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Biomedical subjects

K Bowen

Publications and source records attributed to K Bowen.

16 recordsLinked to original sources
PubMed2001

Disordered eating behaviours in women with Type 2 diabetes mellitus.

The aim of the article is to investigate the relationship between disordered eating, particularly binge eating, and Type 2 diabetes in women. Subjects included 215 women with Type 2 diabetes (mean age: 58.9 years, mean body mass index (BMI)=33.5 kg/m(2)). Measurements included a structured clinical interview for disordered eating (Eating Disorder Examination, EDE), self-report measures of psychological functioning, glycosylated haemoglobin A1c, BMI. A total of 20.9% of women was binge eating regularly. Binge eating was associated with poorer well being, earlier age of diagnosis, poorer self-efficacy for diet and exercise self-management, and higher BMI. Binge eating frequency predicted blood glucose control after controlling for BMI and exercise level. A history of binge eating independently predicted age of diagnosis of diabetes. Binge eating is relatively common in women with Type 2 diabetes. The relationship between binge eating severity and diabetic control is not explained by overweight. Binge eating may be an independent risk factor for Type 2 diabetes.

Journal Article↗
PubMed2000

The search for a better treatment for recurrent Clostridium difficile disease: use of high-dose vancomycin combined with Saccharomyces boulardii.

Recurrent Clostridium difficile disease (CDD) is a difficult clinical problem because antibiotic therapy often does not prevent further recurrences. In a previous study, the biotherapeutic agent Saccharomyces boulardii was used in combination with standard antibiotics and was found to be effective in reducing subsequent recurrences of CDD. In an effort to further refine a standard regimen, we tested patients receiving a regimen of a standard antibiotic for 10 days and then added either S. boulardii (1 g/day for 28 days) or placebo. A significant decrease in recurrences was observed only in patients treated with high-dose vancomycin (2 g/day) and S. boulardii (16.7%), compared with those who received high-dose vancomycin and placebo (50%; P=.05). No serious adverse reactions were observed in these patients. Comparison of data from this trial with data from previous studies indicates that recurrent CDD may respond to a short course of high-dose vancomycin or to longer courses of low-dose vancomycin when either is combined with S. boulardii.

Aged↗
PubMed2000

Child abuse and domestic violence in families of children seen for suspected sexual abuse.

We surveyed families of children seen in a sexual abuse evaluation clinic regarding domestic violence in the child's home and physical and sexual abuse during childhood among the mothers. Domestic violence occurred in 54% (216/402) of the children's homes; 28% (111/392) of mothers reported childhood physical abuse, and 42% (167/395) reported sexual abuse. There were no differences in the rates of domestic violence (chi 2 = 0.42, 2 df, p = 0.8), maternal physical abuse (chi 2 = 2.40, 2 df, p = 0.3), or maternal sexual abuse (chi 2 = 2.11, 2 df, p = 0.3) based on whether our current, patient was at high, medium, or low risk for having actually experienced sexual abuse. Neither domestic violence in the child's home nor the mother's childhood experience of abuse was increased if the child's perpetrator was a relative or lived in the home. Domestic violence in the child's home was more frequent if the mother had experienced physical abuse during childhood (65% 70/107) than if she had not (48%, 130/271; chi 2 = 8.69, p < 0.01). Child sexual abuse is part of a global pattern of victimization, and clinicians must address other forms of family violence when evaluating a child for allegations of sexual abuse.

Adolescent↗
PubMed1999

Medical evaluation of sexual abuse in children without disclosed or witnessed abuse.

OBJECTIVES: To investigate why sexual abuse was suspected and what physical findings were present among children referred for the evaluation of sexual abuse without a verbal disclosure or witnessed abuse, and to determine if the reasons for requesting medical evaluation varied by referral source. DESIGN: Prospective descriptive study. SETTING/PATIENTS: Two groups of consecutive children referred to a sexual abuse evaluation clinic. MAIN OUTCOME MEASURE: Categorization of physical examination findings for likelihood of sexual abuse (definite, suggestive, nonspecific, normal, non-abuse-related finding). RESULTS: Of 393 children studied, 190 (48.3%) had a definite or probable history of sexual abuse, 130 (33.1%) had a suspicious history, and 73 (18.6%) had "no history." The no-history group was referred most often for physical findings (42 patients [57%]). Compared with other referral sources, physicians more frequently referred patients for physical findings, parental anxiety, and behavior changes. Regardless of history, examination findings were normal or nonspecific in 83.5% to 94.4% of cases. Suggestive or definite examination findings were more frequent for children with definite or probable histories, while non-abuse-related findings were more common for the no-history group. Only 2 children (3%) with no reported history of abuse had suggestive physical findings, and none had definite findings. CONCLUSIONS: Physicians are more likely than public agencies to refer children for sexual abuse evaluation for reasons other than disclosure by the child. For most of these children, examination is unlikely to influence the suspicion of abuse. Improved physician training and selected referrals are indicated.

