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Biomedical subjects

J Copeland

Publications and source records attributed to J Copeland.

At least 55 records · Page 3Linked to original sources
PubMed1996

Characteristics of women with alcohol and other drug problems: findings of an Australian national survey.

Two hundred and sixty-seven women were interviewed in a national survey examining the characteristics, treatment needs and treatment experiences of Australian women who had received treatment for their alcohol and other drug problems. More than half the women were mothers, of whom almost one-third had surrendered custody of their children. Polydrug use was the norm among these women, who in general had substantial experience with the legal system. A sizeable proportion of women had experienced physical and psychological health problems such as hepatitis, eating disorders, self-mutilation, suicide attempts and low self-esteem. The majority of the sample had a life-time history of physical or sexual violence. The implications of these findings are discussed and recommendations are provided for attracting and retaining women in appropriate services.

Adolescent↗
PubMed1995

The tetracycline analogs minocycline and doxycycline inhibit angiogenesis in vitro by a non-metalloproteinase-dependent mechanism.

The tetracycline analogs minocycline and doxycycline are inhibitors of metalloproteinases (MMPs) and have been shown to inhibit angiogenesis in vivo. To further study the mechanism of action of these compounds we tested them in an in vitro model of angiogenesis: aortic sprouting in fibrin gels. Angiogenesis was quantitated in this system by a unique application of planar morphometry. Both compounds were found to potently inhibit angiogenesis in this model. To further characterize the activity of these compounds against MMPs, we determined the IC50S of both compounds against representatives of three classes of metalloproteinases: fibroblast collagenase, stromelysin, and gelatinase A. Doxycycline was found to inhibit collagenase, gelatinase A and stromelysin with IC50S of 452 microM, 56 microM and 32 microM, respectively. Minocycline was found to inhibit only stromelysin in the micromolar range with an IC50 of 290 microM. Since these results suggest that these compounds may not have been inhibiting in vitro angiogenesis by an MMP-dependent mechanism, we decided to test the effects of the potent MMP inhibitor BB-94. This compound failed to inhibit aortic sprouting in fibrin gels, thus strongly suggesting that both doxycycline and minocycline act by an MMP-independent mechanism. These results have implications for the mechanism of action of tetracycline analogs, particularly where they are being considered for the treatment of disorders of extracellular matrix degradation including periodontal disease, arthritis, and tumor angiogenesis.

Animals↗
PubMed1995

Use of cumulative meta-analysis in the design, monitoring, and final analysis of a clinical trial: a case study.

From 1983 to 1987, the Department of Veterans Affairs (DVA) Cooperative Studies Program (CSP) conducted a multicenter clinical trial (CSP #207) to determine whether four different antiplatelet regimens compared to placebo could prevent the occlusion of grafts following coronary artery bypass surgery. The study showed that all of the active regimens tended to be better than placebo and that the three regimens containing aspirin were statistically significantly better. A cumulative meta-analysis of 12 trials performed shortly before the end of CSP #207 raised the issue as to whether the meta-analysis, if done earlier, would have changed the conduct of the trial. At the start of the planning period, one trail of size n = 37 had been published with a nonsignificant odds ratio (OR) of 0.74 (95% CI: 0.18, 3.12). At the time that CSP # 207 was approved by the DVA Cooperative Studies Evaluation Committee, two trials had been published (cumulative n = 150, OR = 0.44, 95% CI 0.19, 0.99). At the time patient intake started, five trials showed cumulative n = 769, OR = 0.42, 95% CI = 0.26, 0.68. Although the first 6-month CSP #207 progress report showed no treatment effect, by the time of the 12-month review by the Data Monitoring Board (DMB) a trend was developing in favor of active treatment. If the results of the meta-analysis had been available to the DMB at that time, conceivably the Board would have recommended stopping the placebo arm because of a convincing treatment effect based on the totality of the evidence. Cumulative meta-analysis could be useful as an adjunct in the planning, conduct, and final analysis of a clinical trial. It could also be used as one piece of evidence in the monitoring of the ongoing phase of a trial.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1994

Long-term graft patency (3 years) after coronary artery surgery. Effects of aspirin: results of a VA Cooperative study.

