Search PubMed⌕ Search

Biomedical subjects

L Fisher

Publications and source records attributed to L Fisher.

At least 109 records · Page 6Linked to original sources
PubMed1995

The impact of chronic illness on the health and well-being of family members.

Examined is the impact of dementia on the physical and mental health of all family members caring for an ill parent/spouse. The sample included 97 spouses of patients diagnosed with either Alzheimer's disease or vascular dementia, 186 offspring, and 97 offspring spouses or "in-laws." Multiple regression tested the association between severity of the illness and family member health and well-being. Severity was significantly associated with health and well-being for spouses, offspring, and in-laws, regardless of the amount of caregiving, demonstrating the potential cascading effect of the illness through the family. Use of services displayed no direct association with spouse health and well-being, but service utilization interacted with illness severity. The relationship between severity of illness and spouse health was lower under conditions of high service utilization than under conditions of low service utilization.

Adult↗
PubMed1995

Blepharophimosis syndrome is linked to chromosome 3q.

Blepharophimosis syndrome (BPES, blepharophimosis eyelid syndrome) is a distinctive congenital eyelid malformation which can occur sporadically or be inherited in an autosomal dominant fashion. Previous reports have described associated cytogenetic abnormalities on chromosome 3q. We have ascertained and sampled two BPES families with apparent autosomal dominant inheritance and have tested for linkage with 17 polymorphic markers on 3q. Multipoint analysis generated a maximum LOD score of 3.23 using the markers RHO, ACPP and D3S1238. No evidence of genetic heterogeneity was observed. These studies provide the first non-cytogenetic evidence that a defective gene responsible for BPES is located on 3q22.

Blepharophimosis↗
PubMed1995

Prognostic models and the propensity score.

Subjects in observational studies of exposure effects have not been randomized to exposure groups and may therefore differ systematically with regard to variables related to exposure and/or outcome. To obtain unbiased estimates and tests of exposure effects one needs to adjust for these variables. A common method is adjustment via a parametric model incorporating all known prognostic variables. Rosenbaum and Rubin propose adjustment by the conditional exposure probability given a set of covariates which they call the propensity score. They show that, at any value of the propensity score, covariates are on average balanced between exposure groups. Thus matching on the propensity score leads to unbiased estimators and tests of exposure effect. However, the validity of the method depends on knowing the exposure probability. This quantity is usually not known in observational studies and needs to be estimated.

Bias↗
PubMed1995

An empirically derived typology of families: I. Relationships with adult health.

In this report we describe the development and partial validation of an empirically derived typology of families based on 11 family variable composites derived from the California Family Health Project. Our goal was to use the typology to condense and integrate the findings from previous analyses of a large group of family variables and to account for differences in the self-reported health of adult family members. Exploratory and confirmatory cluster analyses conducted separately by gender classified 97% of the sample into four parallel types for husbands and wives: Balanced, Traditional, Disconnected, and Emotionally Strained. A 1-way MANOVA indicated that all 11 family variable composites significantly differentiated the four family types for husbands and wives. Significant differences among the four family types were also found on 10 demographic and other family variables, using ANOVA. Using MANOVA, we compared the four family types on 12 self-reported health and well-being variables by gender. Both husbands and wives from Balanced and Traditional families reported higher health scores than spouses from Disconnected and Emotionally Strained families, but no single profile of health scores was unique to a particular family type. The four family types provide an integrated and comprehensive framework for describing the family in health research.

Adolescent↗
PubMed1995

An empirically derived typology of families: II. Relationships with adolescent health.

