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Biomedical subjects

K O'Brien

Publications and source records attributed to K O'Brien.

At least 91 records · Page 5Linked to original sources
PubMed1995

Osteoporosis workup: evaluating bone loss and risk of fractures.

Osteoporosis afflicts millions of Americans, causing an age-related increase in the incidence of fractures of the hip, wrist, spine, and other bones. Older patients require assessment of their fracture risk, including evaluation of skeletal fragility and risk of falls. Secondary causes of bone loss should be sought in individuals with bone density lower than expected for age. Preventive measures, such as supplementary calcium and vitamin D, and environmental changes to decrease the risk of falls in the home are recommended. Physical therapy may decrease the risk of falls and help maintain bone mass. Antiresorptive therapy should be considered for any individual at high risk for fracture, regardless of age.

Age Factors↗
PubMed1994

Is the timing of withdrawal bleeding a guide to endometrial safety during sequential oestrogen-progestagen replacement therapy? UK Continuous Combined HRT Study Investigators.

Current regimens of sequential hormone replacement therapy are based on data that show a protective effect on the endometrium of at least 10 days of progestagen. In clinical practice, onset of bleeding on or after day 11 of the progestagen phase is taken as reassurance of a normal endometrium. 413 postmenopausal women taking oestrogen-progestagen hormone replacement therapy with 10 or 12 days of progestagen per cycle completed bleeding diaries for 3 months before endometrial biopsy. For most women, bleeding started around the 13th day after starting progestagen. There was no correlation between endometrial histology and timing of onset of bleeding. 11 (2.7%) women had complex endometrial hyperplasia. The prevalence of hyperplasia was 2.4% with 10 days of progestagen per cycle and 2.8% with 12 days [corrected]. The timing of onset of withdrawal bleeding during oestrogen-progestagen HRT does not predict endometrial hyperplasia.

Endometrium↗
PubMed1994

Patient-carried card prompts vs computer-generated prompts to remind private practice physicians to perform health maintenance measures.

BACKGROUND: We compared the efficacy of a computer-generated prompt sheet placed on the front of patients' charts with a patient-carried prompt card to remind physicians to perform selected health maintenance items. METHODS: A randomized prospective single-blind study was performed in private practice offices in rural eastern North Carolina, with 28 family practitioners and nine general internists participating. Twenty-two physicians were randomized to the computer prompt group and 22 to the card prompt group. Four physicians in the computer group did not complete the study because of computer software problems, and three physicians did not complete the study because their limited staff was unable to enter patient data into the computer. Before the intervention, 20 patient charts (10 males and 10 females) from each physician were audited for the performance of influenza vaccinations, stool for occult blood, pap smears, breast examinations performed by the physicians, and mammograms. One year after the intervention was instituted, chart audits for the above five items were done again on 20 different patient charts for each physician. RESULTS: There was a 7% increase in the performance of influenza vaccinations in the card group (17% vs 24%) compared with a 6% increase in the computer group (20% vs 26%). There was a 5% decrease in the performance of stool for occult blood in the card group (28% vs 23%) compared with a 1% increase in the computer group (30% vs 31%). There was an 11% decrease in the performance of pap smears in the card group (26% vs 15%) compared with a 3% increase in the computer group (23% vs 26%). There was a 2% decrease in the performance of breast examinations by the physician in the card group (35% vs 33%) compared with a 3% increase in the computer group (30% vs 33%). Finally, there was a 3% increase in the performance of mammograms in the card group (22% vs 25%) compared with an 11% increase in the computer group (15% vs 26%). CONCLUSIONS: Our data show a greater increase in performance of health maintenance items in the computer-prompted group. The performance of stool for occult blood, pap smears, breast examinations performed by the physician, and mammograms were increased more in the computer-prompted group than in the card group. However, there was not a statistically significant difference after intervention for any of the audited health maintenance items for either the computer group or the card group. Overall, health maintenance measures were performed in only a minority of appropriate patients.

Adult↗
PubMed1994

The influence of the setting of 'cut-off' points for orthodontic treatment need upon the reliability of the Index of Orthodontic Treatment Need.

