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Biomedical subjects

L Fisher

Publications and source records attributed to L Fisher.

286 records · Page 16Linked to original sources
PubMedDate not supplied

Developing a strategy for managing behavioral health care within the context of primary care.

Although most patients with psychological disorders are diagnosed and treated within the primary care setting, there are few guidelines to help primary care physicians and managed care plan administrators construct programs of behavioral health care that are compatible with the primary care environment. We report the findings from a review of the literature from 1970 to 1996 on factors that predict the use of mental health and substance abuse services with specific reference to primary care. We use a heuristic framework of service use that includes the characteristics of patients, primary care physicians, practice settings, and managed care plans. Recognizing that the factors associated with the use of services center on the primary care practice, we argue that programs of behavioral health care will work best when they are decentralized to account for variations among primary care patients, physicians, and practices; when they are integrated clinically, financially, and administratively within the primary care setting; and when primary care physicians are active leaders in the design and implementation of these services, for clinical and financial reasons.

Behavior↗
PubMedDate not supplied

Social physique anxiety, body esteem, and social anxiety in bodybuilders and self-reported anabolic steroid users.

Social physique anxiety, upper body esteem, social anxiety, and body dissatisfaction were examined among self-reported anabolic steroid (AS)-using bodybuilders, non-using bodybuilders, athletically active exercisers, and non-exercising individuals. Results indicate that: (a) the AS-using bodybuilder group had significantly lower levels of social physique anxiety than non-user groups, (b) AS-using bodybuilders have significantly higher upper body strength ratings than do non-users (non-using bodybuilders, athletically active exercisers, and non-exercisers), and (c) no differences among groups on a measure of social anxiety. Implications for further research and intervention are discussed in terms of the differences between anabolic steroids and other substances of abuse.

Adolescent↗
PubMedDate not supplied

Marital discord and immunity in males.

While limited data suggest significant gender differences in mental and physical health risks following marital disruption, men have not been studied as intensively as women. In this study, self-report data and blood samples were obtained from 32 separated or divorced men and 32 sociodemographically matched married men. Separated/divorced men were more distressed and lonelier, and reported significantly more recent illness than did married men; the former also had significantly poorer values on two functional indices of immunity (antibody titers to two herpesviruses), while not differing significantly on quantitative indices (percentages of helper and suppressor cells and their ratio). Among married men, poorer marital quality was associated with greater distress and a poorer response on one functional immunological measure, antibody to Epstein-Barr virus (EBV), as well as lower helper/suppressor ratios. Among separated/divorced subjects, those who had separated within the past year and who had initiated the separation were less distressed, reported better health, and had a better performance on one functional immunological assay (EBV antibody titers) than did noninitiators. These data are discussed in the context of research on longer-term adaptation to marital disruption.

Adult↗
PubMedDate not supplied

The family and type 2 diabetes: a framework for intervention.

Four broad groups of factors have been linked with self-management behavior in type 2 diabetes over time: (1) characteristics of patients, (2) amount and management of stress, (3) characteristics of providers and provider-patient relationships, and (4) characteristics of the social network/context in which disease management takes place. Of these four, social network/context has received the least amount of study and has been described in terms not easily applicable to intervention. In this paper, we identified the social network/context of diabetes management as residing within the family. We defined the family for clinical purposes, reviewed the literature concerning what is known about the link between properties of the family context of care and outcomes in type 2 diabetes and other chronic diseases, and identified areas of family life that are relevant to diabetes management. This information was then used to demonstrate how a family context of care can serve as a clinical framework for integrating all four groups of factors that affect disease management. Implications of this approach for practice and research are described.

Adaptation, Psychological↗
PubMedDate not supplied

Institutional differences in therapeutic decision making in the Coronary Artery Surgery Study (CASS).

This article examines institutional differences in therapeutic decision making in the Coronary Artery Surgery Study (CASS). The initial decision to use medical therapy or coronary artery bypass surgery for coronary artery disease is studied. Data from the CASS registry and a survey of CASS principal investigators were used to examine the effects of institutional characteristics, individual physician characteristics, and decision making responsibility on the recommended therapy, the actual therapy, and the ratio of the observed to expected number of surgeries. The results indicated that the experience and involvement of the surgeon in the decision making process were related to actual and recommended rates of surgery. The percentage of urgent transfers from other hospitals and the percentage of surgical referrals to outside hospitals were related to the ratio of the observed to expected numbers of surgery, an adjusted rate of surgery. A major conclusion of this study is that despite the effects of certain institutional constructs, scientific criteria in the form of clinical and angiographic data are the most important determinants of whether a patient receives coronary artery bypass surgery.

