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Biomedical subjects

L Fletcher

Publications and source records attributed to L Fletcher.

At least 37 records · Page 2Linked to original sources
PubMed2001

Weight loss and gender: an examination of physician attitudes.

OBJECTIVE: The purpose of this study was to investigate physician attitudes toward the treatment of overweight and obese individuals and to evaluate potential gender differences in treatment recommendations. RESEARCH METHODS AND PROCEDURES: A survey describing several hypothetical patients was sent to 700 randomly selected physicians; 209 (29.9%) returned the survey. Two versions of the questionnaire (one for men and one for women) described three hypothetical patients at three levels of body mass index (BMI) (32, 28, and 25 kg/m(2)). One-half of the physicians received a version of the questionnaire describing the patients as women, and one-half received a version describing the patients as men. Respondents answered questions about attitudes toward treatment and specific interventions and referrals they would view as appropriate. RESULTS: Physicians were more likely to encourage women with a BMI of 25 kg/m(2) to lose weight than men with the same BMI, and indicated that they would suggest more treatment referrals for women than men. Men with a BMI of 32 kg/m(2) were more likely to be encouraged to lose weight than women with the identical BMI. Physicians were more likely to encourage weight loss and see treatment referrals as appropriate for patients with higher BMIS: DISCUSSION: This study indicates that physicians treat male and female patients differently, with physicians more likely to encourage weight loss and provide referrals for women with a BMI of 25 kg/m(2) than for men with an identical BMI and less likely to encourage weight loss for women than men with a BMI of 32 kg/m(2).

Adult↗
PubMed2001

Estimating health needs: the impact of a checklist of conditions and quality of life measurement on health information derived from community surveys.

BACKGROUND: Prevalence estimates of chronic disease vary according to the technique used. Questionnaire surveys may be susceptible to inaccuracies, which may be overcome by addition of a checklist of conditions. This paper presents SF-36 scores and NHS consultation rates for people reporting individual chronic diseases or disabilities in two questionnaire surveys, one of which employed a checklist and one of which did not. We aimed to document differences in estimates of disease prevalence, and to determine whether or not subjective impact on quality of life is the same in people recruited by a checklist as in those who volunteer that they have a chronic disease or disability without the prompt of a checklist. We use these data to estimate the contribution that different chronic diseases and disabilities make to the burden of disease in the community. METHODS: Data were collected in two postal questionnaire surveys conducted in 1991 and 1997 with response rates of 72 per cent and 64 per cent. Both questionnaires included a question on long-standing illness, disability or infirmity, together with the SF-36 health status measure. Respondents to the 1991 survey were asked to specify their illness in a free text response, whereas the 1997 survey offered a checklist of conditions. Prevalence rates of each condition were calculated, together with an 'escalation factor' representing the increase in reporting of specific diseases between the surveys. SF-36 domain and component summary scores were calculated overall and for the groups reporting individual chronic diseases or disabilities. Disease-specific NHS consultation rates were calculated for both surveys. RESULTS: The overall reported rate of chronic disease and disability increased from 28 per cent in 1991 to 42 per cent in 1997. Reported levels of mental health problems and of conditions with a perceived psychosomatic element increased substantially, whereas rates of well-defined conditions were similar. The pattern of SF-36 scores for those reporting chronic disease or disability was similar in the two surveys in spite of very different prevalence rates, and respondents reporting chronic disease had similar levels of health service use. This suggests that they were reporting conditions with similar levels of impact on quality of life. Heart disease, arthritis and mental health problems had the greatest impact on quality of life, and asthma and hypertension the least. CONCLUSIONS: Evidence from SF-36 scores and NHS consultation rates suggests that addition of a checklist of conditions to this community health survey encouraged reporting of illnesses by the genuinely ill and not merely by those who are less severely affected by their disease. This method appears to give a more accurate reflection of health needs than information derived from routine data sources. The combination of prevalence data combined with subjective assessment of quality of life allows an alternative perspective of health needs. This approach highlights the relative importance of musculo-skeletal problems, particularly back pain, and mental health problems to the burden of disease, and the relative lack of importance of conditions such as asthma. It presents a contrast to studies based on other methods of health needs assessment.

Adult↗
PubMed2001

The relative efficacy of fluoxetine and manual-based self-help in the treatment of outpatients with bulimia nervosa.

A randomized, placebo-controlled study was conducted examining the singular and combined effects of fluoxetine and a self-help manual on suppressing bulimic behaviors in women with bulimia nervosa. A total of 91 adult women with bulimia nervosa were randomly assigned to one of four conditions: placebo only, fluoxetine only, placebo and a self-help manual, or fluoxetine and a self-help manual. Subjects were treated for 16 weeks. Primary outcome measures included self-reports of bulimic behaviors. Fluoxetine and a self-help manual were found to be effective in reducing the frequency of vomiting episodes and in improving the response rates for vomiting and binge-eating episodes. Furthermore, both factors were shown to be acting additively on the primary and secondary efficacy measures in this study. Results are discussed in relation to previous research and the implications for treatment of bulimia nervosa.

Adolescent↗
PubMed2001

Congestive heart failure: understanding the pathophysiology and management.

PURPOSE: To explain key concepts involved in the development and management of congestive heart failure (CHF). An overview of medications commonly used in the treatment of CHF is also presented. DATA SOURCES: Selected clinical articles, major research studies, and clinical guidelines. CONCLUSIONS: The prevalence of CHF continues to increase and in the United States alone accounts for more than two million outpatient clinic visits per year at a cost of more than $10 billion annually. With the growing number of people over age 65, coupled with the advances in medical technology, primary care providers are treating many more patients with CHF. IMPLICATIONS FOR PRACTICE: A thorough understanding of the pathophysiology, especially the compensatory neurohormonal systems and ventricular remodeling that are the hallmarks of CHF, is essential for consistent application of the principles of management of this complex condition. Multidisciplinary approaches led by advanced practice nurses have excellent outcomes and improve the quality of life of patients with CHF.