This investigation evaluated the effect of setting cut-off points for treatment allocation upon the reliability of the Index of Orthodontic Treatment Need (IOTN). Cut-off points were placed between the grades signifying 'need' and 'moderate need' and between 'need' and 'no need' for treatment. The reliability of each of these dichotomous decisions was evaluated with (i) the Kappa statistic and (ii) the false positive and false negative rates. We found that the reliability was decreased and the false positive rate was increased when the cut-off point was placed between the 'need' and 'moderate need' for treatment levels. The effect of this variation in reliability is discussed.

Esthetics, Dental↗
PubMed1994

Weight loss in severely obese subjects prevents the progression of impaired glucose tolerance to type II diabetes. A longitudinal interventional study.

OBJECTIVE: To determine if weight loss may prevent conversion of impaired glucose tolerance (IGT) to diabetes, because weight loss reduces insulin resistance. The prevalence of IGT in the U.S. population is estimated at 11.2%, more than twice that of diabetes. Furthermore, because an oral glucose tolerance test is needed for its detection, most of these patients are undiagnosed. Screening for IGT would be meaningful if progression to diabetes could be delayed or prevented. RESEARCH DESIGN AND METHODS: For an average of 5.8 years (range 2-10 years), 136 individuals with IGT and clinically severe obesity (> 45 kg excess body weight) were followed. The experimental group included 109 patients with IGT who underwent bariatric surgery for weight loss. The control group was made up of 27 subjects with IGT who did not have bariatric surgery. The criteria of the World Health Organization was used to detect IGT and diabetes in this population. The main outcome measure of this nonrandomized control trial is the incidence density, or number of events (development of diabetes) divided by the time of exposure to risk. RESULTS: Of the 27 subjects in the control group, 6 developed diabetes during an average of 4.8 +/- 2.5 years of postdiagnosis follow-up, yielding a rate of conversion to diabetes of 4.72 cases per 100 person-years. The 109 individuals of the experimental group were followed for an average of 6.2 +/- 2.5 years postbariatric surgery. Based on the 95% confidence interval of the comparison group, we would expect to find that between 22 and 36 subjects in the experimental group developed diabetes over the follow-up period. Only 1 of the 109 experimental-group patients developed diabetes, resulting in a conversion rate of the experimental group of only 0.15 cases per 100 person-years, which is significantly lower (P < 0.0001) than the control group. CONCLUSIONS: Weight loss in patients with clinically severe obesity prevents the progression of IGT to diabetes by > 30-fold.

Adult↗
PubMed1994

Getting around: a simple office workup to assess patient function.

Normal age-related changes in the musculoskeletal, neurologic, and cardiopulmonary systems result in some decline in function for the older patient. The risk of functional loss is heightened when disease and/or a sedentary lifestyle accompany the normal age-related changes. Primary care physicians are in a key position to identify older adults who are at risk to lose function. Two indicators of loss of mobility are lower extremity weakness and balance deficits, and these can be assessed in a simple office work-up. Referral to a physical therapist who specializes in movement analysis may be indicated when an older adult shows signs of functional decline.

Aged↗
PubMed1994

Using system integration to revise documentation.

Within a 10-month time period, a new system-wide documentation common to five hospitals in the Evangelical Health System was designed and implemented. The documentation system is comprised of the Nursing Admission Assessment, Patient Care Plan, Patient Care Flowsheet, and Patient/Family Education Record. Examples of barriers and success factors as well as the system's framework are presented.

Documentation↗
PubMed1994

Latex allergy in hospital employees.

To investigate the incidence of latex IgE-mediated hypersensitivity, 224 hospital employees were interviewed and prick skin tests were performed to six common aeroallergen extracts, one non-latex "synthetic" glove extract, and four different latex glove extracts. Of the 224 subjects, there were 136 nurses, 41 laboratory technicians, 13 dental staff, 11 physicians, 6 respiratory therapists, and 17 housekeeping and clerical workers. All 224 subjects tested negative for the nonlatex glove (Tactylon) extract but 38 (17%) tested positive for latex extracts. The incidence ranged from 0% in housekeeping staff to 38% in dental staff. Eighty-four percent of the latex skin test-positive employees complained of itching and 68% of rash upon exposure to latex, whereas the latex skin test-negative employees reported these symptoms in 29% and 17%, respectively. Urticaria was a symptom in 55% of the latex skin test-positive and 0.5% of the skin test negative-subjects. Anaphylaxis occurred in 10.5% of the skin test-positive and in none of the skin test-negative employees. Symptoms of sneezing (34% vs 7%), nasal congestion (39% vs 7%), and lacrimation and ocular itching (45% vs 6%) were also significantly different between the latex skin test-positive and latex skin test-negative subjects. We conclude that the incidence of latex IgE-mediated allergy in hospital employees is 17%. The symptoms of anaphylaxis and hives when using latex gloves are sensitive predictors of IgE-mediated latex allergy.

