Search PubMed⌕ Search

Biomedical subjects

L Jack

Publications and source records attributed to L Jack.

17 recordsLinked to original sources
PubMed2006

Effectiveness of community health workers in the care of persons with diabetes.

AIMS: The purpose of this systematic review was to examine the effectiveness of community health workers in supporting the care of persons with diabetes. METHODS: Computerized searches were conducted of multiple electronic bibliographic dababases until March 2004. We identified studies in any language and of any design that examined the effectiveness of diabetes-related interventions involving community health workers and reported outcomes in persons with diabetes. Results were synthesized narratively. RESULTS: Eighteen studies were identified, including eight randomized controlled trials. Most studies focused on minority populations in the USA. The roles and duties of community health workers in diabetes care were varied, ranging from substantial involvement in patient care to providing instrumental assistance in education sessions taught by other health professionals. Participants were generally satisfied with their contacts with community health workers and participant knowledge increased. Improvements in physiological measures were noted for some interventions and positive changes in lifestyle and self-care were noted in a number of studies. There were few data on economic outcomes, but several studies demonstrated a decrease in inappropriate health care utilization. CONCLUSIONS: Diabetes programmes include community health workers as team members in a variety of roles. There are some preliminary data demonstrating improvements in participant knowledge and behaviour. Much additional research, however, is needed to understand the incremental benefit of community health workers in multicomponent interventions and to identify appropriate settings and optimal roles for community health workers in the care of persons with diabetes.

Community Health Services↗
PubMed2005

The effectiveness of family interventions in people with diabetes mellitus: a systematic review.

AIMS: To conduct a systematic review of reports of published literature to assess which family interventions are effective in improving diabetes-related outcomes in people with diabetes and family members (blood or non-blood relatives) residing in their homes. METHODS: We searched computerized bibliographic databases (MEDLINE, EMBASE, PsycINFO, CINAHL, WOS, ERIC, Cochrane, CDP, and SocAbs) for randomized clinical trials published in any language that evaluated the effectiveness of family-based interventions with no age restriction. Only studies focused on interventions in young populations (< 18 years) and involving a parent were combined in a meta-analysis for glycated haemoglobin (GHb) using DerSimonian and Laird random effects model. Effect sizes for knowledge outcomes were estimated using the Cohen's d (standardized mean differences) formula. RESULTS: Our searches identified 19 randomized controlled trials. Positive effect sizes of family interventions on knowledge for five studies (N = 217) were demonstrated {0.94 [95% confidence interval (CI) 0.67, 1.82]}. A beneficial effect of interventions on GHb for eight studies (N = 505) was also observed using meta-analysis [-0.6 (95% CI -1.2, -0.1)]. CONCLUSIONS: Evidence suggests that family interventions in family or household members of people with diabetes may be effective in improving diabetes-related knowledge and glycaemic control.

Adult↗
PubMed2000

Health care reform in Oregon: the impact of the Oregon Health Plan on utilization of mammography.

BACKGROUND: In 1994, Oregon implemented the Oregon Health Plan (OHP), extending health care coverage under a system of capitated managed care to uninsured citizens living below the Federal Poverty Level (FPL). We conducted a study to measure receipt of clinical preventive services among women newly enrolled in the OHP. METHODS: Six hundred and sixty six women aged 52-64, and living below the FPL in Oregon were randomly selected from OHP enrollment rosters and interviewed by telephone. A follow-up survey was conducted 1 year later. The main outcome of interest was receipt of a screening mammogram during the first year in the OHP. RESULTS: At enrollment 17% (65/383) of participants had never had health care coverage. Sixty-six percent of the women (220/333) were overdue for a mammogram. Fifty-five percent (121/220) reported cost as the main reason they had not had this procedure. Mammography rates doubled under the OHP (21% to 52%, 95% CI = 0.25-0.38, p < 0.001). Among women who were overdue for a mammogram at the time they enrolled, an expressed plan to get a mammogram (OR3.0, 95% CI = 1.1-8.7, p = 0.04), citing cost as the main reason for being overdue (OR3.0, 95% CI = 1.3-7.2, p = 0.014), receipt of a routine checkup (OR9.5, 95%CI = 3.7-24.9, p < 0.001), and health care provider's (HCP's) recommendation for mammography (OR8.1,95% CI = 2.9-23.0, p < 0.001) were independently associated with receipt of a mammogram. CONCLUSION: The OHP enrolled and successfully delivered clinical preventive services to a medically under served population. Even after removing the financial barrier, obstacles to mammography remain. These may be overcome by health systems changes to insure receipt of routine checkups and appropriate provider recommendations.

Female↗
PubMed1999

Predictors of brain morphology for the men of the NHLBI twin study.

