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Biomedical subjects

L K Brown

Publications and source records attributed to L K Brown.

At least 19 recordsLinked to original sources
PubMed2003

Pulmonary involvement in type 1 Gaucher disease: functional and exercise findings in patients with and without clinical interstitial lung disease.

Pulmonary disease is a well-known complication of Type 1 Gaucher disease (GD), although its incidence is not well established and its severity varies. The purpose of this study was to determine the frequency and extent of pulmonary involvement in patients with GD. Pulmonary involvement was assessed by history, physical examination and chest radiograph in 150 consecutive patients with Type 1 GD presenting at a specialized center for genetic diseases. Five patients were noted to have clinical evidence of pulmonary involvement. Full pulmonary function tests were performed in these five patients and in an additional 13 patients randomly selected from the remaining 145. Many of the 18 patients also underwent radionuclide body imaging with 67 Gallium citrate and 111Indium-tagged leucocyte scans, as well as incremental cardiorespiratory exercise tests. Lung biopsies were available in two patients with lung disease, and a second examination of lung tissue was performed in one of these two patients post-mortem. Clinical lung disease was detected in five patients. All five had dyspnea, diffuse infiltrates, restrictive impairment and low single breath CO diffusing capacity (DLCOSB). Two of these patients underwent exercise testing and showed abnormalities consistent with lung disease (ventilatory limitation, excessive ventilation and increased dead space) as well as decreased VO2 max. and anaerobic threshold (AT). In contrast, in the other 13 patients, physical examination, chest radiographs and pulmonary function were normal (except for a low DLCOSB in one patient). Responses on exercise testing (performed in six of the 13 patients) were consistent with a circulatory impairment (decreased VO2 max. and AT). Our study found that <5% of patients with Type 1 GD have clinical interstitial lung disease. In addition, we found that some patients, without evident lung involvement, may experience limitations in physical exertion and are easily fatigued; this is attributable to impaired circulation.

Adolescent↗
PubMed2003

Promoting safer sex among HIV-positive youth with haemophilia: theory, intervention, and outcome.

The goal of the project was to develop and evaluate theory-based interventions designed to change sexual behaviour and promote safer sex practices of HIV seropositive young men and adolescents with haemophilia to prevent transmission to sexual partners and offspring. Safer sex was defined as abstinence, consistent condom use, or 'outercourse' (intimate, non-intercourse sexual behaviour). This project utilized the Transtheoretical Model developed by Prochaska and DiClemente, which describes behaviour change as an incremental, stage-based process. The 1-year intervention protocol consisted of two individual sessions and two peer-centred activities. One hundred and four adolescents, residing in 22 states, participated. Pre- and post-intervention evaluations were conducted to measure stage progression for participants. The number who were in the action or maintenance stage of change for safer sex was significantly greater at post-test than at pre-test (79 vs. 62%, P < 0.0001). Participants also reported an increased use of outercourse. In addition, significant increases in self-efficacy and knowledge regarding safer sex were demonstrated. Following these stage-based interventions, participants were significantly more likely to be engaging in safer sex behaviours than they were previously. These intervention activities can be adapted for use with other adolescent populations and for other behaviour change goals in adolescents with haemophilia.

Adolescent↗
PubMed2001

HIV testing among young adults and older adolescents in the setting of acute substance abuse treatment.

OBJECTIVES: To examine the feasibility and acceptance of HIV testing among youth in acute substance abuse treatment. METHODS: Youth, aged 18 to 25 years old, in state-funded inpatient detoxification completed a confidential demographic/risk behavior questionnaire, and were offered a choice of no testing, serum-based testing, or oral fluid (Orasure, Epitope, Inc., Beaverton, OR, U.S.A.) HIV testing. RESULTS: In all, 74% of 204 participants accepted HIV testing. In a multivariate model, female gender (odds ratio [OR], 0.32; 95% confidence interval [CI] 0.14-0.74) and having been recently tested (OR, 0.11; 95% CI, 0.05-0.26) were independently associated with refusing testing. Recent sexual activity (OR, 5.4; 95% CI, 1.5-20.4), recent use of methamphetamines (speed) or a combination of cocaine and heroin (speedball) (OR, 3.8; 95% CI, 1.6-9.0), and a recent perceived risk for HIV (OR, 4.6; 95% CI, 1.9-10.9) were independently associated with test acceptance. Thus, 150 of 150 (100%) chose the Orasure test. Overall, 64.6% (97 of 150) of those tested received their results, but among participants requiring a follow-up appointment to learn test results, only 9.2% (8 of 87) returned. CONCLUSIONS: HIV testing is feasible and acceptable in this population. All patients preferred Orasure testing to a serum enzyme-linked immunosorbent assay (ELISA). Most youth tested in detoxification will only learn their results if they are provided during treatment. Rapid HIV testing with same-day results could improve follow-up rates.

