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Biomedical subjects

J Gardner

Publications and source records attributed to J Gardner.

At least 199 records · Page 11Linked to original sources
PubMed1999

Race, culture, and psychotherapy: transference to minority therapists.

We present observations on the use of racial and cultural stereotypes in psychoanalytic psychotherapy with patients from the majority culture and with those from minority backgrounds. Earlier work has centered on black/white patient dyads and has not taken other possible combinations into account. "Race" and "culture" have sometimes been used synonymously. Our clinical experience indicates that there is some overlap in the themes of transferences to us as members of different racial minorities. We note, however, that for the African-American therapist, projections are more often based on racial stereotypes, whereas for the Chinese-American therapist, projections are based more on cultural assumptions. When careful attention is paid to the manifestations of racial and cultural stereotyping, much can be learned about the patient's inner life, to the benefit of the analytic work.

Black or African American↗
PubMed1999

Is age a barrier to the aggressive treatment of ovarian cancer with paclitaxel and carboplatin?

OBJECTIVE: The objective of this study was to determine whether the toxicities associated with chemotherapy are age related in women treated for ovarian cancer. METHODS: Patients with stage II-IV epithelial ovarian cancer underwent cytoreductive surgery. Adjunctive therapy was given to each patient consisting of intravenous (IV) paclitaxel 175 mg/m(2) over 3 h with a subsequent 30-min IV infusion of carboplatin. Carboplatin dose was calculated to achieve a targeted area under the curve (AUC) of 5.0-7.5. Treatment was repeated at 21- to 28-day intervals for six cycles. Toxicities were graded after each dose of chemotherapy. Results were analyzed using the Wilcoxon rank sum test and log likelihood ratio to compare toxicities in women age <60 years old to women >/=60 years old. RESULTS: Fifty-three women, 22 of whom were >/=60 years old, were treated with 309 cycles of chemotherapy. Forty-eight patients (92%) completed all six cycles. AUC dosing of carboplatin was equivalent for both groups. Carboplatin dose reduction occurred in 75% of patients for grade 4 neutropenia or thrombocytopenia. No patient required a reduction in the paclitaxel dose. Neutropenia was less frequent in women >/=60 years old than in women <60 years old (P = 0.02). There was no difference between women <60 years old and women >/=60 years old in the incidence of anemia, thrombocytopenia, or the use of growth factors. A 68% complete clinical response rate was observed in women >/=60 years old compared to a 74% complete response rate for women under age 60 (P = 0.22). CONCLUSION: Age is not a barrier to the aggressive treatment of ovarian cancer with this regimen of paclitaxel and carboplatin.

Adult↗
PubMed1999

Broad clavicles in trisomy 8 mosaicism: a new sign.

Symmetrical clavicular widening was observed in a boy with mosaic trisomy for chromosome 8. This sign may be considered in conjunction with other clinical and radiographic features as an indication for chromosomal studies.

Adolescent↗
PubMed1999

Treatment of vancomycin overdose using high-efficiency dialysis membranes.

Two children underwent acute hemodialysis using high-efficiency dialysis membranes for vancomycin intoxication (plasma levels 238 microg/ml and 182 microg/ml). During a 3-h treatment, plasma vancomycin removal was on average 60%, with a calculated vancomycin half-life (t(1/2)) of 2 h. This is in contrast to a recent report using charcoal hemoperfusion for vancomycin intoxication (plasma level of 137 microg/ml), which resulted in a 40% relative plasma clearance and a calculated vancomycin t(1/2) of 12.5 h for a 4-h treatment. The choice of optimal modality for clearing a toxin should take into account the availability of equipment, protein or lipid binding of the toxin, and inherent risks of charcoal hemofiltration (large extracorporeal circuit, reversible hypocalcemia, heat loss, reversible coagulation defects) versus risks of high-efficiency hemodialysis (large extracorporeal circuit).

Anti-Bacterial Agents↗
PubMed1999

Hemodialysis adequacy in Network 5: disparity between states and the role of center effects.

The purpose of this study was to determine whether an observed difference in hemodialysis adequacy between states in Network 5 was due to variations in patient characteristics and to what extent dialysis center effects played a role in the observed disparity between states. This was a retrospective observational study of 6,969 patients dialyzed at centers in Maryland and Virginia. There were 3,919 patients on hemodialysis at 89 facilities in Virginia and 3,050 subjects dialyzed at 65 centers in Maryland. The mean urea reduction ratio (URR) was higher in Virginia compared with Maryland (68.2 +/- 0.1% v 66.0 +/- 0.2%, P < 0.0001, respectively), and there continued to be a mean difference in URR of 1.8% between VA and MD (P < 0.0001) after adjusting for several covariates. The differences in URR between states varied depending on facility proprietary status, size as measured by number of stations, and relationship to hospital (free-standing or hospital-based). Furthermore, the center where a patient dialyzed, when treated as a fixed effect, accounted for 15% of the variance in URR. The mean difference of 1.8% in URR between states persisted in a mixed-effects model that included all covariates along with adjusting for dialysis centers as a random effect. The disparity in dialysis adequacy between states in Network 5 could not be accounted for by demographic characteristics, case mix factors, or a large center effect observed in the region. Therefore, we conclude that underlying national reports on dialysis adequacy are heterogeneous results related to differences across regions such as states within a given Network. This difference between states is not explained by the strong center effect found on adequacy in this population of hemodialysis patients.

