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Biomedical subjects

J Miranda

Publications and source records attributed to J Miranda.

At least 55 records · Page 3Linked to original sources
PubMed1997

Oral Cancer Case Finding Program (OCCFP).

The aim of the Oral Cancer Case Finding Program (OCCFP) is to reduce the morbidity and mortality rates of oral cancer in Cuba. This program is based on health education of the whole population and a thorough examination of the oral complex, by specially trained stomatologists, of patients attending every stomatological care centre. Between 1983 and 1990, 10,167,999 such patients were examined country-wide and a total of 30,478 were referred as presenting some sort of alteration; 8259 complied with their referral. In this group, 2367 leucoplakias and 853 other precancerous lesions were diagnosed and treated. These 3220 premalignancies should have some influence on the cancer morbidity rates. Five hundred and eighty-one epidermoid carcinomas and 127 other malignant neoplasms were also detected for a total of 708 malignancies. The effectiveness of this program can be evaluated by the increments in diagnoses of Stage I oral cancer from 22.8% to 48.2% on account of the most advanced stages (II, III and IV) which decreased from 77.2% to 51.8%. The object of this paper is to present the results of OCCFP up to 1990.

Cuba↗
PubMed1997

Case-finding instruments for depression. Two questions are as good as many.

OBJECTIVE: To determine the validity of a two-question case-finding instrument for depression as compared with six previously validated instruments. DESIGN: The test characteristics of a two-question case-finding instrument that asks about depressed mood and anhedonia were compared with six common case-finding instruments, using the Quick Diagnostic Interview Schedule as a criterion standard for the diagnosis of major depression. SETTING: Urgent care clinic at the San Francisco Department of Veterans Affairs Medical Center. PARTICIPANTS: Five hundred thirty-six consecutive adult patients without mania or schizophrenia. MEASUREMENTS AND MAIN RESULTS: Measurements were two questions from the Primary Care Evaluation of Mental Disorders patient questionnaire, both the long and short forms of the Center for Epidemiologic Studies Depression Scale, both the long and short forms of the Book Depression Inventory, the Symptom-Driven Diagnostic System for Primary Care, the Medical Outcomes Study depression measure, and the Quick Diagnostic Interview Schedule. The prevalence of depression, as determined by the standardized interview, was 18% (97 of 536). Overall, the case-finding instruments had sensitivities of 89% to 96% and specificities of 51% to 72% for diagnosing major depression. A positive response to the two-item instrument had a sensitivity of 96% (95% confidence interval [CI], 90-99%) and a specificity of 57% (95% CI 53-62%). Areas under the receiver operating characteristic curves were similar for all of the instruments, with a range of 0.82 to 0.89. CONCLUSIONS: The two-question case-finding instrument is a useful measure for detecting depression in primary care. It has similar test characteristics to other case-finding instruments and is less time-consuming.

Adult↗
PubMed1997

Exhaled nitric oxide during exercise in primary pulmonary hypertension and pulmonary fibrosis.

STUDY OBJECTIVES: Nitric oxide (NO), a potent vasodilator, is present in the exhaled air of humans. We wished to quantify NO production in patients with abnormalities of the pulmonary circulation. PARTICIPANTS: Nine patients with primary pulmonary hypertension (PPH), six with pulmonary fibrosis (PF), and 20 normal volunteers were studied. INTERVENTIONS: All subjects were studied at rest and during continuous incremental (ramp) cycle ergometry exercise. All patients with PPH and nine matched normal volunteers also performed constant exercise at equal absolute work rates. MEASUREMENTS AND RESULTS: The concentration of NO was measured continuously in mixed expired air, and the rate of NO production (VNO) calculated. Peak exercise capacity was markedly impaired in both patient groups. VNO was similar at rest in the PPH patients (142 +/- 84 nL/min) and the normal subjects (117 +/- 45 nL/min), but lower in the PF patients (66 +/- 13 nL/min; p < 0.05; analysis of variance with Bonferonni correction). While VNO in normal subjects more than doubled by peak exercise to 268 +/- 85 nL/min, there was no significant rise with exercise in either patient group (PPH, 155 +/- 81 nL/min; PF, 91 +/- 67 nL/min). Constant work rate exercise induced a significant rise in VNO in the normal subjects (rest, 101 +/- 68 nL/min; exercise, 147 +/- 87 nL/min; p < 0.001) but no significant change in the PPH patients (rest, 127 +/- 111 nL/min; exercise, 68 +/- 65 nL/min). CONCLUSIONS: We conclude that the low resting VNO in PF may be due to loss of normal functional pulmonary capillary bed. The increase in VNO seen in normal subjects may be associated with dilatation and recruitment of the pulmonary capillary bed during exercise, and failure to increase VNO during exercise in disease states may reflect an inability to recruit the capillary bed.

