

This study assesses the influence of menstrual cycle phases and hormones on female sexual interest in both a nonclinical sample of volunteers (n = 18) and women who complained of premenstrual tension (n = 150). Women were assessed prospectively for two menstrual cycles with daily symptom charts. In addition mental status was assessed clinically and the Moos Menstrual Distress Questionnaire completed in the follicular and premenstrual phases. On the basis of these assessments women were assigned to subject groups. During the second cycle, daily 24-h urinary estrogens and urinary pregnanediol were determined. Sexual interest and feelings of well-being were recorded on a daily symptom rating chart. Sexual interest was found to be significantly higher in the follicular and ovulatory phases, than in the luteal, premenstrual, or menstrual phases. Sexual interest and feelings of well-being were correlated (R = 0.29). Sexual interest and feelings of well-being were not correlated with urinary estrogen or pregnanediol levels.

Adult↗
PubMed1994

5' proximal regions of Arabidopsis nitrate reductase genes direct nitrate-induced transcription in transgenic tobacco.

Nitrate reductase (NR) is the first enzyme in nitrate assimilation, a critical process for plant survival. The regulation of NR gene expression is complex, involving both internal and external factors. Of these, nitrate induction of NR gene expression has been studied most extensively and is well conserved among bacteria, fungi, and higher plants. We are interested in understanding the mechanism of nitrate induction of higher plant NR genes. Here we describe promoter analyses of the 5' flanking regions of the Arabidopsis NR genes, NR1 and NR2, with respect to nitrate induction of gene expression. To facilitate these analyses, a nitrate induction procedure using T1 transgenic tobacco plants was established. Approximately 1.5-kb 5' flanking regions of the two Arabidopsis NR genes (NR1 and NR2) were fused to a reporter gene and its expression in transgenic plants was analyzed. Deletion analyses of these regions show that 238- and 188-bp 5' flanking regions of the NR1 and NR2, respectively, contain sequences responsive to nitrate induction.

Arabidopsis↗
PubMed1994

Focus groups in family practice research: an example study of family physicians' approach to wife abuse.

Focus groups have been extensively used in marketing research and recently adapted for studies in the behavioral sciences and primary care. The purpose of this paper is two-fold: 1) to describe the application of focus group methodology to research in family practice, and 2) to demonstrate the use of this qualitative method to examine a specific issue--family physicians' approach to wife abuse.

Adult↗