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Biomedical subjects

J Dwyer

Publications and source records attributed to J Dwyer.

At least 73 records · Page 4Linked to original sources
PubMed1994

A prospective study of adolescents who choose among levonorgestrel implant (Norplant), medroxyprogesterone acetate (Depo-Provera), or the combined oral contraceptive pill as contraception.

OBJECTIVES: Levonorgestrel implants (Norplant) and medroxyprogesterone acetate injections (Depo-Provera) represent additional contraception options for adolescents. The purpose of this study was to examine prospectively clinical profiles among adolescents who chose one of the two long-term contraceptives compared with profiles among those who chose the combined oral contraceptive pill (OCP). METHODS: Girls who needed contraception and did not require confidentiality were presented with a contraceptive menu consisting of Norplant (n = 58), Depo-Provera (n = 66), or OCP (n = 75). At baseline and follow-up visits over 6 months, patients were interviewed regarding gynecologic history, side effect symptoms, and satisfaction. The average age of subjects was 15.5 years (range 11 to 20 years); 66% were African-American and 34% white. RESULTS: Significantly more teens who chose Depo-Provera (73%) reported having used some method of birth control previously than those selecting either Norplant (30%) or OCP (26%). Adolescents who chose either Norplant (34%) or Depo-Provera (43%) were significantly more likely to have been pregnant previously than those choosing OCP (12%). Those selecting Depo-Provera were significantly more likely to report a history of genital infection with Chlamydia trachomatis (42%) than those in the other two contraceptive groups (22%). Prevalences of reported recent depression and fatigue before initiation of treatment were high, exceeding 35% across the three groups. A total of 105 and 40 adolescents were assessed at 3 and 6 months, respectively. At follow-up, more than 80% of OCP users maintained regular menstrual cycles, whereas over 80% of those choosing Norplant or Depo-Provera had disrupted cycles. Complaints of nausea and dizziness among Norplant users and fatigue among Depo-Provera and OCP users increased significantly between the baseline and follow-up visits. Reports of local reactions to the Norplant device were common but not clinically significant. Blood pressure readings, facial acne, and body mass index did not change over time in any treatment group. Subjects in the Norplant and Depo-Provera groups appreciated freedom from daily compliance to maintain contraceptive effectiveness and the "hidden" nature of the method. Appointment compliance at the end of 6 months was 78% for Depo-Provera, 40% for Norplant, and 46% for OCP. CONCLUSIONS: The implant and injection forms of contraception appear to be especially popular among girls with previous pregnancies or birth control use. The common occurrences of medical symptoms and sexually transmitted diseases before initiation of therapy underscore the importance of baseline evaluation. Norplant users may be warned about nausea and dizziness as well as minor local symptoms around the insertion site and unpredictable uterine bleeding patterns. Adolescent patients choosing Depo-Provera may expect amenorrhea by the end of 6 months of therapy along with possible fatigue. Early intervention may be needed with adolescents who choose Norplant or OCP to encourage better compliance with follow-up appointments.

Adolescent↗
PubMed1993

Immunologic and psychologic therapy for patients with chronic fatigue syndrome: a double-blind, placebo-controlled trial.

PURPOSE: To evaluate the potential benefit of immunologic therapy with dialyzable leukocyte extract and psychologic treatment in the form of cognitive-behavioral therapy (CBT) in patients with chronic fatigue syndrome (CFS). PATIENTS AND METHODS: Immunologic and psychologic treatments were administered to 90 adult patients who fulfilled diagnostic criteria for CFS in a double-blind, randomized, and placebo-controlled study. A four-cell trial design allowed the assessment of benefit from immunologic and psychologic treatment individually or in combination. Outcome was evaluated by measurement of global well-being (visual analogue scales), physical capacity (standardized diaries of daily activities), functional status (Karnofsky performance scale), and psychologic morbidity (Profile of Mood States questionnaire), and cell-mediated immunity was evaluated by peripheral blood T-cell subset analysis and delayed-type hypersensitivity skin testing. RESULTS: Neither dialyzable leukocyte extract nor CBT (alone or in combination) provided greater benefit than the nonspecific treatment regimens. CONCLUSIONS: In this study, patients with CFS did not demonstrate a specific response to immunologic and/or psychologic therapy. The improvement recorded in the group as a whole may reflect both nonspecific treatment effects and a propensity to remission in the natural history of this disorder.

Adolescent↗
PubMed1993

Vegetarian diets for treating nephrotic syndrome.

