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Biomedical subjects

L Peterson

Publications and source records attributed to L Peterson.

At least 55 records · Page 3Linked to original sources
PubMed1998

Resource allocation in general practice care.

OBJECTIVE: Complexity of care provided by general practitioners (GPs) is poorly addressed by current measures. Resource allocation for health care in inpatient settings utilises complex descriptions of clinical content and process to produce 'casemix' resource units. This pilot project explored the potential application of these concepts to the funding of general practice in Australia. METHOD: Prospective data were collected from three practices in the same community on one day in the same week. GP generated data included reasons for encounter, age and gender of the patient, whether the problems were new or old, what tests and referrals were initiated for each problem and global complexity ratings. Data collected from the patients included problems presented, problems not dealt with and satisfaction ratings. These data were used to explore the determinants of consultation complexity in general practice. RESULTS: There were statistically significant correlations between: global complexity and problem type (coded to ICPC Chapter); global complexity and number of problems seen; and global complexity and consultation billing level. A resource allocation formula which considers broader descriptions than current fee descriptors is suggested. CONCLUSIONS: Aspects of the casemix concept may have some relevance to how resources could be allocated in general practice, but this would require substantial further investigation.

Australia↗
PubMed1998

The treatment of isolated articular cartilage lesions in the young individual.

The treatment of isolated articular cartilage defects is an evolving field in orthopaedic surgery today. We have summarized the basic science and clinical date on the treatment of isolated articular cartilage defects. Further long-term controlled studies are required in order to compare definitively the efficacy of treatments in this difficult clinical area. In future studies, inclusion/exclusion criteria must be detailed, and classification systems need to be standardized Comparative analysis can then be performed to assess the efficacy of various techniques.

Adolescent↗
PubMed1997

Recurring structural chromosome abnormalities in peripheral blood lymphocytes of patients with mycosis fungoides/Sézary syndrome.

Cytogenetic analysis was performed on peripheral blood lymphocyte cultures from 19 patients with mycosis fungoides (MF)/Sézary syndrome (SS) stimulated with either phytohemagglutinin, a conventional mitogen, or a combination of interleukin-2 (IL-2) plus IL-7. The use of both PHA-stimulated and IL-2 plus IL-7-stimulated cultures enhanced the ability to identify clonal abnormalities. Clonal abnormalities were observed in 11 patients (53%) including one with monosomy for the sex chromosome as the sole abnormality. Five of the 11 patients with clonal abnormalities had normal peripheral white blood cell counts, indicating detectability of clones in the absence of frankly leukemic disease. The presence of clonal abnormalities correlated with advanced stage disease and a significantly reduced survival duration from the time of cytogenetic studies. Clonal abnormalities involving chromosomes 1 and 8 were observed in six cases. In five cases with aberrations of chromosome 1, loss of material involved the region between 1p22 and 1p36. In an additional case, a reciprocal translocation involving 1p33 was observed. Clonal abnormalities involving chromosomes 10 and 17 were observed in 5 cases, clonal abnormalities involving chromosome 2 in 4 cases, and clonal abnormalities involving chromosomes 4, 5, 6, 9, 13, 15, 19, and 20 in 3 cases. In 2 cases a der(8)t(8;17)(p11;q11) was observed. Regions of the genome that encode T-cell receptors were not involved in abnormalities. The region between 1p22 and 1p36 is identified as a region of the genome that requires detailed analysis toward the identification of potential gene(s) involved in the process of malignant transformation and/or progression in MF/SS.

Adult↗
PubMed1997

Family processes and child risk for injury.

Although injuries are the leading health threat to children, behavioral interventions within the family to prevent injuries remain relatively unexplored. In this paper, the parenting literature relevant to maltreatment injuries is reviewed in order to offer a broader picture of the potential influence of the family on all kinds of injuries. Factors that influence parental supervision of risky child behavior, relationship issues that may potentiate risky behavior, and the role of behavioral rules in reducing risky responding are considered. Suggestions for future research on family processes in injury socialization and intervention options are advanced.

Behavior Therapy↗
PubMed1997

Influence of fibrin sealant (Tisseel) on osteochondral defect repair in the rabbit knee.

Fibrin adhesives have been shown to improve the natural repair of musculoskeletal tissues. Growth hormone (GH) has a chondrogenic effect on immature cartilage. To test if a fibrin adhesive with and without GH could improve the natural repair of a joint surface lesion, we made a 9 x 4 mm2 osteochondral defect in the femoral groove of adult New Zealand rabbits. The defect in one of the knees was filled with the fibrin adhesive Tisseel, while the defect in the other knee was left untreated as a control. Another group of rabbits was treated in both knees with fibrin adhesive with local addition of GH during 1 week on one side. The experiments showed that the fibrin treatment impaired the natural repair of the osteochondral defect and that GH addition had no effect on the healing process. In a second in vitro experiment, chondrocyte migration into the fibrin adhesive Tisseel was compared to migration into rabbit and human blood clots. No cell migration was seen into the fibrin adhesive, while there was migration into the blood clots. We conclude that a fibrin adhesive like Tisseel is not suitable as a scaffold to promote repair of osteochondral defects in the rabbit knee.