Adult↗
PubMed1996

Do primary care patients accept psychological treatments?

Most individuals seeking care for psychological distress go to primary care physicians rather than to mental health professionals. Many have symptoms of distress that do not meet criteria for psychiatric disorders; pharmacotherapies are generally not available for these subsyndromal problems. Preliminary studies suggest that psychosocial therapies may be useful. The aim of this paper was to learn whether medical patients would accept psychological treatments for 1) depression, an explicit psychopathology; 2) stress, a nonpathological, but psychological, problem; and 3) medical problems, a nonpsychological issue. Respondents were 131 primary care patients at San Francisco General Hospital, a public sector hospital. The results show that most of the patients (107 of 131) found psychological interventions acceptable. In addition, the vast majority were willing to have the treatments focus on psychological issues such as depression and stress. This study demonstrates that primary care patients find psychological interventions acceptable.

Adult↗
PubMed1996

Ectopic ureter with complete ureteric duplication: conservative surgical management.

To assess the outcome of conservative procedures, the authors reviewed their experience in the management of 31 ectopic ureters with complete ureteric duplication. Twenty-eight girls and three boys (aged 19 days to 10 years; mean, 30 months) were operated on between 1968 and 1994. Twenty-four of the children presented for evaluation of dribbling urinary incontinence and/or febrile urinary tract infections; seven presented after prenatal ultrasonographic diagnosis of hydronephrosis. The location of the ectopic orifice was identified in 25 children: bladder neck (6), posterior urethra (6), vagina (7), and vestibule (6). Upper pole nephroureterectomy was performed in 16 children who had nonfunctioning renal segments. Ureterovesical reimplantation was performed in 10 children who had functioning segments. In five borderline cases, temporary cutaneous ureterostomy was performed, followed by ureteropyelostomy (2), ureterovesical reimplantation (2), and upper pole nephrectomy (1). Histological examination of the polar nephrectomy specimens showed lesions of dysplasia in only four cases (24%). The follow-up period ranged from 6 months to 20 years (mean, 66 months). All children who presented with incontinence became continent after polar nephrectomy or conservative surgery. One child required surgical revision of the ureteropyelostomy anastomosis. Of the 12 children who had ureterovesical reimplantation, none needed further procedures. Ectopic ureters in duplex systems with functioning renal segments should be conserved.

Biopsy↗
PubMed1996

Introduction to the special section on recruiting and retaining minorities in psychotherapy research.

This article introduces a special section devoted to the issue of recruiting and retaining ethnic minorities in psychotherapy research. Although minorities make up approximately 27% of the population of the United States (U.S. Bureau of the Census, 1994), the major psychotherapy studies conducted to date have been based almost exclusively on White populations. In March 1994, however, a new policy of the National Institutes of Health (NIH) mandated that women and members of ethnic minority groups be included in all NIH-funded projects involving human participants, unless a clear and compelling rationale justifies their exclusion. Knowledge about effective and culturally sensitive means of contacting, recruiting, and retaining minorities is an important resource for researchers who now wish to conduct NIH-funded studies. In the series of articles constituting this special section, strategies and advice are provided for researchers who want to recruit and retain minorities in psychotherapy research.

Female↗
PubMed1996

Recruiting and retaining low-income Latinos in psychotherapy research.