Blood Urea Nitrogen↗
PubMed1999

Validity of a food frequency questionnaire in assessing nutrient intakes of low-income pregnant women.

OBJECTIVE: In 1989, a validation study of eight nutrients was performed on a modified food frequency questionnaire (FFQ) specifically designed for low-income pregnant women. The purpose of this study was to broaden the scope of the previous study by assessing the validity of the FFQ for 17 additional nutrients. METHODS: The Pregnancy Food Frequency Questionnaire (PFFQ) was administered to a sample of 295 low-income, pregnant women aged 14-43 years living in Massachusetts. A randomly selected subsample of 101 women who provided at least one diet recall and reported intake of less than 4,500 calories were included in this analysis. RESULTS: Mean intake of 25 nutrients as assessed by one administration of the PFFQ and up to three diet recalls collected over 1 month were similar. Unadjusted correlation coefficients between nutrient intake measured by diet recalls and the questionnaire ranged from .28 (carotene) to .61 (folate). After adjusting for energy intake the correlations ranged from .03 (B12) to .46 (folate). The correlations corrected for day-to-day variation were higher, ranging from .07 (B12) to .90 (zinc). The mean correlation was .47 and there were 54% over .40. CONCLUSIONS: A food frequency questionnaire for English-speaking, low-income, pregnant women can provide maternal and child health practitioners and researchers a valid estimate of diet across a wide range of nutrients.

Adolescent↗
PubMed1999

Planning for information technology key skills in nurse education.

New recruits to courses in nursing, midwifery and health visiting come from a wide range of educational backgrounds and it is reasonable to expect that this diversity will also be reflected in the range of their experience and competence with information technology (IT). Accommodating such variety can make the planning of appropriate training to enhance and develop their IT skills difficult. In order to explore the likely extent of diversity in IT experience and skills in today's recruits, the project reported here examined the competence, attitudes and previous IT training of two consecutive cohorts of new entrants to a higher diploma programme. The surveys add weight to the view that nurse educators do face a considerable diversity in new students' competence and experience with IT. Further analysis has also shown that subgroups of the cohorts, characterized by their age, gender, education or previous IT training, differed significantly in a 'knowledge of computers' score but not in their attitudes to IT. Arising from the results, the paper argues that, in seeking to develop a consistent level of IT literacy, core IT competence should be identified and all courses should have the clear objective of raising students' confidence in using computers.

Adult↗
PubMed1999

Variations in infant mortality rates among municipalities in the state of Ceará, Northeast Brazil: an ecological analysis.

BACKGROUND: Infant mortality rates vary substantially among municipalities in the State of Ceará, from 14 to 193 per 1000 live births. Identification of the determinants of these differences can be of particular importance to infant health policy and programmes in Brazil where local governments play a pivotal role in providing primary health care. METHODS: Ecological study across 140 municipalities in the State of Ceará, Brazil. RESULTS: To determine the interrelationships between potential predictors of infant mortality, we classified 11 variables into proximate determinants (adequate weight gain and exclusively breastfeeding), health services variables (prenatal care up-to-date, participation in growth monitoring, immunization up-to-date, and decentralization of health services), and socioeconomic factors (female literacy rate, household income, adequate water supply, adequate sanitation, and per capita gross municipality product), and included the variables in each group simultaneously in linear regression models. In these analyses, only one of the proximate determinants (exclusively breastfeeding (inversely), R2 = 9.3) and one of the health services variables (prenatal care up-to-date (inversely), R2 = 22.8) remained significantly associated with infant mortality. In contrast, female literacy rate (inversely), household income (directly) and per capita GMP (inversely) were independently associated with the infant mortality rate (for the model including the three variables R2 = 25.2). Finally, we considered simultaneously the variables from each group, and selected a model that explained 41% of the variation in infant mortality rates between municipalities. The paradoxical direct association between household income and infant mortality was present only in models including female illiteracy rate, and suggests that among these municipalities, increases in income unaccompanied by improvements in female education may not substantially reduce infant mortality. The lack of independent associations between inadequate sanitation and infant mortality rates may be due to the uniformly poor level of this indicator across municipalities and provides no evidence against its critical role in child survival. CONCLUSIONS: These results suggest that promotion of exclusive breastfeeding and increased prenatal care utilization, as well as investments in female education would have substantial positive effects in further reducing infant mortality rates in the State of Ceará.

