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Biomedical subjects

J B Brown

Publications and source records attributed to J B Brown.

At least 91 records · Page 5Linked to original sources
PubMed1993

Menstrual cycle hormonal profiles of women with and without premenstrual syndrome.

This paper compares the urinary hormone profiles of estrogen and pregnanediol in women with documented premenstrual syndrome (PMS) (n = 65) and asymptomatic volunteers (n = 18). Daily 24-h urine samples were collected for an entire menstrual cycle. Subject groups did not differ significantly in menses length or in the day of the preovulatory estrogen peak. Cycle length was significantly shorter for the volunteers (p < 0.05). The day of the pregnanediol peak occurred significantly later for the PMS patient group than for the asymptomatic volunteers (p < 0.05). Split plot analysis of variance showed no significant differences overall between subject groups for levels of urinary estrogen or pregnanediol. This study did not find evidence of progesterone deficiency amongst sufferers of the premenstrual syndrome.

Adult↗
PubMed1993

Patients, friends, and relationship boundaries.

When patient and physician are close friends, both professional and personal relationships can suffer. Jointly exploring and setting explicit boundaries can help avoid conflict and maintain these valuable relationships. This is particularly important when the physician practises in a small community where such concurrent relationships are unavoidable.

Adaptation, Psychological↗
PubMed1993

Identifying and treating wife abuse.

BACKGROUND: Wife abuse, acknowledged as a critical problem in our society, is often undetected by family physicians. The purpose of this study was to identify the problems and potential solutions encountered by family physicians in the identification and treatment of wife abuse in London, Ontario. METHODS: Family physicians in London were recruited to participate in four focus groups. The groups' discussions were audiotaped and transcribed. The transcripts were analyzed using qualitative methodology to determine relevant themes. RESULTS: Thirty-two physicians (16 male and 16 female) participated in the focus groups. The majority were in group practice (81%). The average number of years in practice was 11.75. An analysis of the focus group session identified two major clinical themes with subcategories: (1) physician issues (ie, identification, treatment); and (2) patient issues (ie, barriers to identification, symptom presentation). CONCLUSIONS: The focus groups served as an effective method to engage family physicians in isolating their own as well as their patients' difficulties in confronting this serious problem.

Family Practice↗
PubMed1992

Application of time-series analysis for the recognition of increases in urinary estrogens as markers for the beginning of the potentially fertile period.

Time-series analysis was applied to the urinary total estrogen data from 142 ovulatory menstrual cycles to determine the first statistically significant increase as a marker for the beginning of the potentially fertile phase. Application of the Trigg's tracking signal to each cycle detected an increase in urinary total estrogens above the baseline in every case, with a cumulative probability of > or = 95%. The distribution of first increase days ranged from 10 days before 3.5 days before the presumed day of ovulation with a mean of 6.5 +/- 1.4 days. The significant parameters in the calculation of the tracking signal are the smoothing constant (alpha) which is related to the number of baseline observations, the baseline mean for the cycle, and the variation of the baseline mean. The method allows a calculation of the tracking signal as the cycle unfolds and a statistical assessment can be given each day. The procedure is easily adaptable for computer calculation, and because it is applied to individual cycles avoids the use of population means with the loss of information inherently associated with the combination of data from many cycles. The Trigg's tracking signal is an appropriate method of analysis of menstrual cycle data and represents a satisfactory alternative to the more usual cumulative sum procedure. The distribution of the first increases constitutes a reference standard for urinary estrogen assays.

Adult↗
PubMed1992

The experience of asthma.