Adolescent↗
PubMed2001

Dopaminergic therapy with carbidopa L-dopa for left neglect after stroke: a case series.

OBJECTIVE: To evaluate the efficacy of carbidopa L-dopa (Sinemet) in reducing left spatial neglect after stroke. DESIGN: Case series. SETTING: Inpatient neurorehabilitation unit in a regional rehabilitation center. PARTICIPANTS: A convenience sample of 4 women with right brain strokes and left neglect. INTERVENTION: A trial of carbidopa L-dopa to treat left neglect, if indicated by selected subtests of the Behavioral Inattention Test (BIT). MAIN OUTCOME MEASURES: Baseline and posttreatment evaluation with the modified BIT and the FIM instrument. RESULTS: Three of 4 subjects had significant improvements in their modified BIT scores (8%, 12%, 27%, respectively) and their functional status on the FIM. CONCLUSION: With further study, carbidopa L-dopa may be shown to reduce unilateral spatial neglect and thereby improve rehabilitation outcomes.

Activities of Daily Living↗
PubMed2001

A prospective study of psychological distress and sexual risk behavior among black adolescent females.

OBJECTIVE: The purpose of the study was to examine the association between adolescents' psychological distress and their sexually transmitted disease/human immunodeficiency virus (STD/HIV)-associated sexual behaviors and attitudes. METHOD: Sexually active black adolescent females (N = 522) completed, at baseline and again 6 months later, a self-administered questionnaire that assessed sexual health attitudes and emotional distress symptoms (using standardized measures, alpha =.84), a structured interview that assessed STD/HIV-associated sexual risk behaviors, and a urine screen for pregnancy. RESULTS: In multivariate analyses, controlling for observed covariates, adolescents with significant distress at baseline were more likely than their peers, after 6 months, to be pregnant (adjusted odds ratio [AOR]: = 2.0), have had unprotected vaginal sex (AOR = 2.1), have nonmonogamous sex partners (AOR = 1.7), and not use any form of contraception (AOR = 1.5). Additionally, they were also more likely to: perceive barriers to condom use (AOR = 2.2), be fearful of the adverse consequences of negotiating condom use (AOR = 2.0), perceive less control in their relationship (AOR = 2.0), have experienced dating violence (AOR = 2.4), feel less efficacious in negotiating condom use with a new sex partner (AOR = 1.6), and have norms nonsupportive of a healthy sexual relationship (AOR = 1.7). DISCUSSION: The findings suggest that psychological distress is predictive over a 6-month period of a spectrum of STD/HIV-associated sexual behaviors and high-risk attitudes. Brief screening to detect distress or depressive symptoms among adolescent females can alert the clinician to the need to conduct a sexual health history, initiate STD/HIV-preventive counseling, and refer for comprehensive psychological assessment and appropriate treatment. Among adolescents receiving STD treatment, those with even moderate emotional distress may be at heightened risk for further unhealthy outcomes. STD/HIV interventions should also consider psychological distress as one potential risk factor that may impact program efficacy.

Adolescent↗
PubMed2000

Transverse myelitis associated with restless legs syndrome and periodic movements of sleep responsive to an oral dopaminergic agent but not to intrathecal baclofen.

Periodic limb movement disorder (PLMD) and restless legs syndrome (RLS) are related sleep disorders that occur with increased frequency in spinal cord disease. Effective treatment may be obtained with dopaminergic or opioid drugs, while anticonvulsants, benzodiazepines, and possibly baclofen may be helpful. This report describes a patient who developed RLS and PLMD after acute transverse myelitis associated with infectious mononucleosis, and failed to respond to intrathecal baclofen. All symptoms of RLS/PLMD resolved after treatment with pergolide.