Brazil↗
PubMed1999

Immunogenicity of a human immunodeficiency virus (HIV) polytope vaccine containing multiple HLA A2 HIV CD8(+) cytotoxic T-cell epitopes.

Compelling evidence now suggests that alphabeta CD8 cytotoxic T lymphocytes (CTL) have an important role in preventing human immunodeficiency virus (HIV) infection and/or slowing progression to AIDS. Here, we describe an HIV type 1 CTL polyepitope, or polytope, vaccine comprising seven contiguous minimal HLA A2-restricted CD8 CTL epitopes conjoined in a single artificial construct. Epitope-specific CTL lines derived from HIV-infected individuals were able to recognize every epitope within the construct, and HLA A2-transgenic mice immunized with a recombinant virus vaccine coding for the HIV polytope also generated CTL specific for different epitopes. Each epitope in the polytope construct was therefore processed and presented, illustrating the feasibility of the polytope approach for HIV vaccine design. By simultaneously inducing CTL specific for different epitopes, an HIV polytope vaccine might generate activity against multiple challenge isolates and/or preempt the formation of CTL escape mutants.

AIDS Vaccines↗
PubMed1999

Picornavirus receptor down-regulation by plasminogen activator inhibitor type 2.

Therapeutic interference with virus-cell surface receptor interactions represents a viable antiviral strategy. Here we demonstrate that cytoplasmic expression of the serine protease inhibitor (serpin), plasminogen activator inhibitor type 2 (PAI-2), affords a high level of protection from lytic infection by multiple human picornaviruses. The antiviral action of PAI-2 was mediated primarily through transcriptional down-regulation of the following virus receptors: intercellular adhesion molecule 1 (ICAM-1, a cellular receptor for the major group of rhinoviruses), decay-accelerating factor (a cellular receptor for echoviruses and coxsackieviruses), and to a lesser extent the coxsackie-adenovirus receptor protein (a cellular receptor for group B coxsackieviruses and group C adenoviruses). Expression of related cell surface receptors, including membrane cofactor protein and the poliovirus receptor, remained unaffected. These findings suggest that PAI-2 and/or related serpins may form the basis of novel antiviral strategies against picornavirus infections and also therapeutic interventions against ICAM-1-mediated respiratory inflammation.

CD55 Antigens↗
PubMed1999

Abuse history: is it really important in the medical encounter?

The negative effects of a history of severe abuse as a child are becoming increasingly well known to the physician and, in the adult survivor, include both mental health and physical sequelae. Intervention for emotional and psychologic consequences can include a mental health referral. Awareness of physical sequelae can aid the physician in diagnosis and intervention. However, the impact of severe childhood abuse in the medical encounter does not end with diagnosing and managing somatic complaints and/or providing a mental health referral. Severe childhood abuse directly affects the physician-patient relationship by causing the predictable difficulties that adult survivors of severe abuse experience in any of their intimate relationships.

Adult↗
PubMed1999

Relationship between health services, socioeconomic variables and inadequate weight gain among Brazilian children.

This ecological analysis assessed the relative contribution of behavioural, health services and socioeconomic variables to inadequate weight gain in infants (0-11 months) and children (12-23 months) in 140 municipalities in the State of Ceara, north-east Brazil. To assess the total effect of selected variables, we fitted three unique sets of multivariate linear regression models to the prevalence of inadequate weight gain in infants and in children. The final predictive models included variables from the three sets. Findings showed that participation in growth monitoring and urbanization were inversely and significantly associated with the prevalence of inadequate weight gain in infants, accounting for 38.3% of the variation. Female illiteracy rate, participation in growth monitoring and degree of urbanization were all positively associated with prevalence of inadequate weight gain in children. Together, these factors explained 25.6% of the variation. Our results suggest that efforts to reduce the average municipality-specific female illiteracy rate, in combination with participation in growth monitoring, may be effective in reducing municipality-level prevalence of inadequate weight gain in infants and children in Ceara.

Adolescent↗
PubMed1999

Management of double-layered patellae by compression screw fixation.

Tripartite patella is a form of double-layered patella in which the anterior layer is bipartite. It was first described by Büttner in 1925 (1). More recently, an association with multiple epiphyseal dysplasia has been described (2,3). In this article, we describe a case of symptomatic tripartite patella in a 13-year-old child who was subsequently found to have features of multiple epiphyseal dysplasia. Her patellae had an abnormal excursion with a click and a visible jump in the longitudinal line of movement, but no lateral instability. We present a surgical solution not previously described by fusion of the two main components and report an excellent result.

Adolescent↗