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Biomedical subjects

J M Robbins

Publications and source records attributed to J M Robbins.

At least 55 records · Page 3Linked to original sources
PubMed1993

Common peripheral vascular diseases.

Among the most common causes of morbidity and mortality in elderly individuals are the manifestations of the various peripheral vascular diseases. Many chronic degenerative diseases, which begin in middle age, are associated with peripheral vascular disease. Heart disease, hypertension, hyperlipidemia and diabetes are all risk factors for peripheral vascular diseases and also common degenerative conditions in our society. Other risk factors, such as diet, smoking, stress, lack of exercise, and obesity, are also closely associated with peripheral vascular disease. Aging itself is also a risk factor. Appropriate treatment for disease processes such as diabetes and hypertension and control of other preventable risk factors have been shown to reduce the morbidity and mortality seen in peripheral vascular disorders. Our rapidly aging population requires increasing amounts of medical resources, placing an enormous burden on society because the aged population are generally more dependent upon government-sponsored health care services. The podiatric practitioner is in a position as a primary care provider to influence the health practices of our aging population. The implementation of a health practice that stresses prevention and wellness as well as the appropriate management and a referral of patients with peripheral vascular disorders will limit the morbid results of peripheral vascular diseases.

Aged↗
PubMed1992

Does episiotomy prevent perineal trauma and pelvic floor relaxation?

OBJECTIVE: To compare the outcomes of the current practice of liberally or routinely employing episiotomy to prevent perineal tears and pelvic floor relaxation (control group) to a policy of restricting episiotomy use to specific fetal and maternal indications (experimental group). DESIGN: A randomized controlled trial (RCT). SETTING: Three university hospitals in Montreal. SUBJECTS: Seven hundred three low-risk women enrolled at 30 to 34 weeks of gestation were randomized late in labor to the designated trial arm, by parity, and followed up to 3 months postpartum. MAIN OUTCOME MEASURES: Antepartum and postpartum information on perineal trauma and pain, pelvic floor symptoms (urinary incontinence), and sexual activity was collected through the use of standard questionnaires; pelvic floor function was measured by electromyographic (EMG) perineometry. RESULTS: Restricting episiotomy use in primiparous women was associated with similar sutured perineal trauma to the liberal or routine approach. Multiparous women in the restricted episiotomy group more often gave birth with an intact perineum (31% compared with 19%, odds ratio (OR) = 1.85, 95% confidence interval (CI) = 1.09 to 3.16). All but one 3rd/4th-degree perineal tear was associated with median episiotomy (46 of 47 in primiparous women and 6 of 6 among multiparous women). No difference between trial groups was found in postpartum perineal pain, antepartum and 3-month postpartum EMG perineometry, and urinary and pelvic floor symptoms. CONCLUSIONS: We found no evidence that liberal or routine use of episiotomy prevents perineal trauma or pelvic floor relaxation. Virtually all severe perineal trauma was associated with median episiotomy. Restriction of episiotomy use among multiparous women resulted in significantly more intact perineums and less perineal suturing.

Adult↗
PubMed1992

Fibroblast growth factors in connective tissue disease associated interstitial lung disease.

Fibrosis is a major cause of morbidity and mortality in chronic inflammatory diseases, especially interstitial pulmonary disorders. Fibroproliferation is an important part of this fibrotic response, and is mediated largely through growth factors such as platelet-derived growth factor (PDGF), insulin-like growth factor (IGF) I and tumour necrosis factor-alpha (TNF-alpha). Although there is some evidence implicating these cytokines in fibrotic disorders, strong evidence in vivo is almost nonexistent. In order to ascertain the role that these factors play in inflammatory lung disorders associated with connective tissue diseases, alveolar mononuclear cells have been obtained from subjects by bronchoalveolar lavage and assessed for the spontaneous release of fibroblast growth factors. The study population consisted of subjects with a variety of different connective tissue disorders, both with and without inflammatory pulmonary complications. It was found that lavage cells spontaneously secreted fibroblast growth factor activity over 24 h with maximum activity detected at 6 to 12 h. Growth factor activity could be detected in most subjects with connective tissue disease-associated inflammatory lung disease and some normal subjects, but the amount of growth factor activity was much higher in the former than in the latter. By means of antibody depletion experiments all growth factor activity from lavage cells of normal patients was attributable to TNF-alpha while patients with interstitial lung disease secreted large amounts of PDGF and fibronectin in addition to TNF-alpha. Approximately 40-50% of the total released growth factor activity could be accounted for by PDGF, and 100% by the combination of PDGF, TNF-alpha and fibronectin. While TNF-alpha is released from the bronchoalveolar lavage cells of many subjects, in addition, many patients with interstitial lung disease also release spontaneously, large amounts of fibroblast growth factor activity attributable to PDGF and fibronectin.

Bronchoalveolar Lavage Fluid↗
PubMed1991

Attributions of common somatic symptoms.