In this report from the California Family Health Project, we describe the relationship between an empirically derived family typology based on parent data, and the self-reported health and well-being of 151 adolescent offspring. The typology is comprised of four family types: Balanced, Traditional, Disconnected, and Emotionally Strained. Three adolescent health indices were constructed from 13 self-reported health variables using principal components and multidimensional scaling analyses: Physical Health, Emotional Health, and Alcohol Abstinence. ANOVA indicated that Physical Health was significantly different among adolescents in the four family types. The findings varied, however, depending upon whether the typology was based on mothers' or fathers' appraisals of the family. In the father-based typology, adolescents from Traditional families scored highest while those from Emotionally Strained and Balanced families scored lowest. In the mother-based typology, adolescents from Balanced, Traditional, and Emotionally Strained families scored equally high, while those from Disconnected families scored significantly lower than those from the other three family types. Differences on Abstinence were significant only in the father-based typology. Adolescents from Traditional and Emotionally Strained families drank less than adolescents from Disconnected families. No significant differences among adolescents were found for Emotional Health, and adolescent gender did not interact significantly with family type to affect any of the three health indices. Traditional and Disconnected family types had offspring who clearly stood apart with higher and lower health scores, respectively. The results are discussed in terms of the current literature on social environment and health.

Adolescent↗
PubMed1995

Dependent care, caregiver burden, hardiness, and self-care agency of caregivers.

This is a partial replication of a descriptive correlation study that examined the relationship between dependent care, caregiver burden, health-related hardiness, and self-care agency of caregivers. Data from this replication were compared with those of the previously reported study. Data were collected from a home health agency and a radiation-oncology unit. A moderate significant negative correlation was found between objective burden and dependent care. Moderate significant positive correlations were found between self-care agency scores and the commitment/challenge and control subscales of health-related hardiness scores. The major difference between this study and the previous one was in the level of subjective burden. Even though caregivers reported greater levels of subjective burden, the correlation with self-care agency and hardiness was nonexistent. The small subsample of male caregivers (n = 14) prevented a statistical comparison with the previous data; however, in the pooled sample previous findings were supported.

Adaptation, Psychological↗
PubMed1995

Aural tuberculosis.

Since the advent of antituberculous therapy, tuberculosis of the ear has decreased in incidence; but of late, cases of both pulmonary and otologic tuberculosis are on the rise. In addition, the treatment of aural tuberculosis is now more difficult due to resistance to one or more of the routinely used antituberculous pharmacotherapeutic agents. Urban areas and selected populations have been particularly endangered by the re-emergence of this disease. In light of this developing situation, three cases of aural tuberculous infections are presented. Typical and atypical presentations of the disease, including history, signs, symptoms, and radiographic findings are discussed, as are treatment options. The importance of aural tuberculosis as part of the general increase in incidence and resistance of the disease is examined.

Adult↗
PubMed1994

Risk factors for repeatedly reactive HIV-1 EIA and indeterminate western blots. A population-based case-control study.

OBJECTIVE: Causes of indeterminate results of Western blot testing (IWB) for human immunodeficiency virus (HIV) type 1 include seroconversion, HIV-2 cross-reactivity, and autoimmune disease, but most IWB results remain unexplained. This case-control study assessed risk factors for IWB results, including early HIV infection, other retroviral infection, autoantibodies, and other medical conditions. DESIGN: Prospective study to determine HIV seroconversion rate, with a case-control design to assess other risk factors for IWB. Cases (persons with one or more repeatedly reactive HIV-1 enzyme immunoassay with IWB), their current sexual partners, and controls (persons with negative enzyme immunoassay and Western blot results) were recruited from blood banks, health department and prenatal clinics, and private providers in Washington and Oregon. RESULTS: Of 244 cases enrolled, 206 were followed up for 6 months or longer, and six (3.0%; 95% confidence interval [CI], 0.7% to 5.3%) with recent HIV risk behaviors seroconverted. The Western blot banding patterns differed among groups; cases usually had p17 or p24 bands, while controls and cases' sexual partners usually had polymerase bands. Conditional logistic regression indicated that independent risk factors for IWB among male cases and controls were a tetanus booster in the past 2 years (odds ratio, 3.2; 95% CI, 1.2 to 8.6) and sexual contact with a prostitute (odds ratio, 3.0; 95% CI, 1.0 to 9.5). Independent risk factors for women were parity (odds ratio, 1.2; 95% CI, 1.02 to 1.4) and autoantibodies, either rheumatoid factor or antinuclear antibodies (odds ratio, 2.3; 95% CI, 1.03 to 5.6). No cross-reactivity was detected with HIV-2, human T-lymphotrophic virus type 1, feline immunodeficiency or feline leukemia, or bovine immunodeficiency viruses. CONCLUSIONS: Evaluation of persons with reactive HIV-1 enzyme immunoassays and IWB should include an assessment of HIV risk and other possible risk factors, such as alloimmunization (ie, parity or recent immunization) or autoantibodies (ie, antinuclear antibodies and rheumatoid factor). The relationship of IWB among men who reported sex with prostitutes is intriguing and warrants further study.

