Biomedical subjects
J K Williams
Publications and source records attributed to J K Williams.
Effects of convulsant barbiturates on vascular smooth muscle.
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Effects of a convulsant barbiturate on the spinal monosynaptic pathway.
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Screening for genetic disorders.
Recent additions to genetic screening programs include DNA testing to identify carriers of certain disorders, presymptomatic detection of certain disorders, newborn screening for hemoglobinopathies, and maternal serum alpha fetoprotein screening during pregnancy. Purposes and limitations of each of these new screening programs are discussed. Responsibilities of nurse practitioners for educating clients about genetic screening tests is emphasized.
Evolution of a specialty unit in response to a changing patient population.
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Parenting a daughter with precocious puberty or Turner syndrome.
Alterations in sexual maturation present parenting challenges for mothers of these children. The purpose of this exploratory study was to identify specific childrearing problems and management behaviors used by mothers of daughters with two chronic conditions, precocious puberty and Turner syndrome. Problems included communicating with school personnel, supervising peer relationships, and attempting to normalize their daughter's physical appearance. The most common management behavior was taking charge to prevent or attempt to solve problems. Implications for clinical practice include providing anticipatory guidance, supporting parent communication strategies, and providing support and information resources.
A cystic fibrosis handbook for teachers.
The purposes of this project were to (1) develop a handbook on cystic fibrosis for elementary school teachers and to (2) pilot this handbook with a group of teachers and school nurses. The project used a descriptive survey design in which parents, teachers, and school nurses of 14 elementary-age children with cystic fibrosis were recruited from one cystic fibrosis clinic. Interest in using the handbook with their child's teachers was elicited from parents; also, interest in using the handbook was obtained by open-ended questions in a mailed survey sent to teachers and school nurses. Levels of teacher and school nurse knowledge were measured with a true/false pretest and posttest instrument. All parents expressed a desire to use the handbook with their child's teachers. Sixty-seven percent of the teachers and 89% of the school nurses returned the survey, and all endorsed the use of the handbook in their classrooms or schools. Comparison of the pretest and posttest scores from the teachers revealed an increase in teachers' knowledge. Scores on pretest and posttest measures from school nurses were high at each testing time. Results support the use of a printed handbook to promote knowledge of cystic fibrosis in teachers and to support communication among nurses, parents, and teachers.
Children with chronic conditions: educators' views.
The purpose of this qualitative, exploratory study was to identify the concerns and resource needs of educators for effectively teaching children with chronic health conditions, Semistructured audiotaped telephone interviews were conducted with 23 teachers and six principals from urban and rural public schools, grades K-12. The interview included questions in four areas: (a) experiences with children with chronic health conditions, (b) concerns in providing educational services to these children, (c) resources used by educators, and (d) recommendations regarding how information and services can best be provided to educators. The most common concerns were unanticipated medical emergencies and increased absence rates. The major resource for these educators was the school nurse. Educators preferred information specific to a child in their class, provided to them by the school nurse. Results suggest that interventions for teachers are more likely to be effective when they are coordinated with the school nurse and focus on the impact of the condition on a child's ability to function in the classroom. Subsequent research is necessitated to determine effective strategies for specialty nurses to aid school nurses in providing optimum care for these children.
Genetic testing: implications for professional nursing.
Scientific information emerging from human genome research has significant implications for the practice of professional nursing. Professional nurses assist individuals in making decisions about DNA studies, ensure that consent is informed before genetic testing, and help clients cope with genetic information after test results are known. Nurses with advanced education in genetics identify and counsel people who are candidates for DNA testing. Gene identification can have beneficial as well as harmful outcomes. Education is needed to prepare nurses for new roles regarding genetic testing.
Assessment of hormonally active agents in the reproductive tract of female nonhuman primates.