Adult↗
PubMedDate not supplied

Comparison of photorefractive keratectomy on one eye and laser in situ keratomileusis on the other eye of the same patient.

OBJECTIVE: The aim of this study was to compare the results of excimer laser photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) in the same patient. METHODS: All consecutive patients who underwent PRK in one eye and LASIK in the second eye using the same excimer laser (Nidek EC-5000) and had at least 12 months of follow-up were included in this retrospective study (N = 23). Uncorrected and spectacle-corrected visual acuity, final spherical equivalent refraction, and degree of haze were compared. RESULTS: Mean postoperative spherical equivalent refraction in the group of eyes that underwent PRK was +0.73 D (range, -5.50 to +3.50 D). Mean postoperative spherical equivalent refraction in the group of eyes that underwent LASIK was +0.07 D (range, -1.25 to +3.50 D) (P = .046). CONCLUSION: In our study, eyes treated with LASIK had better results than eyes treated with PRK.

Adult↗
PubMedDate not supplied

Bilateral comparison of photorefractive keratectomy for myopia using two excimer lasers.

PURPOSE: The aim of this study was to compare the results of excimer laser photorefractive keratectomy (PRK) in patients who underwent PRK using the Summit Apex (Omnimed) excimer laser in one eye and the Nidek EC-5000 excimer laser in the other. METHODS: All consecutive patients who underwent PRK with the Summit Apex laser (Omnimed) in one eye and the Nidek laser (EC-5000) in the second and had at least 12 months of follow-up were included in this retrospective study (n=30). Uncorrected and spectacle-corrected visual acuity, final spherical equivalent refraction, and grade of subepithelial haze were compared. The average preoperative spherical equivalent refraction of eyes treated with the Summit laser was -6.00 D (range, -2.50 to -8.75 D), and for Nidek-treated eyes it was -5.57 D (range, -2.50 to -8.80 D). RESULTS: Forty-seven percent of Summit-treated eyes and 53% of Nidek-treated eyes had uncorrected visual acuity of 6/6 or better; 61% of Summit-treated eyes and 63% of Nidek-treated eyes had uncorrected visual acuity of 6/7.5 or better; 95% of Summit-treated eyes and 95% of Nidek-treated eyes had uncorrected visual acuity of 6/12 or better (difference not statistically significant). Seventy-three percent of eyes treated with the Summit laser and 80% of eyes treated with the Nidek laser had a postoperative refraction within +/-0.50 D of emmetropia; 97% of Summit-treated eyes and 87% of Nidek-treated eyes had a postoperative spherical equivalent refraction within +/-1.00 D of emmetropia; the difference between the two lasers was not statistically significant. However, the percent of eyes with persistent hyperopia was smaller in the Nidek group after 3 months (P=.0062) and after 6 months (P=.07) than in the Summit group. Videokeratography was not done. CONCLUSION: Both lasers were effective with relatively low side effects. No significant difference was found between the two lasers in postoperative uncorrected visual acuity or refractive outcome. Eyes operated with the Nidek laser had less persistent hyperopia and stabilized earlier.

Adult↗
PubMedDate not supplied

Families of homosexual men: their knowledge and support regarding sexual orientation and HIV disease.

BACKGROUND: The number of homosexual men (gay) with the human immunodeficiency virus (HIV) who will become ill in the next few years is expected to rise dramatically. Many will need and desire support from their families of origin. Understanding the history of family relationships can be crucial for the optimal care of these patients and their families. Little is known, however, about the relationship between gay men and their families of origin. METHODS: A convenience sample of gay men (n = 265) from three northern California cities was surveyed to determine family member knowledge of their sexual orientation and HIV status and perceived family supportiveness regarding issues of HIV disease and acquired immunodeficiency syndrome (AIDS). Fifty-five percent of the sample were HIV negative, 14 percent were HIV positive, 8 percent had received a diagnosis of AIDS, and 23 percent had not been tested. RESULTS: Approximately 70 percent of family members knew a son's or brother's sexual orientation. Fewer family members (50.9 percent) knew a son's or brother's HIV status than knew his sexual orientation. Untested gay men reported the least family knowledge of both sexual orientation and HIV status. There was, however, considerable variation in knowledge among members of the same family, with mothers and sisters knowing HIV status more frequently than fathers and brothers. The amount of supportiveness regarding issues of HIV disease within the family also varied considerably. CONCLUSIONS: It is important for the family physician caring for the gay male patient, his family, or both to understand that the pattern of knowledge and supportiveness among family members concerning sexual orientation and HIV status is selective, even within the same family. The physician needs to assess family members' knowledge and attitudes to plan an overall care strategy.

Acquired Immunodeficiency Syndrome↗