What makes a dental practice grow?
Explore the source record for details and available documents.
Dentistry↗
Biomedical subjects
J B Brown
Publications and source records attributed to J B Brown.
Natural family planning.
It is now well accepted that a woman can conceive from an act of intercourse for a maximum of only about 7 days of her menstrual cycle. The reliability of natural family planning depends on identifying this window of fertility without ambiguity. Several symptomatic markers, cervical mucus and basal body temperature, have been used extensively and with considerable success in most women but failures occur. Ovarian and pituitary hormone production show characteristic patterns during the cycle. Urinary estrogen and pregnanediol measurements yield reliable information concerning the beginning, peak, and end of the fertile period, provided that the assays are accurate and performed on timed specimens of urine. We have developed such enzyme immunoassays for urinary estrogen and pregnanediol glucuronides that can be performed at home. In the early versions of the assays, enzyme reaction rates were measured by eye, but more recently, a simple photoelectronic rate meter has been used. The final problem to be solved is not technologic but whether women are sufficiently motivated to expend the same time and effort each day for 10 days a month, with less cost, on fertility awareness as they spend on making a cup of tea.
Adult↗
Mild to moderate abnormalities of semen do not affect pregnancy rates during ovulation induction with gonadotrophins.
One or more semen analysis results were available for 195 men whose wives responded to ovulation induction with gonadotrophins performed at The Royal Women's Hospital since 1963. Fifty-three men (27%) has subnormal semen analyses by conventional criteria: sperm concentration less than or equal to 20 X 10(6)/ml, motility less than or equal to 40% or normal morphology less than or equal to 50%. The lifetable pregnancy rates were not significantly different for those with subnormal and normal semen (chi 2 = 0.169), by six cycles 64% (s.e.m. = 7) with subnormal semen had conceived compared with 59% (s.e.m. = 5) with normal semen. It appears that lower limits of semen quality could be relaxed for women needing ovulation induction with gonadotrophins.
Female↗
The patient-centred clinical method. 1. A model for the doctor-patient interaction in family medicine.
This article describes a patient-centred clinical method appropriate for family medicine. The method is designed to attain an understanding of the patient as well as his disease. This two-fold task is described in terms of two agendas: the physician's and the patient's. The key to an understanding of the patient's agenda is the physician's receptivity to cues offered by the patient, and behaviour which encourages him to express his expectations, feelings and fears. The physician's agenda is the explanation of the patient's illness in terms of a taxonomy of disease. In the patient-centred clinical method, both agendas are addressed by the physician and any conflict between them dealt with by negotiation. This is contrasted with the disease-centred method in which only the doctor's agenda is addressed. Further articles will describe the patient-centred method in operational terms.
Aged↗
Endogenous sex hormones, prolactin, and breast cancer in premenopausal women.
Forty-one women with breast cancer and 119 controls participated in a case-control study of the relation of endogenous sex hormones to breast carcinoma in premenopausal women. During the follicular phase of the menstrual cycle, one overnight urine specimen was collected. During the luteal phase, urine and blood specimens were obtained. 17 beta-Estradiol, sex hormone-binding globulin, progesterone, and prolactin were measured in plasma, whereas estrogen metabolites (estrone, estradiol, and estriol) and pregnanediol were assessed in the urine. Breast cancer was associated with high-plasma estradiol and prolactin and with low progesterone. Similar but weaker associations were observed for urinary estrogens and pregnanediol in the luteal phase.
Adult↗
Endogenous sex hormones, prolactin, and mammographic features of breast tissue in premenopausal women.
The relationship between levels of certain endogenous hormones and the mammographic features of breast tissue was evaluated in 110 premenopausal women who were referred to hospital-based radiology units for a routine xeromammogram. This analysis was based on specimens collected during the luteal phase of the menstrual cycle. Plasma 17 beta-estradiol, progesterone, and prolactin were measured, as well as urine estrone, estradiol, estriol, and pregnanediol. The main xeromammographic features of the breast assessed were Wolfe's parenchymal pattern and the percentages of the breast showing nodular densities and homogeneous density. In these data, endogenous hormones were not strongly associated with mammographic features of breast tissue. However, women with the N1 and P1 parenchymal patterns had somewhat higher levels of estrogens and prolactin and somewhat lower levels of progesterone than women with the P2 and DY patterns.
Adult↗
Deposition, clearance, and effects of aerosolized amiloride in sheep airways.