Acute Disease↗
PubMed2000

Provider issues in HIV care.

This chapter examines the impact of HIV infection and its associated biopsychosocial complications on provider-patient relationships and addresses the implications for health care teams and organizations. Several interventions are suggested that can relieve the complex stresses that health care providers are currently experiencing as they care for HIV and AIDS patients.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Impact of sexual abuse on the HIV-risk-related behavior of adolescents in intensive psychiatric treatment.

OBJECTIVE: This study compared the HIV-risk-related behaviors and attitudes of adolescents with and without a history of sexual abuse who were in intensive psychiatric treatment. METHOD: Adolescent patients (N=208) completed measures of psychological functioning and HIV-related knowledge, attitudes, and behaviors. RESULTS: Among sexually active adolescents in psychiatric treatment (N=116), those with a history of abuse reported significantly less condom self-efficacy (emotional ability to use condoms), less knowledge of HIV, less impulse control, less frequent use and purchase of condoms, and significantly higher rates of sexually transmitted diseases than their peers. Multiple logistic regression indicated that a history of sexual abuse was strongly associated with inconsistent condom use. CONCLUSIONS: Sexual abuse was associated with HIV-risk-related attitudes and behaviors among adolescents in psychiatric treatment. Clinicians should thus view a history of sexual abuse as a marker for sexual behavior that puts adolescents at risk for HIV.

Adolescent↗
PubMed2000

Sexual behavior change among human immunodeficiency virus-infected adolescents with hemophilia. Adolescent Hemophilia Behavioral Intervention Evaluation Project Study Group.

PURPOSE: To determine the factors associated with the adoption or maintenance of consistent safer sexual behaviors among human immunodeficiency virus-positive adolescents and young adults with hemophilia. METHODS: One hundred eleven adolescents at 10 hemophilia care sites participated in an intervention program designed to increase safer sexual behaviors (abstinence, condom use, or nonpenetrative behavior). The theory-based intervention spanned 1 year. Adolescents attended individual sessions, small group activities, and an intensive group retreat. RESULTS: Patients who maintained or improved safer sexual behaviors were compared with those who relapsed or did not improve. Logistic regression analyses found that improvement and maintenance of safer sexual behavior were significantly associated with perceived peer support for outercourse (odds ratio [OR]: 5.47; confidence interval [CI]: 1.4-20.8), perceived peer support for abstinence (OR: 5.08; CI: 1.2-20.1), and decreased general emotional distress (OR: 4.65; CI: 1.04-20.6). Perceived health status and previous sexual behavior were unrelated to change in safer sexual behavior. CONCLUSIONS: These longitudinal data indicate that improvement and maintenance of safer sexual behavior among adolescents during an intervention is strongly associated with perceptions of peer support for safer sex and lesser degrees of emotional distress. Programs for human immunodeficiency virus-infected adolescents may require developmentally appropriate social and psychological approaches to impact peer norms and emotional well-being.

Adolescent↗
PubMed2000

Children and adolescents living with HIV and AIDS: a review.

Worldwide, more than one million children are infected with human immunodeficiency virus (HIV) and in the United States it has become the sixth leading cause of death among 15-24-year-olds. Despite the trend of increasing rates of infection, advances in therapies have led to survival past 5 years of age for more than 65% of infected children. This global health threat will therefore continue to have a significant impact on child and adolescent psychiatry and psychology. This paper reviews current studies and reports on the consequences of the acquired immunodeficiency syndrome (AIDS) epidemic in the psychiatric care and development of children and adolescents infected by HIV. From a search of all the English-language-based literature on pediatric AIDS, 140 studies are reviewed which address HIV infection and its psychological and social implications. Several topics of mental health significance are examined: (1) the epidemiology of HIV, (2) neurocognitive development among those infected, (3) psychological impact of infection, and (4) the family and social context of HIV. The transition of HIV from an acute, lethal disease to a subacute, chronic disease has enormous implications for the neurocognitive and psychosocial development of children and families. As children and adolescents infected with HIV continue to live longer, normal developmental milestones and educational needs will take on new significance. Many children will continue to be adversely impacted by non-HIV factors such as poverty, inadequate medical services, and a lack of social support. This review outlines recent developments that hold promise to effectively reduce the treatment burden on the infected, their families, and health care providers and to decrease the incidence of transmission to the uninfected.