Adolescent↗
PubMed1994

A case-management system for coronary risk factor modification after acute myocardial infarction.

OBJECTIVE: To evaluate the efficacy of a physician-directed, nurse-managed, home-based case-management system for coronary risk factor modification. DESIGN: Randomized clinical trial in which patients received a special intervention (n = 293) or usual medical care (n = 292) during the first year after acute myocardial infarction. SETTING: 5 Kaiser Permanente Medical Centers in the San Francisco Bay area. PATIENTS: 585 men and women aged 70 years or younger who were hospitalized for acute myocardial infarction. INTERVENTION: In the hospital, specially trained nurses initiated interventions for smoking cessation, exercise training, and diet-drug therapy for hyperlipidemia. Intervention after discharge was implemented primarily by telephone and mail contact with patients in their homes. All medically eligible patients received exercise training; all smokers received the smoking cessation intervention; and all patients received dietary counseling and, if needed, lipid-lowering drug therapy. OUTCOME: Smoking prevalence and plasma low-density lipoprotein cholesterol (LDL) concentrations were measured 2 months after infarction, and functional capacity was measured 6 months after infarction. RESULTS: In the special intervention and usual care groups, the cotinine-confirmed smoking cessation rates were 70% and 53% (P = 0.03), plasma LDL cholesterol levels were 2.77 +/- 0.69 mmol/L and 3.41 +/- 0.90 mmol/L (107 +/- 30 mg/dL and 132 +/- 30 mg/dL) (P = 0.001), and functional capacities were 9.3 +/- 2.4 METS and 8.4 +/- 2.5 METS (P = 0.001), respectively. CONCLUSION: In a large health maintenance organization, a case-management system was considerably more effective than usual medical care for modification of coronary risk factors after myocardial infarction.

Adult↗
PubMed1994

Risk factors for transmission of Mycobacterium tuberculosis in a primary school outbreak: lack of racial difference in susceptibility to infection.

Recent data have suggested that there are racial differences in the susceptibility to infection by Mycobacterium tuberculosis. An opportunity to test this suggestion was afforded by an outbreak of tuberculosis in a racially mixed elementary school in St. Louis County, Missouri. A physical education teacher was discovered to have cavitary pulmonary tuberculosis. Of 343 students in the school, 176 (51 percent) were found to be tuberculin skin test positive (> or = 5 mm induration by Mantoux method); 32 children had abnormal chest radiographs. More frequent contact with the physical education teacher was associated with infection (p < 0.001). Black children were no more likely to be infected than were white children (relative risk (RR) = 0.98, 95% confidence interval (CI) 0.78-1.22). However, black children who were tuberculin positive had larger skin reactions than did white children (mean, 18.9 vs. 16.6 mm, p < 0.001) and were more likely to have abnormal chest radiographs (RR = 2.76, 95% CI 1.44-5.27). Among tuberculin-positive children, low body mass index (less than 10th percentile) was associated with active disease (RR = 2.90, 95% CI 1.45-5.80). The analysis of race was unchanged after controlling for sex, body build, and level of contact with the physical education teacher. Widespread tuberculous infection resulted from contact with a highly infectious staff person. Thin body build was a risk factor for active disease. Black children were no more susceptible to infection than were white children, although they more commonly developed radiographic evidence of active disease.