Ambulatory Care Facilities↗
PubMed1999

Will acarbose improve the metabolic abnormalities of insulin-resistant type 2 diabetes mellitus?

Individuals with type 2 diabetes mellitus (n = 105; age 36-71 years) on diet therapy alone, and with quite good glycaemic control (mean HbA1c approximately 7.0%) were randomized to receive acarbose (100 mg three times daily) or placebo for 16 weeks, and changes in clinical and metabolic parameters indicative of Syndrome X were monitored. Fasting levels of glucose, glycosylated haemoglobin (HbA1c), true insulin, proinsulin, fibrinogen and lipids were measured four times weekly, and glucose, insulin, proinsulin and triglyceride responses to a standardized 1.6 MJ breakfast were determined at 0, 1 and 2 h post meal. Analysis was on an intention-to-treat basis. Fasting levels of glucose (P < 0.0001), triglycerides (P = 0.03) and HbA1c (P = 0.003) were reduced by acarbose over the 16 weeks of treatment. The mean change in HbA1c from week 0 to 16 differed by 0.4% (P = 0.003) between the two groups. Insulin (P = 0.06), proinsulin (P = 0.07) and glucose (P < 0.0001) responses to the standard meal were reduced. These data show that acarbose reduces fasting glucose and triglyceride levels, lowers HbA1c and limits the glycaemic and insulin response to food in individuals with type 2 diabetes mellitus with Syndrome X. Pharmacological agents that improve the metabolic environment and reduce insulin resistance have the potential to limit the progression of atherogenesis associated with type 2 diabetes mellitus.

Acarbose↗
PubMed1997

Evaluation of a diabetes education program in Newcastle, NSW.

OBJECTIVE: To assess the level of coverage and effectiveness of diabetes education provided by the Newcastle Diabetes Education and Stabilisation Centre (DESC) to people taking insulin. RESEARCH DESIGN AND METHODS: A community based survey of people presenting a prescription for insulin to retail pharmacies in the Hunter Region. The study characterised participants and non-participants in the DESC program by social and demographic factors and assessed the knowledge, blood glucose control and symptoms of diabetic complications they reported. The study also assessed their attitude towards diabetes and diabetic self-care and their feelings towards and use of clinical services. RESULTS: There were 229 respondents, 75% had attended the DESC course, however single males living in rural areas were significantly less likely to attend. Course attenders were more likely to do blood tests and visit an ophthalmologist and podiatrist than non-attenders, but were not more knowledgable about diabetes or reported fewer complications. Despite high levels of use of health care services including eye care, by people with diabetes, and an overall positive attitude to diabetes management, the study revealed a widespread ignorance of the serious consequences of diabetes. CONCLUSIONS: People with diabetes taking insulin in the Hunter Region have an overall positive attitude to diabetes and a high level of participation in a formal diabetes education program. Attendance was associated with increased use of eye care and foot care services, despite little demonstrable effect on knowledge or self-reported diabetes control.

Adult↗
PubMed1996

Self-reported dieting and weight histories of newly diagnosed NIDDM patients.

OBJECTIVE: To investigate the role of weight and dieting history in newly diagnosed NIDDM patients. DESIGN: Weight, age and sex-matched comparison of weight and dieting histories in NIDDM patients and non-clinical controls. SUBJECTS: 50 newly diagnosed NIDDM patients and 50 matched non-diabetic controls. MEASUREMENTS: Structured Clinical Interview. RESULTS: Findings indicated that there were no differences in the dieting and weight histories between the comparison groups. However within the NIDDM group significant relationships were found between weight and dieting histories and age of diagnosis. CONCLUSION: Overall the study suggests that there is nothing unusual about the weight and dieting histories of patients with NIDDM compared to non-diabetics with similar current weight. However weight and dieting histories may be important in determining the age of diagnosis of NIDDM.

