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Biomedical subjects

J Robison

Publications and source records attributed to J Robison.

At least 19 recordsLinked to original sources
PubMed1998

Medicaid estate planning: practices and perceptions of Medicaid workers, elder law attorneys, and certified financial planners.

This study examined Medicaid estate planning (MEP) through the experiences and perceptions of three groups in Connecticut: Medicaid eligibility workers (n = 128), elder law attorneys (n = 41), and certified financial planners (n = 29). Respondent groups varied significantly with regard to their perceptions of prevalence and magnitude of MEP, the nature of transferred assets, mechanisms for transfers, and characteristics of the "typical" client participating in asset divestiture for the purpose of qualifying for Medicaid. This substantial lack of concordance among those professionals most closely involved with MEP poses challenges for policy and research in this area.

Aged↗
PubMed1995

Women's caregiving: changing profiles and pathways.

This study draws on panel data from a random sample of 293 wives and mothers, interviewed in 1956 and 1986, to: (1) examine changes in women's caregiving experiences across four different birth cohorts, and (2) assess the likelihood of women becoming caregivers. Women born in the late 1920s and early 1930s reported more episodes of caring for members of an older generation, for disabled children, and for more than one person at a time than women born prior to 1926. The percentage of women with two or more episodes of caregiving increases significantly from the earliest (born 1905-1917) to the most recent cohort (born 1927-1934). Using event history analysis, we tested the effects of social structural variables and subjective dispositions, as well as the number, duration, and timing of competing roles, on the likelihood of women becoming caregivers. We find that women with more traditional life styles are more likely to become caregivers; however, potentially competing roles, such as employment, do not seem to decrease, and actually are positively related to, the likelihood of caregiving. To consider various pathways to caregiving, we also conduct subgroup analyses by cohort and educational level.

Adult↗
PubMed1995

Setting the White House Conference on Aging agenda: recommendations from an expert panel.

The next White House Conference on Aging (WHCoA) will take place in May, 1995. In preparation for the conference, a panel of expert policy researchers was convened to develop recommendations regarding the WHCoA theme and agenda. This article presents in summary form the key findings of this panel. Six major themes are proposed for the agenda. In addition, a strategy is proposed for organizing and prioritizing recommendations that emerge from the 1995 WHCoA.

Aged↗
PubMed1995

Caregiving and women's well-being: a life course approach.

This study demonstrates the utility of incorporating a life course, role context approach in investigations of the ties between particular roles and psychological well-being, using the links between women's caregiving and well-being as a case in point. We draw on panel data from a random sample of 293 women interviewed in 1956 and 1986, considering both current role occupancy and the duration of caregiving as well as a number of factors that may moderate the effects of caregiving on well-being. We find, using ordinary least squares regression, that the effects of caregiving on women's emotional health are moderated by their previous psychological well-being, with caregivers with high prior well-being reporting high subsequent well-being. Other moderators are previous social integration (in the form of religiosity and multiple-role involvements) and other nonfamily roles (worker and volunteer) currently occupied. What women bring to caregiving (in terms of their previous social integration and psychological well-being) shapes its significance for their emotional health. Moreover, the duration and timing of caregiving in women's lives also relate to its effects on their well-being. These findings point to the importance of examining the impacts of particular social roles, such as caregiving, in the context of other roles and resources.

Adaptation, Psychological↗
PubMed1994

Key modifiable factors in weight maintenance: fat intake, exercise, and weight cycling.

OBJECTIVE: This 6- to 42-month follow-up study of a 6-month worksite weight control intervention examined predictors of weight maintenance, with a focus on those that could be modified. SUBJECTS: Twenty-nine participants, 14 men and 15 women, from a behavior modification program completed follow-up measurements. MAIN OUTCOME MEASURES: Height, weight, waist-to-hip ratio, food and beverage intake from a 3-day food record, weight history, social support and physical activity were the main outcome measures. RESULTS: One third of the participants maintained their weight losses within 2 kg at follow-up, although all had higher relative weights at follow-up than immediately after the program. High daily fat consumption (r = .40) and reduced time in physical activity (r = .34) correlated with increased relative weight at follow-up (P < .05). APPLICATION: Because previous weight cycling was so strongly related to weight loss maintenance (r = .55), potential weight program participants should learn and practice the weight maintenance behaviors of reduced dietary fat and regular exercise, independently of and before weight reduction attempts.

Adult↗
PubMed1994

Teamwork in primary care: the views and experiences of nurses, midwives and health visitors.

