Search PubMed⌕ Search

Biomedical subjects

L Fisher

Publications and source records attributed to L Fisher.

At least 127 records · Page 7Linked to original sources
PubMed1993

The California Family Health Project: VI. Multidomain analyses.

The preceding articles in this series have reported associations between each of four domains of family variables (World View, Emotion Management, Structure/Organization, Problem Solving) and the Health of adults in a community-based sample of 225 families. In this article, we explore the relationships among all four family domains (73 variables) and between all four family domains and adult Health. The results of both principal components and multidimensional scaling analyses suggested the viability of the four-family-domain framework. As expected, the pattern of relationships among the variables in each family domain was maintained when Health was added to the analyses. Using multidimensional scaling analysis, we also found that the relationship between some family domains and Health changed when viewed in the context of the other family domains. These shifts suggested the importance of family context on the relationship of that family domain and Health. Family World View and Emotion Management maintained their relationships with Health; family Structure/Organization shifted relatively moderately; and Problem Solving shifted substantially. Family World View and family Emotion Management may be relatively more independent in their relation to family member health than family Structure/Organization and Problem Solving.

Adaptation, Psychological↗
PubMed1993

The California Family Health Project: VII. Summary and integration of findings.

In a series of reports, we have observed the relationships between four domains of family life (World View, Emotion Management, Structure/Organization, Problem Solving), and the health of husbands and wives in a community-based sample of 225 families. In this final article of the series, we provide an overview and summary of the results, by gender, including the structure and patterning of variables both within each family domain and among all four family domains analyzed together. In addition, we review the associations between each family domain and adult health (unidomain analyses), and among all four family domains taken together and adult health (multidomain analyses). Prominent differences in family and health relationships based on gender are described from the perspective of socially and culturally supported sex-role expectations and behavior. The results support the use of a multidimensional family assessment framework in health research that can lead to the further development of empirically based models of family process.

Adaptation, Psychological↗
PubMed1993

Effects of intensive lipid-lowering therapy on the coronary arteries of asymptomatic subjects with elevated apolipoprotein B.

BACKGROUND: Do the benefits of intensive lipid-lowering therapy seen in symptomatic patients extend to high-risk subjects who have never had symptoms? METHODS AND RESULTS: Of 120 men completing the FATS trial, 91 were symptomatic and 29 asymptomatic. All had apolipoprotein B > or = 125 mg/dL, a positive family history, and coronary atherosclerosis. All were counseled in diet and randomized to intensive therapy: colestipol 10 g TID plus either niacin 1 g QID or lovastatin 20 mg BID or to conventional therapy: placebos, or colestipol if low-density lipoprotein cholesterol was elevated. End points included quantitative arteriographic disease change and clinical events over a 2.5-year interval. At baseline, symptomatic and asymptomatic patients had comparable risk profiles, but proximal stenosis severity averaged 36% for symptomatic and 23% for asymptomatic patients (P < .001). Among the 91 symptomatic patients, those in the intensive group experienced definite (> or = 10%S) proximal lesion progression less frequently than conventional (24% of intensive versus 48% of conventional) and definite regression more frequently (36% of intensive versus 15% of conventional) (P = .009). Similarly, among the 29 asymptomatic patients, 19% of intensive versus 38% of conventional had progression and 31% of intensive versus 0% of conventional, regression (P = .04). Ischemia on baseline exercise tolerance testing was associated with significantly greater proximal disease progression among the asymptomatic patients. Clinical cardiovascular events (death, infarction, or revascularization) occurred in 10 of 38 symptomatic patients originally assigned to conventional therapy, compared with 5 of 76 symptomatic patients assigned to intensive (P < .01); no asymptomatic patient had an event. CONCLUSIONS: Asymptomatic subjects with this high-risk profile have less coronary disease at baseline than comparable symptomatic patients, and they have an excellent short-term clinical prognosis. However, asymptomatic subjects are indistinguishable from symptomatic patients in terms of their arterial disease progression with conventional therapy and their regression with intensive. These findings may justify an active treatment strategy in such subjects, particularly those with provokable ischemia.

Adult↗
PubMed1993

B-scan ultrasonic measurement of the lumbar spinal canal as a predictor of industrial back pain complaints and extended work loss.