Using the ovariectomized macaque model of postmenopausal women's health, we investigated the effects of long-term treatments (5 weeks-3 years) with estradiol, conjugated equine estrogens (CEE), esterified estrogens, progestins such as medroxyprogesterone acetate (MPA) and nomegestrol acetate, CEE + MPA, tamoxifen, soybean phytoestrogens (SPEs), a variety of putative selective estrogen receptor modulators (SERMs), and androgens. Agents tested were selected on the basis of beneficial effects on arteries and/or bone. Doses were scaled on a caloric or serum-concentration basis to approximate human clinical doses. We evaluated endometrial and mammary gland histopathology and morphometry and used immunohistochemistry to evaluate cell proliferation and expression of estrogen receptor alpha and progesterone receptor (PR). Both estradiol and CEE induced endometrial hyperplasia. MPA antagonized epithelial proliferation induced by CEE in endometrium and induced pseudodecidual stromal hyperplasia in some animals. Tamoxifen induced endometrial polyps, cystic hyperplasia, stromal fibrosis, and PR expression but not Ki-67 expression. SPEs were not estrogenic at dietary doses and antagonized estrogen-induced proliferation in the endometrium and breast. Nandrolone induced mucometra and an adenomyosis-like change. The potential SERM 17 alpha dihydroequilenin did not have uterotrophic or mammotrophic effects. In general, experimental findings in macaques have been predictive of outcomes in human clinical trials of the same agents.
New genetic discoveries increase counseling opportunities.
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The pathogenicity of behavior and its neuroendocrine mediation: an example from coronary artery disease.
Although it is frequently hypothesized that perturbations of the body's principal axes of neuroendocrine response, especially the sympathetic-adrenomedullary and pituitary-adrenocortical systems, mediate psychosocial influences on disease, evidence directly supporting this hypothesis is sparse at best and, for most disease entities, nonexistent. In this article, we illustrate a research strategy aimed at elucidating the role of behavior in disease pathogenesis by focusing on a single pathologic process--disease of the coronary vasculature--and emphasizing experimental evidence linking such disease to both behavior and sympathoadrenal activation in nonhuman primates. In cynomolgus monkeys, it is found that several psychosocial variables, e.g., social instability, behavioral dominance (in males), and subordination (in females), promote coronary atherogenesis, either independently or in interaction. Animals exhibiting a heightened cardiac responsivity to stress (reactions of probable sympathetic origin) also develop the most extensive coronary lesions and beta-adrenoreceptor blockade prevents the behavioral exacerbation of atherosclerosis. Social stress causes injury to arterial endothelium (also preventable by adrenoreceptor blockade) and, among chronically stressed animals, impairs endothelium-dependent vasomotor responses of the coronary arteries. It is suggested that similar research programs might elucidate the influence of behavior and neuroendocrine factors on the pathogenesis of other disease states and conditions, including susceptibility to infection.
Psychosocial factors, sex differences, and atherosclerosis: lessons from animal models.
OBJECTIVE: Premenopausal women, compared with men, are relatively spared from coronary heart disease and the underlying atherosclerosis. Our purpose has been to elucidate the reason for this difference and to explore the role of behavioral factors in this phenomenon. METHODS: Studies employed socially housed cynomolgus macaques (Macaca fascicularis) fed an atherogenic diet and subjected to behavioral observations. Ovariectomy, with or without hormone replacement, was used to test specific hypotheses about estrogen's role in the protection of females from atherosclerosis and coronary heart disease. RESULTS: Female macaques, like women, are resistant to atherosclerosis. However, this resistance is modified by social status-dominant monkeys develop little atherosclerosis, whereas subordinates resemble males in the amount of lesion that occurs. Subordinate females also are characterized by hypercortisolemia, behavioral dysfunction, and impaired ovarian function; the resulting low concentrations of circulating estrogen perhaps explain their accelerated atherosclerosis. Notably, atherosclerosis is exacerbated in ovariectomized monkeys but is suppressed in association with pregnancy, a hyperestrogenic state. Moreover, exogenous estrogen (an oral contraceptive) inhibits atherosclerosis in premenopausal social subordinates. CONCLUSIONS: To the extent that our results apply to women, they highlight the potential importance of behavioral stressors and their effects on estrogen activity in the premenopausal development of atherosclerosis. The triad of hypercortisolism, ovarian impairment, and psychiatric morbidity found in monkeys also occurs in women and may represent a high-risk state for disorders of the cardiovascular system and perhaps, other estrogen-sensitive tissues.