This paper reports on findings from a study of teamwork in primary care in one family health services authority in England. It is based on interviews using a semi-structured questionnaire with practice nurses, district nurses, health visitors and midwives in 20 practices. Six topics emerged as important in relation to the views of nurses, midwives and health visitors and their experiences of teamwork: team identity; leadership; access to general practitioners; philosophies of care; understanding of team members' roles and responsibilities; and, disagreement regarding roles and responsibilities. Differences in the various views and experiences of teamwork were identified. Midwives and health visitors emerged as the least integrated members of the primary health care team. Recent changes to the organization of primary health care services, as well as professional changes, are seen as accounting for the different experiences of the nursing groups. The potential for teamwork in the future is discussed.

Attitude of Health Personnel↗
PubMed1994

Women's work and caregiving roles: a life course approach.

This study drew on a life course approach and a sample of 293 women from four birth cohorts in upstate New York to examine the relationship over time between women's paid work and their informal caregiving of aging or infirm relatives. We find that such caregiving is an increasingly likely role for women, both as they age and across birth cohorts. One in four (24%) women became caregivers at some time between ages 35-44, and over one in three (36%) of these same women became caregivers between ages 55-64. Only 45 percent of the oldest cohort (born 1905-1917) were ever caregivers, compared to 64 percent of the most cohort (born 1927-1934), an increase of almost 20 percent. Clearly changes in the labor force participation of more recent cohorts of women do not appear to alter their caregiving responsibilities. In fact, women in this sample were equally likely to become caregivers, regardless of whether or not they were employed.

Adult↗
PubMed1993

Duchenne dystrophy: randomized, controlled trial of prednisone (18 months) and azathioprine (12 months)

Prednisone has been shown to improve strength in Duchenne dystrophy. Azathioprine often benefits corticosteroid-responsive diseases and can reduce the dose of prednisone needed. The present study reports a randomized, controlled trial of prednisone and azathioprine designed to assess the longer-term effects of prednisone and to determine whether azathioprine alone, or in combination with prednisone, improves strength. Ninety-nine boys (aged five to 15 years) with Duchenne dystrophy were randomized to one of three groups: (I) placebo; (II) prednisone 0.3 mg/kg/d; or (III) prednisone 0.75 mg/kg/d. After 6 months, azathioprine 2 to 2.5 mg/kg/d was added in groups I and II and placebo added in group III. The study showed that the beneficial effect of prednisone (0.75 mg/kg/d) is maintained for at least 18 months and is associated with a 36% increase in muscle mass. There was weight gain, growth retardation, and other side effects. Azathioprine did not have a beneficial effect. This study suggests that prednisone's beneficial effect is not due to immunosuppression.

Adolescent↗
PubMed1992

A program model to enhance adherence in work-site-based fitness programs.

We describe a program model designed to achieve high adherence, a major problem for work-site exercise/fitness programs. Our model is a 6-month program consisting of 15 1-hour program meetings, with participants exercising on their own time four times per week. Procedures employed to enhance adherence are contracting, group competition, monitoring, and social support. This program model has been applied nine times. One hundred fifty-nine university employees took part in the initial test with a dropout rate of 9% (15 persons). The average adherence rate for nondropouts was 98%, which is higher than rates usually reported in the literature. Adherence was defined as exercising four times a week.

Adult↗
PubMed1991

A comparison of daily and alternate-day prednisone therapy in the treatment of Duchenne muscular dystrophy.

We previously reported the results of a randomized, double-blind 6-month trial of prednisone therapy in which 102 boys aged 5 to 15 years with Duchenne muscular dystrophy received daily doses of 1.5 and 0.75 mg/kg per day and were compared with those receiving placebo. The strength and function in both prednisone-treated groups improved equally and were significantly better than in the placebo group. To compare alternate-day and daily dosing of prednisone with respect to benefits and adverse side effects, the placebo group was started on alternate-day prednisone therapy, and the treatment group regimens were changed to equivalent doses of alternate-day prednisone without breaking the double-blind nature. At the end of 6 months, the group that was changed from daily to alternate-day therapy had declined in strength back to levels observed 12 months previously, at the start of daily therapy. The group in which alternate-day therapy was started showed a significant improvement in strength at 3 months, similar in magnitude to the response of boys treated with daily therapy. However, their strength declined significantly in the subsequent 3 months compared with boys who received daily therapy. The frequency of side effects was not significantly different for alternate-day therapy compared with daily therapy. We conclude that alternate-day prednisone therapy effectively increases strength but does not sustain the improvement to the same extent as daily therapy or mitigate side effects.

Adolescent↗
PubMed1991

Parents of children with emotional disorders: issues for consideration and practice.

Parents with children who have serious emotional disorders face significant personal and family issues in their parental role. Professionals providing services to these families must be sensitive to a variety of issues if they are to provide an emphathic context when these families are seeking help. This paper will explore the stress these families incur, the loss they experience, and the resources needed for coping and the preservation of family integrity. Practice implications will be addressed.

Adaptation, Psychological↗
PubMed1991

Long-term benefit from prednisone therapy in Duchenne muscular dystrophy.