B-scan ultrasonic measurements of lumbar spinal canal diameter were examined as predictors of industrial back pain complaints and extended work loss. Baseline data were collected on 3,020 Washington State aircraft manufacturing workers, and over a mean 3.7-year follow-up period 352 subjects reported industrial back pain complaints. Mean canal measurements of subjects with industrial back pain complaints were smaller at all spinal levels than in subjects without complaints. The mean differences between the groups, however, were extremely small (0.07 mm to 0.51 mm), and not all levels were statistically significant. The relative risk for an L5-S1 measurement 2 standard deviations below the mean was 1.4, yet the measurement explained less than 1% of the uncertainty in predicting complaints. No association was found between canal measurements and claims with extended work loss of greater than one month. The imprecision of the measurements and poor predictive ability indicate that B-scan ultrasonography, as used in this study, is of dubious screening value.

Absenteeism↗
PubMed1993

Autologous bone marrow transplantation for acute lymphoblastic leukemia.

Between December 1979 and February 1991, 89 patients with ALL received autologous BMT. Median patient age was 18.4 years. Ten patients were in first remission, 52 were in second or greater remission and 27 were in relapse at the time of transplant. Conditioning regimens utilized chemotherapy alone (5 patients) or in combination with 10-15.75 Gy total body irradiation (84 patients). Disease-free survival at 1 year is 50% for patients transplanted in first remission, 27% for those in > or = second remission and 8% for patients in relapse. Pre- and post-transplant variables were evaluated in univariate and multivariate analyses for their effect on survival and relapse. Factors significantly associated with improved survival were being transplanted in first remission and achieving a self-sustained platelet count > or = 20 x 10(9)/l in a shorter period of time. A decreased relapse rate after transplant was associated with a lower white blood count at diagnosis, being transplanted in first remission and not being transplanted in relapse.

Adolescent↗
PubMed1993

A maximum confidence approach for measuring progression and regression of coronary artery disease in clinical trials.

BACKGROUND: Imaging trials using arteriography have been shown to be effective alternatives to clinical end point studies of atherosclerotic vascular disease progression and the effect of therapy on it. However, lack of consensus on what end point measures constitute meaningful change presents a problem for quantitative coronary arteriographic (QCA) approaches. Furthermore, standardized approaches to QCA studies have yet to be established. To address these issues, two different arteriographic approaches were compared in a clinical trial, and the degree of concordance between disease change measured by these two approaches and clinical outcomes was assessed. METHODS AND RESULTS: In the Familial Atherosclerosis Treatment Study (FATS) of three different lipid-lowering strategies in 120 patients, disease progression/regression was assessed by two arteriographic approaches: QCA and a semiquantitative visual approach (SQ-VIS). Lesions classified with SQ-VIS as "not," "possibly," or "definitely" changed were measured by QCA to change by 10% stenosis in 0.3%, 11%, and 81% of cases, respectively. The "best" measured value for distinguishing definite from no change was identified as 9.3% stenosis by logistic regression analysis. The primary outcome analysis of the FATS trial, using a continuous variable estimate of percent stenosis change, gave almost the same favorable result whether by QCA or SQ-VIS. CONCLUSIONS: The excellent agreement between these two fundamentally different methods of disease change assessment and the concordance between disease change and clinical outcomes greatly strengthens confidence both in these measurement techniques and in the overall findings of the study. These observations have important implications for the design of clinical trials with arteriographic end points.

Clinical Trials as Topic↗
PubMed1993

Use of granulocyte-macrophage colony-stimulating factor and erythropoietin in combination after autologous marrow transplantation.

The toxicities and possible utility of the combination of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) and recombinant human erythropoietin (rHuEPO) given after autologous BMT were evaluated in this pilot trial. Eighteen patients received the combination and were compared with six concurrent control and 65 historical control patients treated with rhGM-CSF alone. Patients treated with the combination tended to have more rapid recovery to an absolute neutrophil count of 500 x 10(6)/l (median = 12.5 vs 18 days for concurrent and 19 days for historical control patients). There was no apparent impact on red cell transfusion requirements, platelet recovery or duration of hospitalization. Patients treated in the current study with rhGM-CSF plus either rHuEPO or with placebo had a higher incidence of rash than seen in our historical experience using rhGM-CSF. This difference may reflect changes in the source of rhGM-CSF or in the infusion schedule. Erythropoietin can be combined safely with rhGM-CSF after autologous transplantation. Larger controlled trials will be necessary to detect possible therapeutic effects.