This article offers suggestions for recruiting and retaining low-income Latinos in treatment studies. Because Latinos underuse traditional mental health services, places such as medical centers or churches with large Latino constituents are suggested as useful alternative sources. To keep Latinos in research protocols, providing culturally sensitive treatments are necessary. Culturally sensitive treatments should incorporate families as part of recruitment efforts, particularly older men in the family. In addition, showing respect is an important aspect of traditional Latino culture that includes using formal titles and taking time to listen carefully. Finally, traditional Latinos tend to like interactions with others that are more warm and personal than is generally part of a research atmosphere.

Adult↗
PubMed1996

Demystifying the concept of ethnicity for psychotherapy researchers.

At a time when ethnic minority populations are increasing in the United States, few psychotherapy studies are including minorities in their samples. To include ethnic minorities in psychotherapy studies, the complex construct of ethnicity must be carefully measured. In this article, practical advice is offered for conceptualizing, measuring, and interpreting ethnic factors in psychotherapy studies. Also discussed are identifying pathways from ethnicity to psychotherapy outcomes. Pathways that may influence ethnic differences in psychotherapy outcome include cultural factors, minority status, socioeconomic status, acculturation, and immigration experiences.

Acculturation↗
PubMed1996

Gingival enlargement induced by drugs.

Gingival enlargement, an abnormal growth of the periodontal tissue, is mainly associated with dental plaque-related inflammation and drug therapy. Its true incidence in the general population is unknown. Gingival enlargement produces aesthetic changes, pain, gingival bleeding and periodontal disorders. Although gingival overgrowth has been traditionally recognised as an adverse effect of phenytoin therapy, it has recently been reported in association with the use of cyclosporin and calcium antagonists. These 3 classes of drugs produce important changes in fibroblast function, which induce an increase in the extracellular matrix of the gingival connective tissue. In the majority of those patients for whom dosage reduction, or drug discontinuation or substitution is not possible, and for whom prophylactic measures have failed, surgical excision of gingival tissue remains the only treatment of choice.

Anticonvulsants↗
PubMed1996

[Scientific investigation in biomedicine and health sciences in Andalusia].

OBJECTIVES: To evaluate the scientific output in Biomedicine and Health Sciences in Andalusia in the context of the published works on the national scientific output in the last few years. MATERIAL: Descriptive study with seven different information sources: a) final Report of the Experts Committee on Documentation from the Consejería de Salud de la Junta de Andalucía (IME: Indice Médico Español) suplemento internacional: 1980-1994; b) MEDLINE (Comprehensive Medline Ebsco, 1987-1993); c) EMBASE (Excerpta Medica; Elsevier Science Publisher) (1986-1994); d) IME, mechanized version: 1974-1993; Anales del FIS (1989-1993); e) Memoria REUNI: 1993-1994, and f) call for and resolution of research projects from the Consejería de Salud de la Junta de Andalucía (1994). RESULTS AND CONCLUSIONS: Scientific output in health sciences in Andalusia has gown in parallel with the national output from other communities. Nevertheless, in absolute terms this output is scant and the big difference compared with Catalonia and Madrid--the two Autonomous Communities with the largest scientific output--remains unchanged. Grenada is the Andalusian province with the largest output, with Seville, Cordoba and Malaga ranking next. The output in the other Andalusian provinces is very small. The output is apparently independent from the number of inhabitants or the historic presence of a Medicine School. In contrast with Catalonia and Madrid, where the largest output originates in hospitals, the largest output in Andalusia comes from Universities; this fact suggests relevant differences in scientific sub-structure. This suggestion is also endorsed by the lower competition of Andalusia to obtain resources and the lower number of research scholarships. With these results in mind a scientific policy of positive discrimination is proposed which allows the Andalusian Autonomous Community to reach the standard of scientific output in biomedicine and health sciences according to its socioeconomic status.

Databases, Bibliographic↗
PubMed1995

Prevention of depression with primary care patients: a randomized controlled trial.