BACKGROUND: The long-term success of coronary bypass surgery is dependent on graft patency after surgery. This trial was designed to determine if aspirin improved saphenous vein graft or internal mammary artery (IMA) graft patency between 1 and 3 years after coronary artery bypass grafting (CABG). METHODS AND RESULTS: After receiving aspirin 325 mg/d for 1 year after CABG and undergoing a 1-year postoperative cardiac catheterization, patients were randomized to receive either aspirin (325 mg) or placebo for 2 additional years. Angiography was performed 3 years after surgery to determine the primary end point-saphenous vein graft patency in 288 patients and IMA graft patency in 167 patients. At 3 years after CABG, the saphenous vein graft occlusion rate was 17.0% (62 of 365) for patients treated with aspirin compared with 19.7% (74 of 376) for those who received placebo (P = .404). For saphenous vein grafts that were patent at 1 year, the occlusion rate at 3 years was 4.8% (15 of 313) for patients treated with aspirin compared with 4.2% (13 of 310) for patients who received placebo (P = .757). At 3 years, the IMA graft occlusion rate was 10.3% (8 of 78) for patients treated with aspirin compared with 7.9% (7 of 89) for patients who received placebo (P = .594). For IMA grafts that were patent at 1 year, the occlusion rate was 4.3% (3 of 70) for patients treated with aspirin compared with 2.5% (2 of 81) for patients who received placebo (P = .541). CONCLUSIONS: These data suggest that aspirin treatment does not improve saphenous vein graft or IMA graft patency between 1 and 3 years after CABG.

Aspirin↗
PubMed1994

Avascular necrosis of bone after cardiac transplantation. Prevalence and relationship to administration and dosage of steroids.

We studied the relationship of the administration and dosage of steroids to the development of avascular necrosis of bone in 168 patients who had had a heart transplantation (156 patients) or a heart and lung transplantation (twelve patients). One hundred and forty-one of the patients were male and twenty-seven were female. The average age was forty-five years (range, seven to sixty-six years). The average duration of follow-up was forty months (range, twelve to eighty months). Avascular necrosis developed in five patients (3 per cent). The femoral head was involved in three patients (bilaterally in two and unilaterally in one), the medial femoral condyle was involved bilaterally in one, and several sites were involved in the fifth patient. The avascular necrosis was diagnosed an average of five months (range, two to eleven months) after the transplantation. In order to evaluate the influence of the dosage of the steroids on the development of avascular necrosis of bone, the doses of prednisone and Solu-Medrol (methylprednisolone) at one week, one month, six months, and one year after the transplantation were calculated for each patient. There was no association between the cumulative dose of prednisone and the development of avascular necrosis. There was, however, a strong statistical association (p = 0.005), as determined with pooled two-tailed variance analysis, between the cumulative dose of Solu-Medrol administered in the first month after the transplantation and the development of avascular necrosis.

Adolescent↗
PubMed1994

Avascular necrosis superimposed on Legg-Calvé-Perthes disease in a cardiac transplant patient.

The pathogenesis of both Legg-Calvé-Perthes disease (LCPD) and avascular necrosis (AVN) remains controversial. Evidence suggests, however, that both conditions are produced by vascular compromise in the femoral head. A patient with a previous history of LCPD at age eight subsequently developed AVN at age 46 after having a cardiac transplant for ischemic cardiomyopathy. A review of the past ten years' literature disclosed no reports of similar cases.

Femur Head↗
PubMed1993

A comparison of a specialist women's alcohol and other drug treatment service with two traditional mixed-sex services: client characteristics and treatment outcome.