Adolescent↗
PubMed1992

Human general transcription factor IIH phosphorylates the C-terminal domain of RNA polymerase II.

Phosphorylation of the carboxy-terminal domain of the largest subunit of RNA polymerase II is believed to control the transition from transcription initiation to elongation. The general transcription factor IIH (TFIIH) contains a kinase activity capable of phosphorylating this domain. Factors that promote the association of RNA polymerase II with the preinitiation complex stimulate this activity. The transcription factor IIE, which is required for the stable association of TFIIH with the preinitiation complex, affects the processivity of TFIIH kinase.

Adenosine Triphosphate↗
PubMed1992

Effectiveness of once-daily monotherapy with a new nifedipine sustained release calcium antagonist.

Data from 2 separate multicenter, double-blind clinical studies following the same protocol, except for the selection of doses, were pooled to evaluate the efficacy and tolerability of fixed doses of a new sustained-release (SR) formulation of nifedipine compared with placebo in 388 patients with mild to moderate uncomplicated essential hypertension. After a 3-6 week placebo washout period, the patients were randomized to receive either placebo or nifedipine SR-20 mg (study I only), 50 mg, 100 mg, or 150 mg (study II only). Among the 278 patients who completed 6 weeks of active therapy, mean supine diastolic blood pressure reductions from pretreatment baseline were 5.9, 9.3, 9.2, 11.1, and 13.2 mm Hg in the placebo, 20-, 50-, 100-, and 150-mg groups, respectively. The reductions achieved in each of the nifedipine SR groups were statistically significant versus baseline values (p less than 0.001). All nifedipine-SR doses reduced supine systolic blood pressure significantly more than placebo (p less than 0.001). In addition, there was a significant linear relationship between the log of the dose and the blood pressure reduction (p less than 0.05). Automated ambulatory blood pressure recordings performed in 221 of the patients showed that the blood pressure was lowered evenly through the entire 24-hour dosing period. The doses that were effective and associated with the fewest adverse reactions were 20 mg and 50 mg once daily.

Adult↗
PubMed1992

Immunohistochemical localization of PGF2 alpha receptor in the rat ovary.

As a step towards understanding the role of prostaglandin F2 alpha (PGF2 alpha) in ovarian function, a rabbit antiserum against purified PGF2 alpha receptor (PGF2 alpha-R) was produced. This report details the use of this antiserum in immunohistochemical staining of ovaries of non-pregnant and pregnant rats to ascertain which cell types, in vivo, possess PGF2 alpha-R. In non-pregnant rats, three ovarian cell subpopulations contain immunoreactive PGF2 alpha-R. These include: a subpopulation of the cells found in corpora lutea, a subpopulation of the thecal cells surrounding secondary and mature (Graafian) follicles, and a subpopulation of primary and secondary interstitial cells. The ovarian tissues and cell types in which immunoreactive PGF2 alpha-R cannot be demonstrated include: the serosa overlying the ovary and its vessels, the coelomic epithelium and its underlying cortical stroma, medullary stroma and vessels, granulosa cells of primary, secondary and mature follicles, the oocyte, and the blood vessels and stroma within corpora lutea. PGF2 alpha-R immunohistochemical staining of corpora lutea from non-pregnant animals was examined both prior to the start of luteolysis and during luteolysis. During luteolysis, cells undergoing apoptosis stained for the presence of PGF2 alpha-R. PGF2 alpha-R immunohistochemical staining was also examined in corpora lutea during pregnancy and until 4 days postpartum. The major findings here were the apparent large increase in staining intensity of granulosa-lutein cells during pregnancy, and the loss of PGF2 alpha-R immunopositivity of the granulosa-lutein cells during the postpartum period. In summary, three ovarian cell subpopulations, all of which can secrete steroids, possess immunoreactive PGF2 alpha-R.

Animals↗
PubMed1992

The California Family Health Project: I. Introduction and a description of adult health.