AIDS Dementia Complex↗
PubMed1999

Reversal of sleep apnea hypopnea syndrome in end-stage renal disease after kidney transplantation.

Sleep apnea hypopnea syndrome (SAHS) is extremely common in patients with end-stage renal disease (ESRD). Although the underlying mechanisms linking these 2 conditions remain to be better defined, it is likely that multiple factors are involved. We report an individual with ESRD with severe SAHS that resolved after kidney transplantation. The improvement in SAHS paralleling the effective treatment of ESRD suggests the pathogenesis involves an unstable breathing pattern, possibly caused by an altered metabolic state, uremia, and changes in volume status. The possibility that elevations in cytokine levels could be involved also is discussed and deserves further attention.

Adult↗
PubMed1999

Emotional reactions of haemophilia health care providers.

This study investigated the prevalence and impact of job burnout and job satisfaction among health care professionals working with HIV-infected patients with haemophilia, using a survey that included the Maslach Burnout Inventory (MBI). A minority (7.4%) of the 213 respondents met the criteria for job burnout as assessed by the MBI. Nearly 90% of the respondents reported 'liking' their job, although only 46% anticipated being in the same job in 5 years. The following factors were associated with increased degrees of burnout: greater perceived colleague stress, less overall job satisfaction, greater perceived stress in the working environment, fewer team meetings and fewer years of career experience. Mental health professionals were also less likely than physicians to report burnout. A multiple logistic regression found that providers who reported stress with colleagues were 42% more likely than their peers to be classified as experiencing a high level of job burnout. This study underscores the importance of a well-functioning team in buffering the inevitable stresses of caring for haemophilia patients with HIV.

Burnout, Professional↗
PubMed1998

Communicating do-not-resuscitate orders with a computer-based system.

BACKGROUND: Do-not-resuscitate (DNR) orders for critically ill patients are frequently miscommunicated between attending physicians, house staff, and nurses. A computer-based system was developed to improve the communication of a procedure-specific DNR order form. METHODS: Concordance of understanding of patients' DNR status was measured with the use of unstructured DNR orders (period 1), procedure-specific DNR order forms (period 2), and procedure-specific DNR order forms administered with a computer-based communication system (period 3). The 3 components of the DNR order assessed were (1) the clinical events to which the DNR order applied, (2) whether the DNR order withheld all elements of cardiopulmonary resuscitation, and (3) whether other treatments were to be withheld. RESULTS: For the 147 patients, the computer-based system in period 3 (n = 71) improved concordance for attending physicians and nurses or residents for all 3 of the DNR components compared with period 1 (n = 40) and some of the DNR components compared with period 2 (n = 36). Concordance was "substantial" or "almost perfect" as measured by the K statistic during period 3. The proportion of agreement for the composite of all 3 components of the DNR order increased during each period (P<.001, period 3 vs period 1). Overall agreement between all caregivers for the composite DNR order also improved from period 1 (22.2%) to period 2 (47.8%) and period 3 (61.9%; P<.001 vs period 1). Errors in order entry were detected by physicians because of the computer system and corrected in 9.9% of DNR orders in period 3. Progress note documentation of DNR status did not improve during period 3. The procedures of period 3 were considered acceptable by the physician and nursing staff. CONCLUSION: A computer-based system combined with a procedure-specific DNR order form improves communication of patients' DNR status in a critical care setting.

Adult↗
PubMed1998

Sleep-related disorders and chronic obstructive pulmonary disease.

Sleep-disordered breathing is ubiquitous in COPD. Sleep-related hypoxemia results from hypoventilation attributable to reduced respiratory drive and abnormal mechanics, and from probable changes in V/Q matching. An overlap syndrome combining COPD and OSA also has been described. Disturbances in cardiac, hematologic, and pulmonary function, as well as sleep complaints, are common when COPD is complicated by nocturnal hypoxemia, and these sequelae are even more common when COPD and OSA coexist. Treatment with oxygen is the mainstay for COPD and sleep desaturation alone, whereas combined nasal CPAP and oxygen are most frequently used for the overlap syndrome.

Female↗