Female↗
PubMed1993

MRL mice produce anti-Su autoantibody, a specificity associated with systemic lupus erythematosus.

Certain autoimmune mouse strains exhibit features similar to human SLE. To discover genetic and immunologic events governing expression of a new SLE-associated antibody, the presence of anti-Su and its relationship to other SLE-related antibodies (anti-Sm, -ribonucleoprotein, -Ro (SS-A), -La (SS-B)) were determined in MRL and other autoimmune and nonautoimmune mice. By double immunodiffusion, sera from 34/183 (19%) 4- to 10-mo-old MRL/Mp-lpr/lpr (MRL/lpr) and 28/108 (26%) 8- to 20-mo-old MRL/Mp(-)+/+ (MRL/+) mice were positive for anti-Su antibodies. Anti-Sm antibodies were found in 60/183 (33%) and 39/108 (36%) of these animals, respectively. The two specificities were found together in individual mice more frequently than would be predicted by chance. In contrast, C57BL/6-lpr/lpr (B6/lpr) mice rarely showed either specificity. Analysis of F1 hybrids between B6/lpr and MRL/lpr and of F1 x MRL/lpr backcross mice suggested that a small number of autosomal recessive genes controlled the anti-Su and anti-Sm responses. With the exception of a single NZB serum sample, NZB, BXSB, and nonautoimmune mice were negative for all antibodies tested, and no mice were positive for anti-RNP, anti-Ro, or anti-La. MRL/lpr and MRL/+ autoimmune mice thus provide unique models for human SLE, because they express several of the SLE-specific marker autoantibodies. These models should be useful in disclosing molecular and immunologic events governing autoantibody expression in this condition.

Animals↗
PubMed1993

Quantification and kinetics of 25-hydroxyvitamin D3 by isotope dilution liquid chromatography/thermospray mass spectrometry.

A liquid chromatography/thermospray mass spectrometry method has been developed and used to measure the plasma levels and half-life of 25-hydroxyvitamin D3 in adults. The mean plasma levels of 25-hydroxyvitamin D3 averaged 40 ng ml-1 (n = 4) in summer and 30 ng ml-1 (n = 6) in winter. The method was also used to determine the half-life of serum 25-hydroxyvitamin D3 in subjects maintained on either high or low-fiber diets who had been given an intravenous infusion of (6,19,19-2H3)25-hydroxyvitamin D3 sufficient to label 5% of their estimated body pools. The half-life was determined to be 10.4 days (n = 4), which is approximately 50% of the currently accepted value of 19 days, determined using radiolabeled methods. This difference may be due to kinetic isotope effects arising as a result of the tritiated compounds being labeled at sites that undergo Cyt-P450-catalyzed oxidations.

Adult↗
PubMed1993

Abnormal hepatic mitochondrial respiration and cytochrome C oxidase activity in rats with long-term copper overload.

BACKGROUND: Dietary copper overload in the rat is associated with morphological abnormalities and lipid peroxidation of hepatic mitochondria. This study was designed to determine if copper hepatotoxicity was associated with functional alterations in mitochondrial respiration in conjunction with lipid peroxidation. METHODS: Weanling male rats were pair-fed for 8 weeks on diets containing normal or high levels of copper in combination with sufficient vitamin E. Serum and liver samples were obtained, and hepatic mitochondria were isolated by differential centrifugation. RESULTS: Oxidant injury (decreased levels of hepatic glutathione and alpha tocopherol and increased levels of mitochondrial thiobarbituric acid-reacting substances) was present in the copper-overloaded rats. Serum aminotransferase levels correlated with concentrations of mitochondrial copper and thiobarbituric acid-reacting substances. Copper overload caused a decrease in state 3 respiration and the respiratory control ratio in hepatic mitochondria when several electron donors were used. Analysis of the oxidoreductase activities of the four mitochondrial electron transport protein complexes showed that complex IV (cytochrome C oxidase) activity was reduced by 60% in copper overload. CONCLUSIONS: Functional abnormalities of mitochondria accompany lipid peroxidation and the morphological alterations caused by copper overload, supporting the hypothesis that the mitochondrion is one of the major intracellular targets in copper hepatotoxicity.