Persistent Na+ absorption across a relatively Cl- impermeable epithelial barrier may contribute to the smaller water content of airway surface liquid (ASL) in cystic fibrosis. In this study, the feasibility and effectiveness of delivering an inhibitor of Na+ absorption, amiloride, by aerosol to the ASL of awake sheep was evaluated. Aerosolization of 6 X 10(-3) M amiloride, with [14C]amiloride, resulted in an estimated concentration of 7 X 10(-4) M in ASL. The transtracheal electric potential difference (PD), an index of the rate of Na+ absorption, was significantly inhibited (-29%) immediately after aerosolization of amiloride. The inhibition was short-lived and was correlated with rapid disappearance of the drug from ASL (half-time, 10.5 min between 0 and 30 min after aerosolization). Amiloride but not aerosol vehicle increased ASL volume significantly. The unidirectional flow of [14C]amiloride from the lumen to the submucosa across excised, short-circuited sheep airways exceeded flow from submucosa to lumen by a factor of at least 6. This finding suggests that amiloride is actively absorbed and is consistent with the rapid clearance from the airway surface and the short-lived effects of aerosolized amiloride in vivo. We conclude that sufficient concentrations of amiloride can be delivered to sheep airways by aerosol to inhibit PD and Na+ absorption for short periods.
Aerosols↗
A new approach to capital payment in a competitive era.
Explore the source record for details and available documents.
Capital Financing↗
Employers face high stakes in forging capital policy.
Explore the source record for details and available documents.
Capital Expenditures↗
Progesterone and the premenstrual syndrome: a double blind crossover trial.
A double blind, randomised, crossover trial of oral micronised progesterone (two months) and placebo (two months) was conducted to determine whether progesterone alleviated premenstrual complaints. Twenty three women were interviewed premenstrually before treatment and in each month of treatment. They completed Moos's menstrual distress questionnaire, Beck et al's depression inventory, Spielberger et al's state anxiety inventory, the mood adjective checklist, and a daily symptom record. Analyses of data found an overall beneficial effect of being treated for all variables except restlessness, positive moods, and interest in sex. Maximum improvement occurred in the first month of treatment with progesterone. Nevertheless, an appreciably beneficial effect of progesterone over placebo for mood and some physical symptoms was identifiable after both one and two months of treatment. Further studies are needed to determine the optimum duration of treatment.
Adolescent↗
A study of returning fertility after childbirth and during lactation by measurement of urinary oestrogen and pregnanediol excretion and cervical mucus production.
Explore the source record for details and available documents.
Adult↗
The luteal phase after hyperstimulation for in vitro fertilization.
Of 500 cycles in which in vitro fertilization (IVF) was undertaken, laparoscopy was performed 372 times, 272 embryo transfers were carried out, and 55 pregnancies resulted, 30 of which resulted in delivery. Of those patients who underwent laparoscopy, 156 received clomiphene citrate alone, 203 clomiphene citrate and hMG, and 13 hMG alone. All patients were found to have a luteal-phase length of 10 days or greater (measured from the time of ovulation). The midluteal urinary total estrogen (UTE) value and pregnanediol excretion (Pd2) far exceeded the levels seen in normal cycles. There were no significant differences between conceptual and nonconceptual cycles and the high levels encountered would be expected after deliberate hyperstimulation. Fifty-five patients (in whom 11 pregnancies resulted) were monitored every other day throughout the luteal phase after embryo transfer. Both conceptual and nonceptual cycles showed a peak in pregnanediol glucuronide level around luteal day 6, which then fell. The level rose again if the corpus luteum was "rescued" by the implanting embryo. While the difference was not statistically significant, the estradiol levels appeared to decrease earlier in the nonconceptual cycles than in the continuing pregnancy cycles. It is important to note that the pattern of steroid production in the follicular phase was similar in both conceptual and nonconceptual cycles. While these data are not conclusive, they suggest that some nonconceptual cycles may have suffered early corpus luteal regression. Whether luteal-phase support is indicated in patients treated with clomiphene or clomiphene/hMG therapy cannot be determined from this study. However, it is thought that a controlled study of luteal-phase support in patients so stimulated is warranted. It appears that patients treated with hMG alone tend to undergo a compressed cycle and should be given luteal-phase support since other studies have reported shortened luteal phases following such hMG therapy.
Chorionic Gonadotropin↗
Neurodevelopmental screen in the school entrant medical examination as a predictor of coordination and communication difficulties.
A neurodevelopmental screen in the medical examination of 3750 school entrants with a mean age of 5 years 4 months was validated as a predictor of coordination and communication difficulties. Class teachers of 6, 7, and 8 year olds completed a questionnaire about motor and communication success and difficulty in school activities. Below average ratings on the neurodevelopmental screen were associated with later problems in school activities. The findings, reported to all head teachers, suggest some approaches to intervention in school. The neurodevelopmental screen contributes to early assessment of special education needs of clumsy children.