A group of seven asthmatics were identified from family practice, following administration of a questionnaire, as expressing feelings of stigma or pessimism concerning their condition. They were interviewed in depth, using interpretive research methods, concerning their experience of asthma. Interpretive research uses qualitative methods to explore the emotions, feelings and meaning of the event of interest. All the interviews were transcribed verbatim by the principal researcher and analyzed by the technique of immersion and crystallization. The picture of asthma that emerged for the participants in this study gave rise to the concept of a dynamic model to illustrate their asthma experience. The model showed asthma as a continuum from diagnosis to final acceptance. The transition phase included a need to integrate knowledge, experience and self-awareness before progressing to acceptance and control. A mentoring relationship greatly facilitated resolution of the transition phase. Progress along the continuum was accompanied by diminishing fear. Another important theme to emerge was the fact that tiredness and physical limitations were common feelings, irrespective of the severity of the asthma in medical terms. The implications of this research for health workers is that they have much to contribute in assisting asthmatics to gain control over their condition, particularly in respect to understanding what knowledge concerning their condition is relevant to asthmatics and in understanding the potential benefit to asthmatics of a mentoring relationship.

Adaptation, Psychological↗
PubMed1992

Patients as reliable reporters of medical care process. Recall of ambulatory encounter events.

This study explores the reliability of a data source on the quality and content of care rarely used in studies comparing the performance of health care organizations, that is, patient reports obtained from surveys. Evidence of patient survey reliability and validity and report data on patient reporting accuracy were reviewed for ten events that may have occurred during an initial health assessment for new adult enrollees of a health maintenance organization (HMO). Reports of 380 patients obtained through telephone survey were compared with medical records. For chest radiograph, mammogram, and electrocardiogram (EKG), patient reports exhibited both sensitivity and specificity. For serum cholesterol test, patients proved to be sensitive but not specific reporters. For blood pressure measurement, stool kit, and rectal examination, false negative rates were low (less than or equal to 0.10); they were somewhat higher for breast self-examination instruction and pelvic examination (0.21 and 0.22, respectively). Only for testicular self-examination instruction did patient reports fail to confirm medical record documentation (false negative rate = 0.53). Multivariate analysis showed a small association between increasing patient age and decreasing confirmation. Gender did not affect reporting ability, and agreement did not deteriorate over a 2- to 3-month postencounter interval. Patient reports appear to merit greater use in comparative studies of technical quality of care. Key words: quality of health care; quality assurance; health care; ambulatory care; patient recall; patient reports.

Ambulatory Care↗
PubMed1992

Use of health maintenance organization data bases to study pharmacy resource usage in diabetes mellitus.

OBJECTIVE: To evaluate use of medications by patients with diabetes. RESEARCH DESIGN AND METHODS: We analyzed the computerized pharmacy data base of a large health maintenance organization to evaluate cost impact and patterns of usage for all pharmacy products by a defined population of diabetic patients. RESULTS: Diabetic patients received 31.2 dispenses/yr compared with 11.5 for control patients. Total pharmacy costs were threefold higher for diabetic patients ($621 vs. 207/yr) and accounted for approximately 17% of their total health-care costs. Products specifically for the care of diabetes averaged $175/yr or approximately 4.5% of their total health-care costs: 57% received an oral hypoglycemic agent, 34% received insulin, and 6% received both. Cardiovascular drugs accounted for 29% of total costs. There was increased use of most classes of medication by patients with diabetes. CONCLUSIONS: Health maintenance organization management data bases, particularly those storing pharmacy dispensing data, provide useful information on the impact of chronic disease. People with diabetes receive a greater number of most types of medication with a greater overall cost than do nondiabetic people. Previous studies have underestimated the contribution of pharmacy purchases to the costs of caring for a diabetic population.

Adolescent↗
PubMed1991

Use of the Home Ovarian Monitor in pregnancy avoidance.

The application of the Home Ovarian Hormone Monitor to the avoidance of pregnancy by periodic abstinence has been explored. No woman had difficulty with the daily urine testing, and their results consistently identified the distinctive hormone pattern of the ovulatory cycle and the day of ovulation and correlated closely with the mucus symptoms. The tests gave 4 days or more warning of ovulation in 99% of cycles and allowed intercourse to be resumed 1 to 3 days after ovulation in 88%, giving a mean period of abstinence of 7 days. No pregnancy occurred from intercourse during the late safe days defined by the Monitor, but some early-day pregnancies occurred through long sperm survivals of 6 to 8 days, mostly during the return of fertility after breastfeeding. Rules for the avoidance of pregnancy, with the minimum of testing on the basis of these results, are given.