Animals↗
PubMed1993

Social relationships of men at risk for AIDS.

Survey data collected in 1984-85 from a community sample of 637 gay and bisexual men were used to determine the features of social relationships that were most conductive to changes in both psychological health and AIDS-related sexual risk behavior. Multiple regression analyses showed that both the perceived availability of social support and the absence of conflicts in the social network were related to improve psychological health. At the same time, the subjective experience of integration into social networks was associated with increased psychological distress, and validation (the experience of being accepted by others) was related to a higher level of risk activity. These findings are discussed in terms of the social relationships among community members that share a common stressor--in this case the shared problem of being at risk for AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Job satisfaction of paramedics: the effects of gender and type of agency of employment.

STUDY OBJECTIVES: To document specific factors important in paramedic job satisfaction and job performance. DESIGN AND TYPE OF PARTICIPANTS: A cohort analysis sampled 63 male public-agency paramedics and 131 private-agency paramedics (90 male, 41 female). METHODS: Three scales from the Michigan Organizational Assessment Questionnaire measured total job satisfaction. A four-item scale assessed attitudes toward paramedic job performance. RESULTS: Fire paramedics reported highest levels of overall satisfaction, followed by male and female private-agency paramedics. Fire paramedics reported higher levels of intrinsic job satisfaction (eg, opportunity to learn new things) than private-agency paramedics. Differences in extrinsic job satisfaction (eg, pay, benefits) were even greater between fire paramedics and private-agency paramedics. Fire paramedics reported higher satisfaction than female private-agency paramedics with the social rewards of work (eg, the way they are treated by their coworkers). These findings were not explained by age, race, education level, and years on the job. Analysis of the attitudes toward paramedic job performance scale suggested that male paramedics are more likely to believe that female paramedics are not as capable of performing certain job functions. CONCLUSION: Type of agency and gender affect job satisfaction. Male public-agency paramedics are most satisfied, and female private-agency paramedics are least satisfied with their jobs.

Adult↗
PubMed1993

An outbreak of cholera in Maryland associated with imported commercial frozen fresh coconut milk.

In August 1991, the first outbreak of cholera associated with an imported commercial food product occurred among persons attending a private picnic. An epidemiologic investigation showed infection with toxigenic Vibrio cholerae O1, biotype El Tor, serotype Ogawa, in 4 of 6 persons who had consumed coconut milk imported from Thailand. In addition, the US Food and Drug Administration recovered toxigenic V. cholerae O1, biotype El Tor, serotype Ogawa, from 1 of 6 unopened bags of the same brand (but different shipment) of coconut milk as that consumed by infected persons. Investigation in Thailand of the manufacturing process of the implicated coconut milk showed several sanitary violations, suggesting that contamination had occurred during production. This outbreak suggests a model of entrance of V. cholerae into a population and shows the need to evaluate current methods of maintaining the safety of imported foods in the United States.

Adult↗
PubMed1993

A longitudinal study of psychological distress in a cohort of gay men. Effects of social support and coping strategies.

This study presents analyses on questionnaire data collected from a panel of 520 gay men at risk for acquired immune deficiency syndrome, enrolled in the Coping and Change Study (1985-1987). The data were assessed to determine the association of social support and coping styles with subsequent depression and global distress and to investigate whether these predictors of mental health are stable or transient over time. Three different measures of the subjective, qualitative nature of social support were significantly associated with subsequent mental health. Those who reported a subjective sense of isolation experienced significantly more adverse mental health 6 months later at all three measurement periods. Scattered effects were found for perceived social conflict and perceived social support from others. These results indicate that certain types of social support appear to influence mental health in this cohort and, furthermore, that some associations are transient and others more stable over time.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Using focus groups to develop health surveys: an example from research on social relationships and AIDS-preventive behavior.

Focus group data can inform the choice of words or phrases in a questionnaire, the construction of items to measure a given concept, the formation of new hypotheses, and the development of survey procedures. To date, few examples exist to show researchers in health behavior and health education how they might use focus groups for these purposes. This paper provides an example of group discussions that were held with gay and bisexual men on the topic of their experiences of the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) epidemic and illustrates the many ways that focus groups assist in questionnaire development.

Acquired Immunodeficiency Syndrome↗