The prevention of major depression is an important research goal which deserves increased attention. Depressive symptoms and disorders are particularly common in primary care patients and have a negative impact on functioning and well-being comparable with other major chronic medical conditions. The San Francisco Depression Prevention Research project conducted a randomized, controlled, prevention trial to demonstrate the feasibility of implementing such research in a public sector setting serving low-income, predominantly minority individuals: 150 primary care patients free from depression or other major mental disorders were randomized to an experimental cognitive-behavioral intervention or to a control condition. The experimental intervention group reported a significantly greater reduction in depressive levels. Decline in depressive levels was significantly mediated by decline in the frequency of negative conditions. Group differences in the number of new episodes (incidence) of major depression did not reach significance during the 1-year trial. We conclude that depression prevention trials in public sector primary care settings are feasible, and that depressive symptoms can be reduced even in low-income, minority populations. To conduct randomized prevention trials that can test effects on incidence with sufficient statistical power, subgroups at greater imminent risk have to be identified.

Adolescent↗
PubMed1995

Economic aspects of a general vaccination against invasive disease caused by Haemophilus influenzae type b (Hib) via the experience of the Children's Hospital La Fe, Valencia, Spain.

With the aim of studying whether a general vaccination against invasive disease caused by Haemophilus influenzae type b (Hib) is economically profitable bearing in mind the efficacy and safety of the vaccine, its price and the global cost that this disease has in our area, a review is conducted of patients admitted due to invasive disease caused by Hib in the Children's Hospital La Fe, Valencia, born between 1984 and 1993. They total 100, 63 who have meningitis. In the 81 cases (56 with meningitis) born between 1984 and 1990 (years that can be regarded as "closed" since all the patients were younger than 5 years of age) the total cost has been calculated for hospitalization, care during the acute phase, care for the sequelae (6 severe and 7 mild) and death (5 cases). The mean annual cost of care can be calculated at 62 million pesetas, without making an economic valuation of the loss of life, and at 205 million pesetas taking this factor into account. The annual cost of vaccinating the 7000 babies under one year of age and falling within the Hospital's catchment area, on the basis of a vaccination pattern of three doses (at 2, 4 and 6 months) or four doses (at 2, 4, 6 and 15 months) would amount to 63 or 84 million pesetas, normal price to public (not covered by National Health Service), and 40 or 51 million pesetas if acquired by National Health Service. As a conclusion we can state that, even from the economic point of view, without quantifying the cost of the loss of life, a public general anti-Hib vaccination would be profitable in our area since it would mean an administration cost lower than that of the care required by patients. This is without taking into account the fact that emotional, family and social serious disturbances would also be avoided due to hospitalization, sequelae and deaths caused by a disease which is today perfectly preventable.

Bacterial Capsules↗
PubMed1995

Rhizobium tropici chromosomal citrate synthase gene.

Two genes encoding citrate synthase, a key enzyme in the Krebs cycle, have been found in Rhizobium tropici. One of them is in the bacterial chromosome, while the other is in the symbiotic plasmid. We sequenced the chromosomal gene and found that it is very similar to the previously reported plasmidic gene sequence in its structural region but not in its regulatory region. The chromosomal gene is able to complement an Escherichia coli citrate synthase mutant. In R. tropici, a mutant in the chromosomal citrate synthase gene has a diminished citrate synthase activity (in free-living bacteria), a diminished nodulation capacity, and forms nitrogen-fixing nodules. In contrast, the citrate synthase double mutant forms ineffective nodules devoid of bacteroids and forms less nodules than the single chromosomal mutant. It is inferred that both genes are functional and required during the nodulation process in R. tropici.

Amino Acid Sequence↗
PubMed1995

[Early gastric cancer as a metachronic or synchronic tumor. Report of 6 cases].

Through a period of 16 years, 108 cases of early gastric cancer (EGC) were diagnosed at Hospital Mexico, a leading teaching hospital of Costa Rica's social security system and the University of Costa Rica. It was found that in four cases, the gastric neoplasia was a second primary tumor, and in the two remaining cases, the EGC developed synchronously to another neoplasm. Two of the four metachronic EGC were preceded by a uterine cervix neoplasm on stage lla; the third one was preceded by a breast adenocarcinoma, and the fourth one by a larynx cancer in a heavy male smoker. The treatment received for the first cancer was radiation therapy only, except for the breast cancer patient in whom surgery was employed as well. One of the patients with uterine cervix cancer developed an epidermoid bronchogenic cancer 17 years after the first tumor and 8 years after her EGC. In the two male patients with synchro tumors, the EGC developed together with a squasmous cell carcinoma of esophagus, and in the remaining one the EGC appeared simultaneously with a peritoneal mesothelioma. It is important to emphasize the presence of radiation therapy in the metachronous tumors, as well as the antecedent of smoking in the patient with three primary cancers, the esophagus one, and the larynx cancer patient.