Adult↗
PubMed1994

Alzheimer's disease: the impact of the family on spouses, offspring, and inlaws.

This article reports the findings from a study designed to identify qualities of the multigeneration family system that affected the relationship between the demands of Alzheimer's disease on the family and the health and well-being of (a) spouses, (b) offspring, and (c) offspring's spouses or "inlaws." Members of 97 families of patients with Alzheimer's disease, recruited from four University-affiliated Alzheimer's Centers, completed detailed questionnaires and participated in a 45-minute telephone interview to assess care-strain, personal stress, appraisals of three major domains of family life (World View, Structure/Organization, and Emotion Management), and three health and well-being indices (Anxiety/Depression, Somatic Symptoms, and Well-Being). Multivariate multiple regression equations, run separately for each of the three groups of family respondents and each of the three family domains, indicated: (1) no significant associations between the severity of the elder's disease and family member health and well-being; (2) female family members reported poorer health and well-being than male family members; and (3) caregiver strain was negatively associated with family member health and well-being. Further, appraised family qualities were associated with the health and well-being of the three groups of respondents differently: directly for offspring, interactively with severity of patient disorder for inlaws, and not at all for spouses. The data suggested that some family qualities served a protective function, whereas others exacerbated the negative effects of caregiving by affecting personal health and well-being. The findings are interpreted in terms of the different roles and expectations for care-giving placed on spouses, offspring, and inlaws. It is suggested that programs of intervention for patients with Alzheimer's and other chronic diseases should focus on the multigeneration family as the context for care, rather than only on the primary caregiver.

Activities of Daily Living↗
PubMed1994

Monoamine oxidases and alcoholism: studies in unrelated alcoholics, normal controls and alcoholic families.

Monoamine oxidases (A and B) are of great interest in connection with alcoholism. Low MAO activity has been found in the brains and the platelets of alcoholics and their relatives supporting the hypothesis that low MAO activity is a biological marker for vulnerability to misuse. In order to determine the role of the MAO genes in alcoholism we have measured MAO-B activity and typed two simple sequence repeats (one in the MAO-A gene and one in the MAO-B gene) in a sample of 133 unrelated alcoholics, 300 subjects from 30 two- and three-generation pedigrees ascertained through an alcoholic proband, and 92 normal controls. The unrelated alcoholic group did not differ in MAO-B activity from normal controls nor were there significant differences between subtypes. We did, however, find significant differences between alcoholic males and females (t = 2.836, p = .005), a difference that was not present in controls. A two-way analysis of variance of MAO-B activity as a function of the allelic variation of each marker locus and diagnosis among male subjects was performed. There was no evidence for mean differences in activity levels for different alleles. The distribution of MAO-A and MAO-B "alleles" in the alcoholic sample differed from that of the control sample. Affected sib pair linkage analysis of MAO genes and alcoholism showed no evidence for an excess of concordant affected sib pairs suggesting that this region of the X-chromosome does not harbor a susceptibility locus.

Adult↗
PubMed1993

Tachykinin receptors in the rat isolated uterus.

Tachykinin receptors mediating uterotonic effects were examined in preparations from oestrogen-primed rats. In the absence of peptidase inhibitors [Lys5-MeLeu9-Nle10] NKA (4-10) was 14-fold more potent than neurokinin A (NKA), but the two peptides were equipotent in the presence of phosphoramidon alone and in combination with amastatin. The NK-2 receptor antagonist SR 48968 antagonised responses to the tachykinins. These findings indicate that an NK-2 receptor is present in the oestrogen-primed rat uterus and that endopeptidase 24.11 plays a major role to inactivate NKA in this tissue.

Animals↗
PubMed1993

Ganciclovir prophylaxis to prevent cytomegalovirus disease after allogeneic marrow transplant.