BACKGROUND AND PURPOSE: Cross-sectional studies show that cerebrovascular risk factors are associated with increased brain atrophy, accumulation of abnormal cerebral white matter signals, and clinically silent stroke. We extend these findings by examining the relationship between midlife cerebrovascular risk factors and later-life differences in brain atrophy, amount of abnormal white matter, and stroke on MRI. METHODS: Subjects were the 414 surviving members of the prospective National Heart, Lung, and Blood Institute Twin Study, who have been examined on 4 separate occasions, spanning the 25 years between 1969-1973 and 1995-1997. Quantitative measures of brain volume, volume of abnormal white matter signal (WMHI), and volume of stroke, when present, were obtained from those participating in the fourth examination. RESULTS: The mean+/-SD age of the subjects was 47.2+/-3.0 years at initial examination and 72. 5+/-2.9 years at final examination. Average blood pressure (BP) levels were normal, although 32% of the subjects had received or were currently taking antihypertensive medications. As a group, 31% had symptomatic cardiovascular disease, 11% had symptomatic cerebrovascular disease, and 8% had symptomatic peripheral vascular disease. Both systolic and diastolic BP levels at initial examination were inversely related to brain volume and positively related to WMHI volume. Multiple regression analysis identified BP-related measures and vascular risk factors as significant predictors of brain and WMHI volumes. In addition, the magnitude of orthostatic BP change was significantly associated with WMHI volume. Subjects with extensive amounts of WMHI had significantly higher systolic BP at the final examination and a higher prevalence of symptomatic cardiovascular and cerebrovascular disease, without significant differences in the prevalence of hypertension treatment. CONCLUSIONS: Midlife BP measures are significantly associated with later-life brain and WMHI volumes and the prevalence of symptomatic vascular disease. Since WMHI share cerebrovascular risk factors and extensive WMHI are associated with symptomatic vascular disease, extensive WMHI may be a subclinical expression of cerebrovascular disease. Careful treatment of midlife BP elevations may diminish these later-life brain changes.

Age Factors↗
PubMed1994

The implementation of a quality management system in a department of diagnostic radiology.

The quality management systems of the Departments of Diagnostic Radiology of St George's Hospital, London, and Bristol Royal Infirmary (BRI) have been certified with the British Standard 5750. These were the first clinical departments in the UK to be certified to this internationally recognized quality assurance (QA) standard. Quality is a much used term; in this context it is defined as 'fitness for purpose', and quality assurance is the mechanism by which quality is achieved. The paper describes the features of the quality system which have been implemented at St George's Hospital, and how a management concept for manufacturing industries has been adapted successfully to a National Health Service Department. The paper also demonstrates how the quality system has led to the setting and achieving of departmental objectives.

England↗
PubMed1994

Activation dependent and independent VLA-4 binding sites on vascular cell adhesion molecule-1.

Vascular cell adhesion molecule-1 (VCAM) is a cytokine-inducible member of the immunoglobulin superfamily which binds to the integrin VLA-4. VCAM is expressed predominantly on the vascular endothelium where it is involved in the recruitment of mononuclear cells and lymphocytes to sites of inflammation. Two forms of VCAM containing six and seven Ig domains (VCAM-6d; VCAM-7d) are generated by alternative splicing but the physiological significance of this is unknown. We have utilised VCAM deletion mutants, VCAM-transfected cell lines and monoclonal antibodies to assess the functional importance of the individual VCAM domains. We have identified two binding sites on VCAM-7d located in domains 1 and 4 that are involved in the adhesion of the U937 human myelomonocytic cell line. Adhesion to domain 1 is temperature-independent, inhibited by the anti-VCAM mAbs 4B2 or lE10, and insensitive to PMA activation. In contrast, adhesion to domain 4 is temperature sensitive, unaffected by mAbs 4B2 or lE10 and augmented by PMA. Adhesion to both domains can be totally inhibited by the anti-VLA-4 mAb, 2B4. The anti-VCAM mAb 4B2 inhibits adhesion of U937 cells to stably transfected VCAM-7d-CHO cells at 4 degrees C, but, at 37 degrees C the effect of 4B2 on adhesion is modest with incubation times of less than 60 minutes duration. With longer incubation times, its effectiveness gradually increases, so that by 2 hours > 75% of the response can be blocked. Co-incubation with PMA prevents this time-dependent enhancement of 4B2 efficacy but has no significant effect on the inhibitory activity of the anti-VLA-4 mAb 2B4. These data can be explained by postulating a two stage ligand-receptor interaction that involves activation-induced changes in the avidity of VLA-4 for domain 4 of VCAM.

Alternative Splicing↗
PubMed1994

Children from alcoholic families--a population at risk.