Aged↗
PubMed2000

A mathematical model for assessing changes in neurofilament protein levels in neurites and cell bodies of differentiating neuroblastoma cells.

A mathematical model which allows the calculation of the level of neurofilament protein in the cell body (x) and in the neurites (y) of differentiating SK-N-SH cells is presented. The model considers the changes in cell number (proliferating cells) and the number of cells with neurites (differentiating cells). It takes into account the fact that (i) when cells are cultured in differentiating conditions, an increase in cell number is initially observed and (ii) in a non-synchronized population of differentiating cells, the length of neurite extended by individual cells varies within the population. Total neurofilament protein levels in a population of cells were measured by enzyme-linked immunoabsorbant assay and application of the model to the data allowed values for x and y to be calculated. The validity of the model is supported by the fact that the predicted total neurofilament protein levels are highly correlated with the experimentally derived neurofilament protein levels. The model should be of use in temporal studies of cytoskeletal proteins involved in neuronal growth/differentiation and also in studies in which the system is a target of toxic insult.

Cell Differentiation↗
PubMed1999

Endurance training reduces the rate of diaphragm fatigue in vitro.

PURPOSE: The present study examined the effects of endurance training on the contractile and biochemical properties of the rat costal diaphragm in vitro. METHODS: Sixty-four rats were divided into two groups: exercise trained (T) and control (C). Training consisted of treadmill running 5 d x wk(-1), 60 min x d(-1) at approximately 70% of VO2max, over a 10-wk period. RESULTS: Control diaphragm strips produced an average of 12% less force from minute 15 to 50 of a 60-min in vitro fatigue protocol, compared with the T diaphragm strips (P < 0.01). T diaphragms had 10.1% higher citrate synthase (CS) and 12.1% higher superoxide dismutase (SOD) activities compared with the C (P < 0.05). Despite a significant decrease (P < 0.05) in Type IIb myosin heavy chains (MHC) and an increase (P < 0.05) in Type I MHC in T diaphragms, maximal shortening velocity (Vmax) in the diaphragm was not different between T and C animals. No differences were observed in specific force or the relative proportions of myosin light chains between groups. CONCLUSIONS: These findings suggest that endurance training reduces the rate of diaphragm fatigue in vitro but has no effect on Vmax or specific force.

Animals↗
PubMed1997

Bioenergetic characteristics of the costal and crural diaphragm in mammals.

These experiments compared oxidative and glycolytic enzyme activity in the costal and crural diaphragm in seven adult mammals (mouse, rat, rabbit, ferret, sheep, pig, cow) ranging in body mass from approximately 0.03 to 422 kg. Segments of the costal and crural diaphragm from the aforementioned species were homogenized to determine the activities of the glycolytic enzyme, lactate dehydrogenase (LDH), and the Krebs cycle enzyme, citrate synthase (CS). The results indicated that metabolic differences between the costal and crural diaphragm do not exist in all mammalian species. Specifically, CS activity differed (P < 0.05) between the costal and crural diaphragm (costal approximately 36% greater than crural) in only two species (rat and rabbit). Further, the oxidative capacity of the costal and crural diaphragm was significantly correlated with both breathing frequency and resting metabolic rate (r = 0.92 - 0.57; P < 0.05) across the species investigated. In contrast, glycolytic capacity was not significantly correlated (P > 0.05) with either breathing frequency or resting metabolic rate.

Animals↗
PubMed1997

Memories are made of this: the genetic basis of memory.

Total amnesia is rare, but we face an 'epidemic' of memory loss. At present there are around 18 million people worldwide with Alzheimer's disease, and this figure is predicted to double in the next 25 years. While traditional clinical and experimental studies have elucidated much about the basic processes of memory and learning, modern genetic techniques. Only time will tell whether this knowledge will yield preventive or curative therapy for memory loss.

Alzheimer Disease↗
PubMed1997

Myosin phenotype and bioenergetic characteristics of rat respiratory muscles.

These experiments examined the myosin phenotype and bioenergetic enzyme activities in rat respiratory muscles. Muscle samples were removed from adult female Sprague-Dawley rats (N = 8) and analyzed to determine the myosin heavy chain (MHC) and light chain (MLC) isoform content as well as the activities of myofibrillar ATPase (mATPase), citrate synthase (CS; Krebs cycle enzyme), and lactate dehydrogenase (LDH; glycolytic enzyme). Analysis revealed that CS activity and the % type I MHC and %IId MHC isoforms were greater in the costal diaphragm (CO-D) compared with those in the crural diaphragm (CR-D). In contrast, the % type IIb MHC was higher in the CR-D compared with that in the CO-D. LDH and mATPase activity were lower in both the CO-D and CR-D compared with that in the parasternal intercostals (PI), external intercostals (EI), internal intercostals (II), rectus abdominis (RA), and sternomastoid (SM) muscles. CS activity, % type I MHC, %IIa MHC, and the ratio of slow to total alkali MLC (1s/1s + 1f + 3f) were greater in the CO-D and CR-D compared with those in all other respiratory muscles. The RA contained the highest (P < 0.05) % type IIb MHC and lowest CS activity compared with that in all other muscles. Finally, CS activity, mATPase activity, and MHC phenotype did not differ among the PI, EI, II, and SM muscles. These differences in biochemical properties provide the muscles of the respiratory pump with great versatility in functional properties.

Adenosine Triphosphatases↗