OBJECTIVE: To study the efficacy and toxicity of ganciclovir prophylaxis given at engraftment to cytomegalovirus (CMV)-seropositive, allogeneic bone marrow transplant recipients. DESIGN: A double-blind, placebo-controlled study. SETTING: The Fred Hutchinson Cancer Research Center, a referral marrow transplant center. PATIENTS: This study was conducted from November 1990 to August 1991. Ninety-three CMV-seropositive patients were entered into the study before marrow transplant, with 64 patients randomized to receive the study drug after marrow engraftment. Thirty-one patients received placebo, and 33 received ganciclovir. The dose was 5 mg/kg body weight administered intravenously twice daily for 5 days, followed by once daily until day 100 after transplant. MEASUREMENTS: Outcome variables measured were CMV infection, monitored by weekly cultures, and neutropenia, defined as an absolute neutrophil count of 0.750 x 10(-9)/L for 2 consecutive days. Cytomegalovirus disease and mortality were secondary end points. RESULTS: Fourteen (45%) placebo recipients developed CMV infection in the first 100 days after marrow transplant compared with one (3%) ganciclovir recipient (P < 0.001). Nine (29%) placebo recipients developed CMV disease compared with no cases in the ganciclovir group during the first 100 days (P < 0.001). Neutropenia occurred in 10 ganciclovir recipients (30%) compared with no cases in the placebo group during the period of observation (P = 0.001). In a separate analysis, patients on ganciclovir who became neutropenic were at greater risk (relative risk, 4.3; P = 0.02) for bacterial infection. Mortality between the two study groups did not differ statistically at 100 and 180 days. CONCLUSION: Ganciclovir given prophylactically after engraftment is effective in suppressing CMV infection and disease. Neutropenia is an important side effect of ganciclovir use and is associated with an increased risk for bacterial infection.

Adolescent↗
PubMed1993

The Inventory of Negative Thoughts in Response to Pain: factor structure and psychometric properties in a college sample.

The psychometric properties of the Inventory of Negative Thoughts in Response to Pain (INTRP) were investigated in a sample of undergraduate students. Factor analysis identified three factors: negative self-statement, negative social cognition, and self-blame. Reliabilities of the factor scales were high. No significant gender differences were obtained on the factor scales. Correlations between the factor scales and the nine subscales of the Symptom Checklist 90R were positive and significant, except one. The results support the factor structure and reliability of the INTRP in a sample of college students.

Adaptation, Psychological↗
PubMed1993

Decreased weight gain in BB rats before the clinical onset of insulin-dependent diabetes.

Inbred specific pathogen-free diabetes-prone (DP) and diabetes-resistant (DR) BB rats were crossed to produce F1 and intercrossed to produce F2 rats. Diabetes segregates in these crosses as a recessive trait on rat chromosome 4. The weight gain of genetically diabetes-prone rats born to F1 healthy parents was studied to avoid effects of maternal diabetes. The weight gain of the F2 rats was initially not different from the F1 parents. The F2 rats later developing diabetes grew in parallel with their non-affected siblings up until the last 9 days before onset. During these 9 days they showed a decreased weight gain compared to their healthy litter-mates regardless of age. We conclude that decreased weight gain precedes the abrupt clinical onset of diabetes in BB rats and that it may be due to processes associated with the selective loss of beta cells.

Aging↗
PubMed1993

Circulating Borrelia burgdorferi in patients with acute Lyme disease: results of blood cultures and serum DNA analysis.

To determine the usefulness of blood culture and polymerase chain reaction (PCR) analysis in detecting circulating Borrelia burgdorferi or its DNA, blood and serum from untreated patients with acute Lyme disease were examined. None of the cultures of blood or serum from the 7 patients tested demonstrated spirochetes. Similarly, all patient serum samples, assayed in two laboratories, were negative for B. burgdorferi DNA using PCR amplification. These results suggest that in patients with acute Lyme disease, spirochetes, spirochete DNA, or both circulate early, only intermittently, or at low levels and that neither culture nor PCR testing of blood or serum, as currently done, appears likely to prove generally useful in the diagnosis of Lyme disease.

Acute Disease↗