Adult↗
PubMed1991

The natural family planning--lactational amenorrhea method interface: observations from a prospective study of breastfeeding users of natural family planning.

Methods of natural family planning are sometimes difficult for women to use during lactation. When this is so, the lactational amenorrhea method may prove useful. Researchers agree that a fully breastfeeding woman who is amenorrheic is 98% protected from pregnancy for up to 6 months after delivery. The fertility status of 74 users of natural family planning during the time they would have been protected by the lactational amenorrhea method is examined. Underlying hormonal profiles show that there was little ovarian activity during this time. Eight ovulatory events occurred during the period of protection by the lactational amenorrhea method, of which four fulfilled minimum criteria for adequacy; there were no pregnancies during this period. However, some women did report experiencing fertile mucus symptoms during this time that were often unrelated to estrogen production. Using the lactational amenorrhea method rather than natural family planning allows them to avoid unnecessary abstinence.

Amenorrhea↗
PubMed1991

Ultrasonographic patterns of ovarian activity during breastfeeding.

In this study, ultrasonography was used to detect follicular activity in lactating women, and these findings were related to the underlying hormonal profiles and to the mucus symptom. A number of different patterns of follicular development were seen before the women returned to normal fertile cycles during the period that was previously considered to be characterized by ovarian quiescence. Some of the transitory patterns of follicular activity were reflected in rising hormone levels and patterns of fertile mucus that were sometimes confusing for these lactating women who were using natural family planning.

Breast Feeding↗
PubMed1991

Asthma and stigma.

A questionnaire was sent to all asthmatics between the ages of 18 and 60 identified from a rural family practice in Southwestern Ontario. The questionnaire measured various attitudes concerning asthma and was used to identify those respondents reporting high levels of pessimism or stigma in relation to their condition. Seven respondents were then interviewed in depth, using interpretive research methods, to explore the experience of their condition and to attempt to clarify the concept of stigma in asthma. The conclusion of the study was that, for the respondents interviewed, stigma was not a major theme in their illness experience and seemed much less important than the current literature and the initial questionnaire results suggested.

Adolescent↗
PubMed1991

The resumption of ovulation and menstruation in a well-nourished population of women breastfeeding for an extended period of time.

We have studied a large group of Australian women breastfeeding for an extended period of time to determine the duration of lactational anovulation (n = 89) and amenorrhea (n = 101). Salivary progesterone assays were used to determine ovulation. These women had a mean of 322 days of anovulation and 289 days amenorrhea. Less than 20% had ovulated and less than 25% had menstruated by 6 months postpartum. The latest ovulation was at 750 days and the latest menstruation at 698 days. There was no significant correlation between any measure of maternal nutritional status and the duration of anovulation or amenorrhea. Neither the time of first supplement introduction to the baby nor the amount of supplement given was an accurate predictor of the return of ovulation or menstruation. However, our results clearly show that lactational amenorrhea can provide good protection against pregnancy in the 1st 6 months postpartum, even in well-nourished women who are giving their babies supplemental feeds.

Adult↗
PubMed1990

Hormone levels in older women: a study of post-menopausal breast cancer patients and healthy population controls.