Little research has addressed patterns of family and health relationships that reflect both the scope and complexity of family life and the breadth and diversity of health. In the first of a series of articles, we describe the California Family Health Project, a study in which four large "domains" of family life (Structure/Organization, World View, Problem Solving, and Emotional Management) were mapped, described, and compared with a large battery of adult health measures. We first present a brief critical overview of the literature on family and health research, then explain our rationale, define our approach to the multivariate analysis of family and health data, and describe our sample of 225 community-based families. To prepare for analyses with the family variables, we next present descriptive data based on separate principal components analysis (PCA) and multidimensional scaling analysis (MDS) of 14 self-reported health scores for husbands and for wives. No grouping or clustering of health variables emerged for either husbands or wives in the PCAs. A two-dimensional MDS analysis for husbands and for wives displayed the health variables in a circular pattern in which no predominant descriptive dimension or group of discrete dimensions emerged. Consequently, we decided that all 14 health scores will be used in the analyses, with the family variables to follow.

Adult↗
PubMed1992

The California Family Health Project: II. Family world view and adult health.

This article explores the pattern of relationships between family World View and adult Health in a community-based sample of 225 families. Family World View refers to the beliefs, appraisals, and values that define a family's orientation to the world. The interrelationships among eight self-reported family World View variables are described, using principal components analyses (PCA) and multidimensional scaling analyses (MDS). Derived, joint-spouse World Views also are examined using inter-battery factor analysis. The World View variables then are analyzed as a set with 14 self-reported health variables for husbands and wives separately, using canonical correlation. The PCAs for family World View yielded poor solutions for both husbands and wives. The MDS displayed the eight variables in a circular pattern for husbands and for wives, indicating the absence of a single broad dimension, or subgroupings of separate dimensions, that could be used to "describe" the domain. In the canonical analyses, family World View was a strong correlate of Health, with approximately 50% of the variance accounted for by the respective canonical variates. For husbands, what we called Family Coherence, Family Religiousness, Family Life Engagement, and Family Optimism, were correlated with Health. For wives, Family Coherence, Family Religiousness, and Family Optimism, were correlated with Health. Different patterns of health scores emerged by gender, with behavioral indicators, such as Smoking and Drinking, more salient for husbands, and mood indicators, such as Anxiety and Depression, more salient for wives.

Adult↗
PubMed1992

The California Family Health Project: III. Family emotion management and adult health.

This article explores the broad patterning of interrelationships between family Emotion Management and adult Health in a community-based sample of 225 families. Emotion Management refers to how emotion is expressed, acknowledged, and managed by the marital partners. Fifteen reliable-observer ratings of husband-wife behavior were made during each of three 10-minute Emotion Management Interaction Tasks (EMITs). Each of the three tasks "pulled" for the expression of a different emotional theme: loss, intimacy, or conflict. A principle components analysis of the 15 ratings yielded a poor solution. A nonmetric, multidimensional scaling analysis described a two-dimensional, bipolar display with ordering among the variables in each of two wings. One dimension reflected positive versus negative Emotion Management characteristics, and the second reflected active and overt versus passive or covert emotional expression. The pattern of relationships among the couple ratings was similar for each of the three tasks. Using canonical correlation, the couple ratings demonstrated significant associations with 14 adult Health scores for both husbands and wives for the intimacy and conflict tasks, but not for the loss task. Specific gender patterns also emerged. In general, couple overt emotional aversiveness was negatively associated with husbands' health, and couple emotional avoidance/distance was negatively associated with wives' health.

Adult↗
PubMed1992

The California Family Health Project: IV. Family structure/organization and adult health.

This research explores the relationships between each of four "domains" of family life and the health of husbands and wives in a community-based sample of 225 families. In this article we report the association between Family Structure/Organization and adult Health. This family domain refers to the architecture of the family or the structural frame of roles and rules within which the family operates. Interrelationships among 13 self-reported, family Structure/Organization scales are described, using principle components analysis (PCA) and multidimensional scaling analysis (MDS). Derived, joint-spouse or couple Structure/Organization variables also were created using inter-battery factor analysis. The PCA yielded a poor solution, whereas the MDS yielded a good two-dimensional solution, which roughly displayed the scales in a circular pattern for both husbands and wives. The analyses indicated that no single dimension or set of separate subdimensions adequately described the Structure/Organization variables. All 13 scales than were associated with a battery of 14 adult health scales for husbands and wives separately, using canonical correlation. Different aspects of family Structure/Organization were correlated with health for husbands and wives: Organized Cohesiveness, Sex Role Traditionalism, Role Flexibility and Shared Roles for husbands; and Organized Cohesiveness and Differentiated Sharing for wives. Different patterns of health scores also emerged by gender, with behavioral indicators, such as Smoking and Drinking, more salient for husbands, and mood indicators, such as Anxiety and Depression, more salient for wives.