Adult↗
PubMed1995

Mixed-lineage acute myeloid leukemia associated with a suprasellar dysgerminoma.

An association between primary mediastinal germ cell tumors and hematologic malignancies has been recognized since 1985. We present a patient with a suprasellar germ cell tumor and an associated leukemia. A 20-year-old black female presented in December 1987 with a 6-month history of headaches and weight loss, confusion, polyuria, and polydipsia. Evaluation revealed hypernatremia, normal neurologic examination except poor recall, and an enhancing inhomogeneous suprasellar mass on cranial computed tomography. Biopsy of the mass diagnosed a dysgerminoma, which was treated with craniospinal radiation. In February 1988, the patient developed pancytopenia, which resolved with discontinuation of cimetidine and phenytoin. She did well until June 1988 when she presented with skin lesions over the trunk and extremities. Skin biopsy revealed a leukemic infiltration. She was admitted with a WBC 1,500/microliter (without blasts), Hb 11.6 g/dl, PLT 210,000 microliter. Bone marrow biopsy revealed hypercellularity with 50% blasts, demonstrating mixed-lineage acute myeloblastic leukemia (myelomonocytic-M4; megakaryoblastic-M7). The patient was induced with a standard Ara-C/daunorubicin regimen. Two weeks postinduction, she became septic and expired. An autopsy demonstrated leukemic involvement of the spleen, liver, bone marrow, and skin, without residual dysgerminoma. This represents the first reported case of suprasellar dysgerminoma associated with a mixed-lineage leukemia not related to chemotherapy.

Adult↗
PubMed1994

Comparison of cefoperazone plus sulbactam with clindamycin plus gentamicin as treatment for intra-abdominal infections.

This study compared the safety and efficacy of cefoperazone plus sulbactam with that of clindamycin plus gentamicin in the treatment of intra-abdominal infection. Seventy-six patients were included in the analysis of an open, randomized, comparative, single-site trial. Forty-seven patients received cefoperazone-sulbactam, and 29 patients received clindamycin plus gentamicin. Thirty-three patients (70%) who received cefoperazone-sulbactam and 15 patients (52%) who received clindamycin plus gentamicin were cured of infection, did not suffer a relapse within one month after the end of treatment, and did not receive any other antibiotics during the follow-up period (P = 0.17). In patients treated with cefoperazone-sulbactam there were four cases of superinfection, one patient had a prolonged prothrombin time, six patients had a poor response, two patients received antibiotics during follow-up, and one patient died during follow-up because of cancer. Treatment with clindamycin plus gentamicin was associated with five cases of superinfection, four patients had a poor response, four patients had a drug reaction, and one patient required antibiotics in the follow-up period. Serum levels of cefoperazone-sulbactam measured at one and three hours after dosing were consistent with earlier findings in normal volunteers. Two hundred and one pathogens were isolated, and 17 of 122 aerobic isolates (14%) were resistant to cefoperazone-sulbactam, and 17 of 122 (14%) were resistant to both clindamycin and gentamicin. Eleven of 79 (14%) anaerobic isolates were resistant to cefoperazone, none was resistant to cefoperazone-sulbactam, and 10 of 79 (13%) were resistant to clindamycin. The results of this study show that cefoperazone-sulbactam is an effective and safe alternative to clindamycin plus gentamicin in the treatment of intra-abdominal infections.

Abdomen↗
PubMed1994

A comparison of eating behaviors in newly diagnosed NIDDM patients and case-matched control subjects.

OBJECTIVE: To determine whether disordered eating may be problematic in non-insulin-dependent diabetes mellitus (NIDDM). RESEARCH DESIGN AND METHODS: We contrasted the eating behaviors and attitudes in 50 newly diagnosed NIDDM patients with 50 age-, sex-, and weight-matched control subjects. RESULTS: Although 14% of diabetic subjects versus 4% of nondiabetic subjects reported episodes of binge eating (P < 0.10), there was no difference between diabetic and nondiabetic subjects in the prevalence with which they met criteria for binge eating disorder. Diabetic patients with a history of binge eating were significantly heavier, had younger age at diagnosis, and had more problems with eating in response to situational and emotional cues than did diabetic patients who did not binge. CONCLUSIONS: No support was found for greater prevalence of binge eating disorder in newly diagnosed NIDDM patients than in matched nondiabetic control subjects.

Adult↗