Age Factors↗
Health capital policy in the United States: a strategic perspective.
Health capital policy is strategically important not only because of the long-term nature of capital commitments but also because capital requirements often drive institutional behavior far out of proportion to dollars expended. The authors offer a framework for analyzing U.S. health capital policy, much of which is indirect and not always understood to be health capital policy. They emphasize the complex interaction between capital policy and health system configuration and performance, and highlight the long-term effects of current capital policy. They conclude with a likely configuration of the future U.S. health care system and with a discussion of the strategic role of capital policy in creating that future.
Capital Financing↗
Estrogen and sex hormone-binding globulin levels in nulliparous and parous women.
The hormone profiles of nulliparous and parous women on day 11 of their menstrual cycle have been studied in an attempt to seek evidence for the hormonal basis of the protective effect of first birth on breast cancer risk. A previous publication reported that there were significantly lower (26%) early morning prolactin levels in parous women as compared to those levels in nulliparous women but that there were no differences in plasma and urinary estrogen levels. The present study shows, however, that parous women had significantly shorter cycle lengths than nulliparous women of the same age, and the data were reevaluated with this difference being taken into account. After adjustment for cycle length (within the range of 24-32 days) and age, estrogen levels were significantly lower (22%) in parous women compared to those in nulliparous women. Two further aspects of estrogen metabolism were measured in the plasma samples of these women: the binding capacity of sex hormone-binding globulin (SHBG) and the percentage of free estradiol (E2). SHBG levels were 12% higher in parous women, but there was no difference in percentage of free E2. In the previous publication it was suggested that the protective effect of first birth on breast cancer risk was mediated in part by permanently lowering prolactin levels. The current findings suggest that changes in estrogen metabolism also are a factor.
Adult↗
Personal and professional development of teachers in family medicine.
While medical educators have devoted considerable effort to examining the optimal learning environment for teaching family medicine, less attention has been paid to "blocks" that prevent teachers of family medicine from being effective. This paper considers three major aspects of this problem: the personal and professional development of the teacher; blocks that impede this development; and the value of intervening in the teaching-learning process. These concerns are discussed in relation to an intervention program developed at the Byron Family Medical Centre, a family practice teaching unit affiliated with Victoria Hospital Corporation and the Department of Family Medicine, University of Western Ontario, London.
Adult↗
Monitoring early production of chorionic gonadotrophin (HCG) following in vitro fertilization and embryo transfer.
A rapid, sensitive assay was developed for monitoring HCG production and applied to serum and urine collection between days 4 and 20 after OPU in 55 patients treated by ovarian hyperstimulation and IVF. Eleven ongoing pregnancies, 2 ectopic pregnancies and 1 clinical abortion resulted. The earliest detection of a rise in HCG was on day 7 after OPU. The HCG values showed that trophoblastic tissue functioned transiently in another 11 patients and probably in another 5. Thus evidence for functioning trophoblastic tissue was obtained in a total of 30 patients (55%). These findings are important for the further improvement of IVF. No antibodies to administered HCG were detected.
Antibodies↗
Response of a mucinous ovarian tumor of borderline malignancy to human chorionic gonadotropin.
Plasma and urinary steroid hormones were measured before and after an injection of human chorionic gonadotropin (hCG) to a postmenopausal woman with a mucinous ovarian tumor of borderline malignancy. Hormones were also measured in blood from a vein draining the tumor, and circulating gonadotropins and plasma and urinary steroids were measured before and after tumor removal. Baseline levels of plasma progesterone (P), androstenedione (delta 4 A), and estradiol (E2), and urinary estrogens and pregnanediol were high; they increased dramatically in response to hCG and fell after tumor removal. A less striking increase in testosterone, dihydrotestosterone, dehydroepiandrosterone (DHEA), and DHEA sulfate was noted after hCG injection. A gradient existed between tumor vein and peripheral vein levels of P, 17 alpha-hydroxyprogesterone, delta 4 A, E2, DHEA, and cortisol. Plasma follicle-stimulating and luteinizing hormones initially low but rose to the postmenopausal range after surgery. These results indicate the presence of delta 4 and delta 5 androstene pathways within the tumor. The responsiveness of the tumor to hCG provides further evidence that hCG may be the endogenous stimulus to steroid hormone production by epithelial ovarian tumors.
Chorionic Gonadotropin↗