Hormone concentrations in blood and total 12 h urine values were compared between 40 post-menopausal women with breast cancer and 40 control women in a study which carefully controlled for the possible confounding effects of age, weight and pregnancy history by individually matching cases and controls on these factors. Breast cancer cases had received only surgical treatment for their localised disease, which was diagnosed from 1 to 9 years before hormonal evaluation. Cases had 15% higher serum oestradiol levels (P = 0.02), 40% more urinary oestradiol (P = 0.03) and 44% more urinary oestriol (P = 0.04) than control women. Cases also had higher levels of serum and urinary oestrone, but these differences were not statistically significant. The percentages of serum oestradiol not bound to albumin or sex-hormone binding globulin did not differ between cases and controls, nor were there statistically significant differences in the serum levels of prolactin, sex-hormone binding globulin or dehydroepiandrosterone sulphate. These results provide further support for the hypothesis that breast cancer risk is determined in part by post-menopausal serum oestrogen concentration.

Aged↗
PubMed1990

Development of mouse ovarian follicles from primary to preovulatory stages in vitro.

An in-vitro culture system was developed in which primary mouse follicles from 12-16-day-old mice grew to the preovulatory stage. The important determinants of growth in culture were the inclusion of stroma with the primary follicles, the age of the mouse, the presence of FSH and LH, the use of culture dishes with a hydrophobic membrane and the use of post-menopausal human serum to supply growth factors. During culture the pieces of ovarian tissue containing the primary follicles coalesced to form characteristic spherical clusters. The cultured follicles appeared to be normal as determined by the appearance and organization of the granulosa cells, the appearance of the antrum and the accompanying steroidogenesis, but the ova had not resumed meiosis. The results show that the growth of mouse follicles starting from the primary stage is critically dependent on adequate concentrations of FSH.

Age Factors↗
PubMed1990

Home monitoring of gonadotropin ovulation induction using the Ovarian Monitor.

The safe use of gonadotropins relies on close hormonal and/or ultrasound monitoring to assess the response to treatment, requiring multiple hospital visits. Home monitoring with the Ovarian Monitor (St. Michael Research Foundation, Macleod, Victoria, Australia) minimizes hospital visits and overcomes many of the logistic difficulties associated with gonadotropin use. It utilizes a system of homogenous enzyme immunoassay using lysozyme conjugates to measure quantitatively either urinary estrone-3 or pregnanediol-3-glucuronide. Results obtained by 24 patients in 57 cycles using the Ovarian Monitor at home correlate closely with results obtained in the laboratory (estrone-3-glucuronide r = 0.955; pregnanediol-3-glucuronide r = 0.958). Cycle outcomes (ovulation, 74%/cycle; clinical pregnancy, 30%/cycle; multiple pregnancy, 13%/pregnancy; hyperstimulation, 11%/cycle) are no different from those achieved in laboratory-monitored patients. Home monitoring can be as safe and effective as laboratory monitoring, offers significant social benefits, and improves access to this form of therapy.

Adult↗
PubMed1988

A case-control study of male breast cancer.

A case-control study was conducted in Los Angeles County, CA, of 75 male breast cancer cases aged 20-74 yr at diagnosis to investigate the role of a number of suspected risk factors. The study involved both interviews and laboratory measurements. Factors under study included fertility and marital history, obesity, alcohol and cigarette consumption, use of drugs known or suspected of causing gynecomastia, family history of breast cancer, history of radiation exposure to the upper body, sex chromatin analysis, serum levels of prolactin, testosterone, estrone, estradiol and sex-hormone-binding globulin, as well as urinary levels of estrone, estradiol, and estriol. Two patients versus no controls tested positive for sex chromatin and were excluded from further analyses. The only statistically significant risk factor identified was greater weight of the cases at age 30; a man who weighed 80 or more kg at age 30 had twice the risk of breast cancer of a man weighing less than 60 kg at that age. Serum estrone levels were positively, and sex-hormone-binding globulin levels were negatively, related to body weight, and we interpret the greater weight of the cases as suggesting that the underlying risk factor is an increased exposure to bioavailable estrogen. None of the differences observed between cases and controls for either the serum or urinary hormone levels was, however, statistically significant and there did not appear to be any large absolute excess of estrogens or deficit of testosterone in the cases. This apparent contradiction may be explained by the fact that there was little difference in weight between the cases and controls at the time of sampling.

Adult↗