Adult↗
PubMed1992

The California Family Health Project: V. Family problem solving and adult health.

This article explores the relationship between family Problem Solving and the Health of adults in a community-based sample of 225 families. Family Problem Solving refers to the ways in which the family conducts itself to resolve a shared problem. Sixteen observer ratings of family Problem-Solving behavior during a 30-minute task were developed, based on the Simulated Family Activity Measure (SIM-FAM), and good interrater agreement was achieved. Principal Components Analysis (PCA) yielded a set of three well-constructed, interpretable dimensions: Problem-Solving Effectiveness, Problem-Solving Style, and Sociomotor Activity. Multidimensional scaling analyses (MDS) suggested that family problem-solving behavior involved an organized, means-end sequence of family behaviors in which aspects of style served problem-solving effectiveness. All 16 Problem-Solving variables were analyzed with a set of 14 health variables, for husbands and wives separately, using canonical correlation. No subset of Problem-Solving variables was significantly associated with a subset of Health variables for either husbands or wives, although there was a significant association between the two sets of variables when taken as a whole. Given previous research on family Problem Solving, we conclude that the absence of significant associations between particular aspects of family Problem Solving and Health may be due to our use of a community-based rather than a stressed or clinical sample. Associations between Family Problem Solving and Health might best be viewed in the context of other family variables.

Adult↗
PubMed1992

Predictive value of pulmonary function tests before marrow transplantation.

OBJECTIVE: To evaluate association between pulmonary function tests (PFT) performed before marrow transplantation and mortality after transplant. SETTING: A single marrow transplantation research center. DESIGN: Case-series review. PATIENTS: All patients between January 1986 and July 1990 who performed PFT before a first marrow transplant for the treatment of malignancy (n = 1297) were included in study. Six hundred twenty-eight (48 percent) patients had morphologically or cytologically active malignant neoplasms at the time of transplant. Allogeneic marrow transplants were performed in 1,056 (82 percent) and autologous transplants were performed in 235 (18 percent). Three hundred seventy-two (29 percent) patients received HLA-nonidentical donor marrow. Graft-vs-host disease prophylaxis was methotrexate and cyclosporine in 901 (85 percent) of the allogeneic recipients. Most patients were prepared for transplant with total body irradiation in addition to cyclophosphamide (n = 1,059, 82 percent), while 230 (18 percent) were conditioned with busulfan and cyclophosphamide. MEASUREMENTS AND MAIN RESULTS: The overall mortality during the first six months of follow-up was 44 percent. Respiratory failure requiring assisted mechanical ventilation occurred in 23 percent (n = 298) of patients. A proportional hazards regression analysis was used to evaluate the predictive value of PFT results: (1) FEV1/FVC; (2) P(A-a)O2 gradient; (3) TLC; and (4) Dcosb (the latter two presented a percent of predicted). Abnormalities in TLC, Dcosb, and P(A-a)O2 were found to be significantly associated with death in univariate analysis. Next, the value of PFT for prediction above and beyond other baseline covariates was evaluated by first using the step-up stepwise proportional hazards model to select predictive variables other than the PFT variables. Then each of the PFT variables was tested in the presence of these other variables. The factors of age, primary diagnosis, relapse status, and donor-recipient HLA nonidentity were found to be risks for death and were entered as covariates. Each of the variables of PFT were entered stepwise into the model. Dcosb (RR = 1.43 for a value 80 percent of predicted) and P(A-a)O2 (RR = 1.28 for a value of 20 mm Hg) were found to be independent risk factors for death. The use of assisted mechanical ventilation appeared to increase proportionately with the increase in mortality among patients with abnormal Dcosb or P(A-a)O2. CONCLUSIONS: Decreased Dcosb and increased P(A-a)O2 gradient before marrow transplant carry significantly increased risk of death after marrow transplant. The risk associated with abnormal PFT is less than that associated with other recognized risk factors, such as relapse status and donor-recipient HLA nonidentity. Respiratory failure does not appear to account entirely for the increased mortality associated with abnormal pretransplant PFT. PFT should be used in assessing fully the risks to recipients of marrow transplants for malignancy, but should not be used as absolute exclusion criteria for transplantation.

Adolescent↗