Eighty subjects from a specialist women's service (SWS) and eighty subjects from two traditional mixed-sex treatment services (TMS) were recruited to a comparative, longitudinal study of changes in alcohol and other drug associated problems. Both the SWS and the TMS programs were principally based on the traditional disease model and the 12-step philosophy but the SWS employed only female staff and provided residential childcare. The SWS succeeded in attracting significantly more lesbian women, women with dependent children, women sexually abused in childhood and with a maternal history of substance dependence than the TMS. Six months following treatment there were no significant differences in any measure of treatment outcome between the two treatment groups. The results suggest that the simple provision of women-only treatment and childcare without changing treatment content does not substantially improve treatment outcome in women with severe alcohol and other drug related problems.

Adult↗
PubMed1992

The prevalence of dementia among elderly people living in Zaragoza and Liverpool.

The prevalence of dementia in elderly people living in the community was compared using data from Zaragoza (Spain) and Liverpool (UK). A standardized interview, the Geriatric Mental State (GMS), was administered to a random sample of 1070 persons in Liverpool and 1080 in Zaragoza. Using diagnoses derived from the GMS-AGECAT package we found no significant difference between the prevalence of dementia in Zaragoza (7.4%) and Liverpool (5.0%). The expected increase in prevalence with age was found, but the two cities did not appear to differ in the relationship between age and prevalence. No sex difference was apparent, and the two cities do not differ in the relationship between sex and prevalence.

Aged↗
PubMed1992

A comparison of predictors of treatment drop-out of women seeking drug and alcohol treatment in a specialist women's and two traditional mixed-sex treatment services.

The problem of high levels of client drop-out in drug and alcohol treatment is frequently reported in the literature. In the course of conducting an evaluation of a specialist women's treatment service, the inadequacy of the data on women-specific predictors of treatment drop-out was highlighted. Using a retrospective design, the characteristics of 160 women who left treatment less than 5 days after admission were compared to the 160 women who stayed longer than 5 days and were enrolled in the evaluation study. The findings of this study suggested that women who were employed, had a history of sexual assault (especially in adulthood), nominated alcohol as their drug of choice, were not married, older than 25 years of age and had demonstrated a sympathy with the agency's treatment philosophy were less likely to drop-out of treatment. In addition, for lesbian women, women with a history of sexual assault in childhood, and those with dependent children, attendance at a specialist women's service reduced the incidence of treatment drop-out.

Adolescent↗
PubMed1992

A comparison of women seeking drug and alcohol treatment in a specialist women's and two traditional mixed-sex treatment services.

The paucity of research on the treatment needs of women with substance abuse problems has been a serious impediment to the development of empirically validated treatment programmes. Women continue to be seriously under-represented as research subjects and clients of treatment services. This study compares the characteristics of 80 women attending a specialist women's treatment service with those of eighty women attending two traditional mixed-sex treatment agencies. Women attending a gender-sensitive service were significantly more likely to have dependent children, to be lesbian, to have a maternal history for drug or alcohol problems and to have suffered sexual abuse in childhood. These results suggest that gender-sensitive treatment services may be recruiting women who might not otherwise have sought treatment for their substance dependence problems.

Adolescent↗
PubMed1991

Starting aspirin therapy after operation. Effects on early graft patency. Department of Veterans Affairs Cooperative Study Group.