Two successive, 6-month, randomized, double-blind, controlled trials of prednisone showed that 0.75 mg/kg/d was the optimal dose to improve strength in boys with Duchenne muscular dystrophy (DMD). We attempted to maintain 93 boys on that dose for an additional 2 years. During the 3 years of observation, the decline in average muscle strength scores of all boys taking prednisone was 0.072 units/yr, as compared with an expected decline of 0.341 units/yr from natural history controls. The occurrence of side effects in some boys prevented maintenance of the full dose, which may have lessened the response. At the time of last visit, dosages ranged from 0.15 mg/kg to 0.75 mg/kg. In addition to maintaining their strength, several of the boys actually improved their performance in lifting kilogram weights and in some timed function tests. Treatment of DMD with prednisone significantly slows the progression of weakness and loss of function for at least 3 years.

Adolescent↗
PubMed1989

Duchenne muscular dystrophy: patterns of clinical progression and effects of supportive therapy.

Two-hundred eighty-three boys with Duchenne dystrophy and 10 with Becker dystrophy have been followed for up to 10 years in a protocol that accurately measured their function, strength, contractures, and back curvature. Clinical heterogeneity is noted. Patients whose muscles were stronger were more likely to die from a cardiomyopathy. Weaker patients died from respiratory failure. A series of milestones is defined, which is of use in following the illness in an individual patient. This approach permits a scoring system that allows the severity of the disease to be defined in an individual boy. Evaluation of physical therapy and surgical intervention shows that night splints and scoliosis surgery are effective forms of treatment.

Cardiomyopathies↗
PubMed1988

Identification of inflammatory cells in bovine milk by flow cytometry.

Cells recovered from normal or mastitic bovine milk were examined by flow cytometry. All milk samples contained particulate material that was heterogeneous in size and that produced a right-angle light-scatter signal equal to or greater than that produced by human or bovine neutrophils. Although this material labeled with Hoechst 33342, it produced fluorescence intensities below that of intact bovine cells, suggesting that it consisted of cell fragments. Mastitic milk additionally contained other populations of cells that were poorly resolved from the normal particulate material by size (electronic volume sensor) and right-angle light scatter. In order to improve this resolution, the milk cells were incubated with carboxydimethylfluorescein diacetate (CMFDA) to label intact cells. When milk samples labeled with CMFDA were examined by dual-parameter analysis using green fluorescence and right-angle light scatter, five or more populations of cells could be identified in mastitic milk. These populations included intact and degenerate neutrophils, lymphocytes, including both small and activated cells, monocytes, and large activated macrophages containing many vacuoles and phagocytosed particles. Using this procedure, all the animals in the University of Nevada-Reno Holstein dairy herd were tested once a month for 6 months. In addition, individual animals with mastitis were examined one or more times each day during the course of the inflammatory process. In the routine screening, the flow cytometric examination detected mastitis before overt symptoms developed. In cows identified to have mastitis, the flow cytometric examination provided prognostic information regarding the success of treatments.

Animals↗
PubMed1987

Clinical investigation of Duchenne muscular dystrophy. A methodology for therapeutic trials based on natural history controls.

Between 1979 and 1987 we documented the natural history of Duchenne muscular dystrophy in 170 patients, aged from 3 to 23 years, by making serial measurements in over 5000 individual evaluations. This database makes it possible to design and conduct therapeutic trials using natural history controls. Such trials do not replace the need for randomized placebo-controlled trials of promising agents but they do require fewer patients, are cost-effective, and permit the use of high-risk therapy where toxicity monitoring may be important. Natural history-controlled trials, therefore, may serve as a screening method for new therapeutic agents. Drugs showing a significant benefit can then be evaluated in a randomized controlled trial.

Adolescent↗
PubMed1987

Norepinephrine kinetics during orthostatic stress in congestive heart failure.

To evaluate the determinants of the plasma norepinephrine (NE) response to orthostatic stress, NE kinetics were measured during steady-state infusion of [3H]NE of high-specific activity for two consecutive 90-minute periods; the first was supine, and the second was during 60 degrees head-up tilt. In 6 normal subjects, plasma NE increased from 242 to 570 pg/ml, and NE clearance decreased from 1.43 to 1.00 l/min X M2. In 6 patients with congestive heart failure, there was no significant change in plasma NE during orthostatic stress. This has been interpreted previously to indicate that there was little activation of the baroreflex arc. In fact, NE clearance decreased from 1.08 to 0.79 l/min X M2; however, there was a decrease in NE spillover from 4.04 to 2.88 nmol/min X M2. A reduction of organ blood flow with tilt could be responsible for the reduced NE clearance by both groups, but the mechanism for the reduction in NE spillover with tilt in congestive heart failure is unclear.

Adult↗