Vegetarian diets based on soy-protein appeared to be effective in treating the hyperlipidemia of nephrotic syndrome. Whether there is a unique effect of soy or whether all very low-fat, low-saturated-fat, low-cholesterol, and low-protein diets have similar effects remains unknown.

Adolescent↗
PubMed1993

Dietary fiber and colorectal cancer risk.

A meta-analysis of 13 case-control studies suggests that intakes of dietary fiber and risk of colon cancer are inversely associated. Weaker associations were observed between risk of colon cancer and dietary intake of ascorbic acid and beta-carotene.

Colorectal Neoplasms↗
PubMed1993

Obesity. Workshop III. AHA Prevention Conference III. Behavior change and compliance: keys to improving cardiovascular health.

The workshop provided the opportunity to discuss issues and develop and integrate ideas. The following recommendations for public policies, education programs, and high-priority research initiatives were developed: Recommendations for Public Policies: Focus on prevention by requiring school programs to emphasize appropriate diet, physical activity, and general health guidance to promote cardiovascular health and prevent disease through federal funding. Provide better access to exercise (city planning, work-site interventions). Influence food availability and accessibility. Influence reimbursement policies for effective early intervention and prevention strategies for obesity. Reevaluate policies for use of drugs in the treatment of obesity. Recommendations for Education Programs: Sponsor scientific workshop to: Define the most appropriate weight standards for prevention and treatment. Identify who should lose weight and why, when, and how. Promote the fact that obesity is an important health risk factor, even at moderate levels, and that excess visceral fat is particularly hazardous. Target health care professionals, consumers, and the media for education about: Nature of obesity as a heterogeneous syndrome. Recommendations for diet, exercise, behavioral interventions, drugs, and surgery. Recognition of special needs of populations of different ethnicity, gender, age, etc. State-of-the-art treatment and treatment programs. High-Priority Research Initiatives: Build better bridges between basic research and treatment/prevention practices. Acknowledge that obesity is a heterogeneous syndrome that may best be characterized as different obesities. Research on defining subtypes. Implications for etiology and treatment. Better characterization of genotypes and phenotypes. Study the effects of weight loss, weight gain,and weight cycling on medical and psychosocial outcomes and mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

A vital sign: progress and prospects in nutrition screening of older Americans.

The population of older Americans over 65, and particularly over 75 and 85 years of age, when daily activities affecting eating and food-getting are often compromised, is growing rapidly. Screening to identify risk factors to nutritional and general health, and further assessment and intervention for those who are found to be at risk is essential. The Nutrition Screening Initiative is a voluntary effort of several major health professional organizations focused on promoting better nutrition screening and nutritional care for our nation's elderly. This article describes some of the nutrition-related problems faced by older Americans. The progress of the Nutrition Screening Initiative is reviewed, and some simple steps to implement the Initiative's recommendations in physician offices and other health care settings serving older Americans are provided. By adopting and using the simple screening and assessment tools that are provided, or by developing individualized tools, the practicing physician can incorporate these essential components of comprehensive geriatric assessment into office practice. This will do much to alleviate remediable problems early, and to control or ameliorate those that cannot be prevented. Some useful supportive continuing medical education efforts, resources available, and measures that are being taken at the community level are summarized. A case study of some potential problems and how they might be alleviated is provided. Finally, some potential avenues in both the health and social services system for more effective interventions to deal with problems are identified.

Aged↗
PubMed1992

Cell-mediated immunity in patients with chronic fatigue syndrome, healthy control subjects and patients with major depression.

The chronic fatigue syndrome (CFS) is characterized by severe persistent fatigue and neuropsychiatric symptoms. It has been proposed that the abnormalities in cell-mediated immunity which have been documented in patients with CFS may be attributable to a clinical depression, prevalent in patients with this disorder. Cell-mediated immune status was evaluated in patients with carefully defined CFS and compared with that of matched subjects with major depression (non-melancholic, non-psychotic) as well as healthy control subjects. Patients with CFS demonstrated impaired lymphocyte responses to phytohaemagglutinin (PHA) stimulation, and reduced or absent delayed-type hypersensitivity (DTH) skin responses when compared either with subjects with major depression or with healthy control subjects (P less than 0.05 for each analysis). Although depression is common in patients with CFS, the disturbances of cell-mediated immunity in this disorder differ in prevalence and magnitude from those associated with major depression. These observations strengthen the likelihood of a direct relationship between abnormal cell-mediated immunity and the etiology of CFS.

Adolescent↗
PubMed1992

Cooperative relationships between professional societies and the food industry: opportunities or problems?