Aged↗
PubMed1995

The heart in the primary antiphospholipid syndrome.

Twenty consecutive female patients (mean age 30.1 years) with Primary Antiphospholipid Syndrome (PAPS) were studied cardiologically through noninvasive methods and compared with 20 age-and sex-matched healthy subjects. On physical examination 13/20 patients (65%) with PAPS had a valvular abnormality. In 12/20 (60%) patients with PAPS the ECG was abnormal, mainly due to sinus tachycardia in 5 (25%) and acute myocardial infarction in 3 (15%). In 7/20 patients with PAPS (35%) abnormal pulmonary findings were detected by X-ray and in 6 (30%) they were related to dilated pulmonary arch and pulmonary hypertension. In 14/20 cases (70%) with PAPS, abnormal echocardiographic findings were present; 13/20 patients (65%) had valvular complications attributable to PAPS: mitral insufficiency in six cases; mitral valve prolapse in three and aortic insufficiency in three. Two had pulmonary artery hypertension and two, tricuspid regurgitation (one attributable to PAPS). All valve diseases were regurgitant with mild to moderate hemodynamic repercussion. No stenotic lesions were detected. The mean mitral thickness in patients with mitral valve involvement was 7.0 +/- 1.6 mm, compared to 2.8 +/- 0.7 mm in patients with normal valves and 3.1 +/- 0.9 mm in the control group (p < 0.001). The mean aortic valve thickness in patients with aortic valve involvement was 3.6 +/- 0.5 mm compared to 1.5 +/- 0.3 mm in patients with normal valves and 1.4 +/- 0.4 in the control group (p < 0.001). None of the patients from the control group had valve disease (p < 0.0001). Three cases (15%) had pericardial effusion diagnosed by echo. Two patients with PAPS died during the 4.7 +/- 1.2 years of cardiological follow up, due to acute myocardial infarction and embolic cerebrovascular accident, respectively. In conclusion, cardiologic complications are common in PAPS, including left side regurgitant lesions that might be hemodynamically significant, acute myocardial infarction, pericardial effusion and pulmonary hypertension.

Adult↗
PubMed1994

HIV and tuberculosis infection in San Francisco's homeless adults. Prevalence and risk factors in a representative sample.

OBJECTIVE: To determine the prevalence and risk factors for human immunodeficiency virus (HIV) and tuberculosis (TB) infection and investigate the relationship between these two infections in homeless adults. DESIGN: Cross-sectional study. SETTING: Inner-city shelters and free meal programs. PARTICIPANTS: A representative sample of 1226 adults (> or = 18 years) were enrolled from community sites. MAIN OUTCOME MEASURES: Serum HIV-1 antibody status and tuberculin skin test reactivity. RESULTS: Human immunodeficiency virus seroprevalence was 8.5% (95% confidence interval [CI], 7.0% to 10.1%) and the prevalence of TB infection was 32% (95% CI, 30% to 37%). Nineteen percent of the HIV-seropositive subjects had positive tuberculin skin tests. Independent risk factors for HIV infection included younger age, black race, male homosexual contact, injection drug use, use of injection drugs in shooting galleries, and selling sex. Tuberculosis infection was associated with the duration of homelessness and living in crowded shelters or single-room-occupancy hotels. Injection drug use, a risk factor for HIV, was also a risk factor for TB, with a particularly strong association in women. No evidence of an association between TB and HIV infection was found, even after accounting for anergy. CONCLUSIONS: The homeless population in the United States should be considered a group at high risk for HIV infection and TB. Given the constellation of risk factors present, the high prevalence of infection, and lack of access to medical services, we anticipate that these communicable diseases in this population will represent a growing public health problem.

Adult↗