Three studies explored the causal attributions of common somatic symptoms. The first two studies established the reliability and validity of a measure of attributional style, the Symptom Interpretation Questionnaire (SIQ). Three dimensions of causal attribution were confirmed: psychological, somatic and normalizing. The third study examined the antecedents and consequences of attributional style in a sample of family medicine patients. Medical and psychiatric history differentially influenced attributional style. Past history and attributional style independently influenced clinical presentations over the subsequent 6 months. Symptom attributional style may contribute to the somatization and psychologization of distress in primary care.

Adaptation, Psychological↗
PubMed1991

Three forms of somatization in primary care: prevalence, co-occurrence, and sociodemographic characteristics.

Three definitions of somatization were operationalized: (a) high levels of functional somatic distress, measured by the Somatic Symptom Index (SSI) of the Diagnostic Interview Schedule; (b) hypochondriasis measured by high scores on a measure of illness worry in the absence of evidence for serious illness; and (c) exclusively somatic clinical presentations among patients with current major depression or anxiety. Of 685 patients attending two family medicine clinics, 26.3% met criteria for one or more forms of somatization. While DSM-III somatization disorder had a prevalence of only 1% in this population, 16.6% of the patients met abridged criteria for subsyndromal somatization disorder (SSI 4,6). Hypochondriacal worry had a prevalence of 7.7% in the clinic sample. Somatized presentations of current major depression or anxiety disorder had a prevalence of 8%. The three forms of somatization were associated with different sociodemographic and illness behavior characteristics. A majority of patients met criteria for only one type of somatization, suggesting that distinct pathogenic processes may be involved in each of the three types.

Adult↗
PubMed1990

Factors important to students in selecting a residency program.

A 22-item questionnaire, designed to assess the factors students considered important when they ranked residency programs, was distributed to the 1988 senior class of Tulane University School of Medicine just before the submission deadline of the National Residency Matching Program. Completed surveys were obtained from 111 of the 157 graduating students (approximately 71%) and were representative of the entire class in terms of sex, age, race, marital status, and anticipated field of specialization. Results of this investigation suggest that the satisfaction of a program's house officers and the seniors' general impression at the interview were the most important selection factors of the matriculating seniors surveyed. Diversity of the training experience and geographic location were also important selection factors. House officer benefits and salary were low-priority factors in the seniors' program selections.

Career Choice↗
PubMed1990

Illness worry and disability in fibromyalgia syndrome.

Fibromyalgia (FM) is a common syndrome of functional somatic symptoms. This article examines whether an amplifying somatic style (increased body awareness and illness worry) might explain the distress and disability expressed by FM patients. Twenty FM patients were compared to twenty-three rheumatoid arthritis (RA) patients on measures of depressive and somatic symptomatology, pain, disability, and amplifying somatic style. FM patients reported greater somatic symptomatology, equivalent levels of pain, and less physical disability than did RA patients. No differences were observed between groups on body awareness or illness worry. Illness worry correlated highly with symptomatology for both groups but with physical disability only among FM patients. Results suggest that disability in functional somatic syndromes may be determined by patients' worry about having a serious disease. Feelings of vulnerability and apprehension about having an illness of unknown origin may contribute to FM sufferers' activity limitations, inability to sustain a work effort, and varied somatic distress.

Activities of Daily Living↗
PubMed1988

Therapists' perceptions of difficult psychiatric patients.

Psychotherapists often describe patients who present management problems as "difficult patients." This article describes a 5-factor scale to measure how therapists perceive difficult psychiatric patients. Reliability and validity evidence is presented for scales labeled Demanding, Help Rejecting, Unreachable, Dangerous, and Poor Fit. Fifty-four psychiatric outpatients identified as difficult to treat by two or more therapists were compared with 54 control psychiatric outpatients matched on age, sex, marital status, and diagnosis. Therapists rated difficult patients higher on each scale. Patients rated higher on the Demanding, Help Rejecting, and Poor Fit scales were heavier and more varied users of the treatment system than were those rated lower on these scales. The scale helps identify causes of staff dissatisfaction and inappropriate organization of services and suggests how to meet the special needs of difficult patients. Problem patients can be seen as denying the competence and authority of the mental health professional but also as central to the unique mandate of psychiatry. The reward system should more adequately support those therapists who care for the patients often avoided by others.

Ambulatory Care↗
PubMed1988

Somatization and depression in fibromyalgia syndrome.

Psychiatric diagnoses, self-reports of symptoms, and illness behavior of 20 fibromyalgia patients and 23 rheumatoid arthritis patients were compared. The fibromyalgia patients were not significantly more likely than the arthritis patients to report depressive symptoms or to receive a lifetime psychiatric diagnosis of major depression. These results do not support the contention that fibromyalgia is a form of somatized depression. Fibromyalgia patients, however, reported significantly more somatic symptoms of obscure origin and exhibited a pattern of reporting more somatic symptoms, multiple surgical procedures, and help seeking that may reflect a process of somatization rather than a discrete psychiatric disorder.