A variety of cooperative relationships may potentially exist between professional or voluntary organizations and food companies: endorsements of food products, health messages, or educational and informational materials; certification of nutrient components of food products that meet a certain standard of a society; and acceptance of food advertising in society publications and the display of food products at society meetings. We queried the American Heart Association, the Society for Nutrition Education, the American Cancer Society, the American Diabetes Association, and the American Dietetic Association about past and present policies on these various relationships. Specific examples of cooperative relationships are discussed, weighing risks and benefits to the food company, the professional or voluntary organization, and the public. Guidelines are suggested for professional societies in evaluating different cooperative relationships, with the public's health and nutritional well-being as the primary consideration.

Advertising↗
PubMed1992

Mistreatment of the aged in the home environment in northern France: a year survey (1990).

As the percentage of the population which is aged increases in the developed countries, public health problems arise from the limited autonomy and physical or mental infirmity of the elderly. Cohabitation arrangements, often used to permit the elderly to stay at home, can give rise to conflict and the mistreatment of the aged. We analysed questionnaires distributed in 1990 to 25 home nursing units and two hospitals in a part of the northern region of France. Fifty-five observations of mistreatment were collected, 22 from hospital and 33 from home-based inquiries. The types of mistreatment and the characteristics of the victims and perpetrators are detailed and discussed. Penal and legal aspects of mistreatment of the aged in France are discussed.

Aged↗
PubMed1992

Resting metabolic rate and body composition of Pima Indian and Caucasian children.

Since a low metabolic rate (for a given body size and body composition) is a risk factor for body weight gain and obesity is prevalent among Pima Indians, we have tested whether Pima Indian children have a low resting metabolic rate (RMR) as compared to Caucasian children. Body composition (bioelectrical resistance) and RMR were measured in 43 Pima Indian children (22 male/21 female, mean +/- s.d. 9.9 +/- 1.1 years) and 42 Caucasian children (21 male/21 female, 9.7 +/- 1.2 years). Pima children were taller (143 +/- 9 vs. 137 +/- 8 cm, P less than 0.001), heavier (48.6 +/- 15.8 vs. 32.9 +/- 7.8 kg, P less than 0.001) and fatter (39 +/- 10 vs. 24 +/- 7% fat, P less than 0.001) than Caucasians. Absolute values of RMR were higher in Pimas than in Caucasians (6234 +/- 1201 vs. 5171 +/- 715 kJ/day, P less than 0.001), but similar when adjusted for differences in body size, body composition and sex. Contrary to our hypothesis, we did not find a decreased RMR in Pima children when compared to Caucasian children. Therefore, the high prevalence of obesity in Pima children at age 10 suggests that excess energy intake and/or low levels of physical activity might be the major aetiological factor. However, this study does not exclude the possibility that a low metabolic rate might be a predisposing factor at an earlier age.

Basal Metabolism↗
PubMed1991

Assessing comprehensive nursing performance: the Objective Structural Clinical Assessment (OSCA). Part 1--Development of the assessment strategy.

Nursing courses in Australia are preparing graduates for comprehensive practice within Universities. The evaluation of safe and effective comprehensive nursing performance requires the consideration of a much broader range of practice competencies than has previously been the case. In particular there is a need to explore integrated assessment approaches that closely resemble the realities of the health care setting. Part 1 of this paper provides an overview of the Objective Structured Clinical Assessment (OSCA) which it is suggested is an effective way of assessing student comprehensive nursing performance. Some theoretical considerations in OSCA development are discussed and then an outline of the processes involved in designing and implementing an OSCA provided. Part 2 describes an evaluation project supported by the NSW Nurses' Registration Board. The aim of the study was to determine the validity and reliability of the use of the OSCA as an integrated assessment tool as a measurement of the extent to which a student nurse can plan and deliver safe and effective comprehensive nursing care.

Australia↗
PubMed1991

Assessing comprehensive nursing performance: the objective structured clinical assessment (OSCA). Part 2--Report of the evaluation project.

Part 1 of this paper described the development of an assessment strategy used to measure the clinical performance of student nurses undertaking preparation for practice within the tertiary education sector. The challenge of developing an appropriate technique in assessment to accommodate a comprehensive nursing register was described. Features of the design and implementation were also provided. Part 2 describes an evaluation project developed by the staff and supported by a research grant from the New South Wales (NSW) Nurses Registration Board. The aim of the study was to determine the validity and reliability of the Objective Structured Clinical Assessment (OSCA) technique. The research design incorporated the use of triangulated data: student questionnaires, judgments made by a panel of experts and an analysis of the statistical correlation between the students' results in the OSCA and results in other areas of assessment.

Clinical Competence↗