This article focuses on children of alcoholics as a population at risk, and discusses strategies for assessment and intervention by school nurses. Information about alcohol abuse and the effects of problem drinking on children is provided. Case history examples will offer additional illustration, with resiliency being highlighted.

Adolescent↗
PubMed1988

Structure and expression of the guinea-pig alpha-lactalbumin gene.

The entire guinea-pig alpha-lactalbumin gene was isolated from a genomic DNA library constructed in the bacteriophage lambda L47. The complete nucleotide sequence of the gene and its immediate 5' and 3' flanking sequences were determined and compared with those of the human and rat alpha-lactalbumin genes. This demonstrates that the size, organization and sequence of the exons is highly conserved between species, and reveals the presence of the highly conserved potential regulatory 'milk box' consensus sequence [RGAAGRAAA(N)TGGACAGAAATCAA(CG)TTTCTA] between positions -140 and -110 relative to the transcriptional start point. A guinea-pig LINE repeat sequence was also present in the 5' flanking region between positions -520 and -1195. Transfection of the alpha-lactalbumin gene cloned in a bovine papilloma virus vector into the mouse C127 and human MCF-7 mammary tumour cell-lines gave rise to stable but seemingly constitutive expression of alpha-lactalbumin. Expression was from the correct transcriptional start point, resulting in the accumulation of correctly processed mRNA and the secretion of alpha-lactalbumin into the culture medium.

Animals↗
PubMed1986

Micro-scale ultracentrifugation as an alternative to ultrafiltration for the determination of the unbound fraction of phenytoin in human serum.

Free phenytoin has been determined using micro-scale ultracentrifugation followed by analysis by EMIT. The effect of temperature on the determined free fraction was investigated and the ultracentrifugation procedure validated against ultrafiltration. Ultracentrifugation gave free fractions which were on average 16% lower than those obtained using ultrafiltration, but correlation was good, as was the correlation with measurements of total phenytoin (r = 0.90). Micro-scale ultracentrifugation is a simple procedure which can be of great utility in the measurement and investigation of free drug levels.

Blood Proteins↗
PubMed1985

The value of the Radial Head-Capitellum view in radial head trauma.

The value of the Radial Head-Capitellum view has been assessed in a series of 28 consecutive cases of radial head fracture. Additional useful information was obtained in 21% of cases. The Radial Head-Capitellum view may be a valuable additional view in assessing radial head trauma.

Clinical Trials as Topic↗
PubMed1981

Baby talk.

Explore the source record for details and available documents.

Aged↗
PubMedDate not supplied

Impaired student performance in the clinical setting. A constructive approach.

A challenge for even the most seasoned faculty member is dealing with a student who arrives for clinical experience in an impaired state. Little guidance is available for faculty regarding protocol for the immediate removal of an unfit student from the clinical setting or for subsequent actions aimed at helping the student constructively address the problem. The authors provide guidance to faculty for the development of a policy to address issues pertaining to the impaired student.

Absenteeism↗
PubMedDate not supplied

Heuristic model linking contextual processes to self-management in African American adults with type 2 diabetes.

PURPOSE: This article examines the influence of various environmental factors on the diabetes self-care practices of African American adults with type 2 diabetes. METHODS: A heuristic model was developed that considers how community barriers and supports, availability and use of insurance, diabetes education, medical provider-patient relationships, extended family processes, and psychological functioning may indirectly affect metabolic control through the patient's ability to regulate diabetes. RESULTS: The proposed model offers a framework to demonstrate the complexity of diabetes management that may be unique to the African American experience. CONCLUSIONS: A comprehensive view of the environmental context will lead to new and more effective approaches in diabetes education and counseling for African American adults with type 2 diabetes.

Black or African American↗
PubMedDate not supplied

Body size and body shape: perceptions of black women with diabetes.

PURPOSE: This qualitative study was conducted to explore perceptions of body size and shape in a group of black women with Type 2 diabetes. METHODS: Thirty-three black women with Type 2 diabetes participated in one of three focus groups to discuss perceptions about body size and body shape. Transcriptions of the discussion were analyzed for themes of participants' perceptions about their bodies, their ideas about body size and body shape, and personal and environmental influences on their preferences about size and shape. RESULTS: Participants preferred a middle-to-small body size but indicated that a middle-to-large body size was healthier. They also said that a large body size did result in some untoward social consequences. Participants preferred a pear-shaped body (a figure without abdominal adiposity). The three major influences on body image perceptions were children, parents, and the media. CONCLUSIONS: With these findings in mind, diabetes education programs that are geared for black women may benefit from the inclusion of key family members. Additionally, the importance of body image perceptions should be recognized in the design and implementation of weight-related diabetes education programs.

Adult↗