Aged↗
PubMed1986

An endogenous mouse mammary tumor virus genome common in inbred mouse strains is located on chromosome 6.

We have examined EcoRI-restricted cellular DNA from mouse-hamster somatic cell hybrids. Results of this analysis show that the unit II mouse mammary tumor virus proviral genome is located on mouse chromosome 6. Restriction analysis of cellular DNA from (C3H/OuJ X Czech II) X Czech II backcross mice showed a strong linkage between unit II and Igk. The gene order of these markers on chromosome 6 relative to the Raf and Kirsten murine sarcoma virus ras-2 proto-oncogenes was established.

Animals↗
PubMed1982

Treatment for a nondisease: the case of low blood pressure.

This paper documents diagnosis and treatment of hypotension among a sample of subjects visiting blood pressure screening booths as part of a hypertension screening survey in Montreal. Of 1019 subjects, over one quarter had been diagnosed as hypotensive. Though low blood pressure is harmless for the majority of people, almost 10% of the screened sample reported receiving treatment from their physicians for the condition. Treatment typically consisted of harmless, but ineffective placebo-like medications including veal liver extract capsules or injections, iron capsules, tonics and vitamin B12 liquid, injections or capsules. Additional analysis discovered little meaningful difference in systolic and diastolic readings among individuals treated for hypotension, those diagnosed but not treated, and an undiagnosed group. Subjects receiving the hypotensive label from practitioners were typically older women with less education and income. Findings are discussed in light of the overlap between statistical and pathological models of illness; presenting symptoms of patients and their demands for treatment; and assumptions of physicians in diagnostic decision-making. It is speculated that medical definition of a nondisease such as low blood pressure may serve to individualize discomfort when true etiology lies in the environment; legitimate neglect of responsibilities and obligations by assigning one to the sick role; or cause organization of vague impulses into symptoms. Hypotension should be included in utilization studies to determine prevalence of treatment, life history of those being treated and complaints offered for treatment.

Adult↗
PubMedDate not supplied

Fatigue in primary care: prevalence, psychiatric comorbidity, illness behavior, and outcome.

OBJECTIVES: To identify the prevalence, psychiatric comorbidity, illness behavior, and outcome of patients with a presenting complaint of fatigue in a primary care setting. METHODS: 686 patients attending two family medicine clinics on a self-initiated visit completed structured interviews for presenting complaints, self-report measures of symptoms and hypochondriasis, and the Diagnostic Interview Schedule (DIS). Fatigue was identified as a primary or secondary complaint from patient reports and questionnaires completed by physicians. RESULTS: Of the 686 patients, 93 (13.6%) presented with a complaint of fatigue. Fatigue was the major reason for consultation of 46 patients (6.7%). Patients with fatigue were more likely to be working full or part time and to be French Canadian, but did not differ from the other clinic patients on any other sociodemographic characteristic or in health care utilization. Patients with fatigue received a lifetime diagnosis of depression or anxiety disorder more frequently than did other clinic patients (45.2% vs. 28.2%). Current psychiatric diagnoses, as indicted by the DIS, were limited to major depression, diagnosed for 16 (17.2%) fatigue patients. Patients with fatigue reported more medically unexplained physical symptoms, greater perceived stress, more pathologic symptom attributions, and greater worries about having emotional problems than did other patients. However, only those fatigue patients with coexisting depressive symptoms differed significantly from nonfatigue patients. Patients with fatigue lasting six months or longer compared with patients with more recent fatigue had lower family incomes and greater hypochondriacal worry. Duration of fatigue was not related to rate of current or lifetime psychiatric disorder. One half to two thirds of fatigue patients were still fatigued one year later. CONCLUSIONS: In a primary care setting, only those fatigue patients who have coexisting psychological distress exhibit patterns of abnormal illness cognition and behavior. Regardless of the physical illnesses associated with fatigue, psychiatric disorders and somatic amplification may contribute to complaints of fatigue in less than 50% of cases presented to primary care.

Adolescent↗
PubMedDate not supplied

Cognitive and social correlates of the Toronto Alexithymia Scale.

The authors examine the relationship of the Toronto Alexithymia Scale (TAS) to sociodemographic characteristics, medical history, symptomatology, and illness cognition in a sample of 244 family medicine patients. The TAS had moderate internal reliability. In multiple regression analysis, the TAS was related to age, education, depressive symptoms, emotion suppression, self-consciousness, illness worry, and tendency to attribute somatic symptoms to psychological causes. Factor analysis of the TAS yielded four factors: Factor 1 (difficulty identifying feelings and bodily sensations) was related to education, social desirability, depressive symptoms, and private body-consciousness. Factor 2 (externally oriented thinking) was related to emotion suppression and self-consciousness. Factor 3 (difficulty expressing feelings to others) was related to age, social desirability, severity of past medical illness, depressive and somatic symptoms, and emotion suppression. Factor 4 (reduced daydreaming) was related to age and self-consciousness. The TAS measures conceptually distinct dimensions that are best studied as separate factors in psychosomatic models.

Adult↗