Interactive effects of soy protein and estradiol on coronary artery reactivity in atherosclerotic, ovariectomized monkeys.
OBJECTIVE: Results of recent clinical trials indicate that mammalian estrogens may be less effective in reducing coronary heart disease risk than once thought. This study was designed to determine whether mammalian estrogen's coronary artery dilator benefits could be enhanced by adding soy with phytoestrogens. DESIGN: Forty-five atherosclerotic, ovariectomized monkeys were fed one of four diets: (1) atherogenic diet with casein/lactalbumin as source of protein (Casein, n = 12); (2) casein diet with micronized estradiol equivalent to a woman's dose of 1 mg/day (Casein + E2, n = 12); (3) atherogenic diet with soy protein with phytoestrogens (129 mg woman/day equivalent) (Soy, n = 11); and (4) the soy diet plus estradiol (Soy + E2, n = 10). METHODS: Quantitative angiography and intravascular Doppler were done after 6 months of experimental diet to measure changes in diameter and coronary flow reserve in the circumflex coronary artery in response to intracoronary acetylcholine and nitroglycerin. RESULTS: Arteries from the E2 and Soy + E2 groups dilated in response to acetylcholine 5 +/- 3% and 12 +/- 5%, respectively (p < 0.05 vs. Casein). There was an interactive effect of soy and E2 on dilator response to acetylcholine (p < 0.05). Flow reserve was greatest in animals fed casein + E2 and soy + E2 (2.3 +/- 0.3 and 2.6 +/- 0.5, respectively; p < 0.05 vs. Casein). Soy protein alone had no effect on coronary artery reactivity (p > 0.05). CONCLUSION: Soy protein itself does not affect coronary artery dilator responses but interacts with estradiol to promote dilator responses to acetylcholine.
The bicycle seat stool in the treatment of vaginal agenesis and stenosis.
The Ingram method for creating a neovagina in women with vaginal agenesis or stenosis by using an intermittent pressure technique was performed on 45 patients between 1975 and 1982. Poor patient compliance has been the major drawback of previously reported pressure techniques. To overcome this, the Ingram method employs a unique approach using Lucite dilators and a mobile bicycle seat stool. Extensive nursing participation and a successfully treated former patient used as a motivating role model have significantly contributed to the acceptance of this method. Thirty-seven of the 45 patients were able to experience coitus subsequent to treatment.
Teratogenic potential of valproic acid.
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Noncontraceptive benefits of oral contraceptive use: an evidence-based approach.
Numerous noncontraceptive benefits of oral contraceptive (OC) use have been identified. These include a reduction in ovarian and endometrial cancers, functional ovarian cysts, pelvic inflammatory disease, benign breast disease, iron-deficiency, menstrual disorders, dysmenorrhea, bone loss, and acne. The best "evidence" is in the area of cancer prevention, maintenance of bone mineral density (BMD) and the treatment of acne vulgaris. Based on the body of evidence available today, several evidence-based clinical recommendations can be made regarding BMD. In young, reproductive-age women with a hypoestrogenic condition, there is a protective effect on BMD with OC use. In older reproductive-age women with declining ovarian function, there is also a protective effect on BMD with OC use. With long-term use of OCs (greater than 5 years) protection increases with increasing duration of use. There is a high degree of biologic plausibility for the beneficial effect of OC use on states associated with androgen excess, such as acne. Two randomized, placebo-controlled, multicenter clinical trials of a triphasic norgestimate-containing OC were published. Using evidence-based criteria, there is strong evidence that this OC effectively treats acne vulgaris. As further experimental and observational studies are completed, they should substantiate many of the other known benefits; thus, further evidence-based recommendations will be possible.
Genetic counseling in pediatric nursing care.
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