BACKGROUND: Although aspirin therapy started before operation improves vein graft patency after coronary artery bypass grafting, it also causes bleeding. The objective of this prospective, centrally directed, randomized, double-blind, placebo-controlled trial was to compare the effects of aspirin therapy started before operation with aspirin started 6 hours after operation on early (7-10-day) graft patency. METHODS AND RESULTS: Patients were randomized to receive either aspirin 325 mg or placebo the night before surgery; after operation, all patients received aspirin 325 mg daily, with the first dose administered through the nasogastric tube 6 hours after operation. Angiography was performed in 72% of the analyzed patients an average of 8 days after operation, and the primary end point was saphenous vein graft patency in 351 patients. Internal mammary artery graft patency was also assessed in 246 patients because many individuals received both internal mammary artery and vein grafts. In the patients given preoperative aspirin, the vein graft occlusion rate was 7.4 +/- 1.3% compared with 7.8 +/- 1.5% in those who received preoperative placebo (p = 0.871). In the subgroup of patients receiving Y grafts, 0.0% of the grafts were occluded in the preoperative aspirin group compared with 7.0 +/- 3.6% in the preoperative placebo group (p = 0.066). The internal mammary artery occlusion rate was 0.0% (0 of 131) in the aspirin group compared with 2.4 +/- 1.4% (three of 125) in the placebo group (p = 0.081). Patients in the aspirin group received more transfusions than those in the placebo group (median, 900 versus 725 ml, p = 0.006). The reoperation rate for bleeding in the aspirin group was 6.3% compared with 2.4% in the placebo group (p = 0.036). Median chest tube drainage within the first 6 hours after operation was 500 ml in the aspirin group compared with 448 ml in the placebo group (p = 0.011). CONCLUSIONS: Thus, preoperative aspirin is associated with increased bleeding complications and offers no additional benefit in early vein graft patency compared with starting aspirin therapy 6 hours after operation. There was a trend, although not significant, toward improved early patency for Y grafts and internal mammary artery grafts with preoperative aspirin.

Aged↗
PubMed1991

Comparison of the results of a standardized AIDS prevention program in three geographic locations.

A standardized AIDS prevention program, Stop AIDS, was tested with gay and bisexual men in 3 different geographic locations: metropolitan Chicago; Orange County, California; and Phoenix, Arizona, employing a test of AIDS knowledge, attitudes, and behavior. Results indicted that the Chicago participants began with the most knowledge about AIDS but gained least in the workshop, ending lowest, while the Orange County participants started with the least knowledge and gained the most, ending highest. The same change pattern was demonstrated in terms of attitudes. However, all groups started the discussion group with approximately the same risk behavior for HIV transmission, and all groups committed to the same amount of change in risk behavior at workshop termination, demonstrating the independence of behavior change from knowledge and attitude changes. Additionally, all 3 groups had the same 8 of 15 significant correlations of measures with no correlation between knowledge about AIDS, attitudes toward AIDS, and post-workshop intentions regarding risk behavior. These results indicate that Stop AIDS is an effective prevention program in all 3 locations, but that this and other programs should emphasize actual risk-behavior change rather than knowledge increase or healthier attitudes to produce the greatest lethality reduction.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Long-term follow-up comparing subclavian flap angioplasty to resection with modified oblique end-to-end anastomosis.

The definitive surgical procedure for correction of aortic coarctation remains controversial. Therefore, we retrospectively reviewed a total of 56 children under 4 years of age with coarctation repair between 1977 and 1986. Thirty-four had the subclavian flap angioplasty technique and 22 had resection with oblique end-to-end anastomosis. The group was further subdivided to include only the 23 infants less than 3 months of age--eight infants with resection with oblique end-to-end anastomosis (less than or equal to 3ETE) and 15 infants with subclavian flap angioplasty (greater than or equal to 3SFA). The remaining 33 patients older than 3 months of age were divided into 14 patients with resection and oblique end-to-end anastomosis (greater than 3ETE) and 19 patients with the subclavian flap angioplasty technique (greater than 3SFA). The overall mortality was not significantly different between techniques. Postoperative hypertension was significantly more prevalent with end-to-end anastomosis than with the subclavian flap angioplasty technique (p less than 0.01). Seven patients had recurrent coarctation. The 6-year actuarial freedom from recoarctation was 93% +/- 6% in the less than or equal to 3SFA group compared with 53% +/- 20% in the less than or equal to 3ETE group (p less than 0.02), but there was no significant difference in those children operated on at a later age regarding the type of coarctation repair. Therefore, we recommend subclavian flap angioplasty in patients less than 3 months of age. In those older than 3 months either procedure is safe and the risk of recoarctation is similar.

Actuarial Analysis↗