Animals↗
PubMed1997

A novel immunoglobulin superfamily receptor for cellular and viral MHC class I molecules.

The human cytomegalovirus UL18 gene product is a homolog of cellular major histocompatibility (MHC) class I antigens. UL18 has been proposed to protect virus-infected cells against natural killer (NK) cell cytotoxicity by engaging NK cell killer inhibitory receptors (KIR) for MHC class I. UL18 binds to a novel immunoglobulin superfamily glycoprotein, designated Leukocyte Immunoglobulin-like Receptor (LIR-1). This protein is distinct from, but related to, known KIRs and binds cellular MHC class I antigens. The cytoplasmic domain of LIR-1 contains four putative immunoreceptor tyrosine-based inhibitory motifs. Upon tyrosine phosphorylation, LIR-1 associates with the tyrosine phosphatase SHP-1. In contrast to KIRs, LIR-1 is expressed predominantly on monocytic and B lymphoid cell types, suggesting a distinct biological function.

Amino Acid Sequence↗
PubMed1997

Survey of pediatric hospitals' preparation programs: evidence of the impact of health psychology research.

A survey of all 123 nonchronic-care pediatric hospitals in the United States revealed that 75% of hospitals responding had greatly increased the use of effective medical procedure preparation technologies, such as filmed modeling and coping skills instruction, in comparison to the last survey. Respondent characteristics such as position (e.g., nurse, child life worker, physician), degree (e.g., RN, MA, PhD), and length of time in the position failed to predict the type of techniques selected, but higher respondent knowledge and more psychological sources of preparation information did predict the use of preparation techniques used for drawing blood that experts rated as more effective. Challenges for more effective dissemination of research in the future are considered, as is the need for increased study of research-implementation links.

Analysis of Variance↗
PubMed1997

Transactional patterns of child, mother, and father adjustment in insulin-dependent diabetes mellitus: a prospective study.

Utilized both interview and self-report methods to examine transactional patterns of child, mother, and father adjustment in a sample of children and adolescents with insulin-dependent diabetes mellitus (IDDM). Overall, levels of child and parental adjustment were relatively stable over the 1-year study period. Regression analyses revealed that increases in fathers', but not mothers', distress over time contributed significant incremental variance to poorer subsequent children's adjustment, after controlling for demographic (age, gender, and SES) and disease parameters (illness duration and metabolic control). Decline in fathers' adjustment was a significant predictor of better mothers' adjustment at follow-up; child adjustment was not significantly associated with mothers' adjustment. Variations in both children's and mothers' adjustment made significant, independent contributions to predicting subsequent fathers' adjustment. Findings illustrate the transactional nature of relationships that exist in families of children with IDDM and underscore the importance of family systems or biobehavioral family treatment approaches in the clinical management of children with chronic illnesses.

Adaptation, Psychological↗
PubMed1997

Problem solving and diabetes regimen adherence by children and adolescents with IDDM in social pressure situations: a reflection of normal development.

Investigated problem-solving ability and reported regimen adherence among children, early adolescents, and middle adolescents with IDDM in response to hypothetical social situations where a choice between diabetes regimen adherence and peer desires must be made. Sixty-seven 8- to 17-year-olds with IDDM from two distinct U.S. geographical areas participated. Results indicated that compared to children with IDDM, adolescents with IDDM had better problem-solving abilities in response to social pressure situations, possibly reflecting their greater cognitive maturity. However, adolescents were also more likely to choose behaviors that are less regimen adherent. Differences in levels of problem-solving ability and adherence between the two regional subsamples were also found. Similar developmental patterns were found in both groups, showing the robust nature of the observed age-related trend of decreasing adherence in social situations despite increasing problem-solving abilities. Findings were interpreted in the context of normal adolescent development. Results are conceptually important for those interested in the transaction between peer and social influences and adherence for children and adolescents with IDDM, as well as other health behaviors.

Adolescent↗
PubMed1997

The role of childhood stressors in the intergenerational transmission of alcohol use disorders.

OBJECTIVE: This study examined relations between childhood stressors (e.g., disrupted family rituals, embarrassment, neglect, abuse), family history of paternal alcoholism, and alcohol use disorders in late adolescence and early adulthood. Of particular interest was the extent to which stressor exposure mediated the association between paternal and offspring alcohol use disorders. METHOD: A mixed-gender sample of 457 (238 female) participants, approximately half (N = 234) with a family history of paternal alcoholism, were assessed for alcohol use disorders and childhood stressors via clinical interviews. RESULTS: Family history of paternal alcoholism was associated with every childhood stressor examined, often strongly. In addition, a number of childhood stressors (e.g., verbal, emotional, physical and sexual abuse) were related to an alcohol use disorder in late adolescence/early adulthood. However, only a portion of the effect of family history on a subsequent alcohol use disorder was accounted for by the childhood stressors we examined. CONCLUSIONS: Findings indicate that self-reported childhood stressors are strongly related to a family history of alcoholism, but are only moderately and inconsistently related to the development of an alcohol use disorder. Moreover, they appear to, at best, only partially mediate the relation between family history of alcoholism and an alcohol use disorder.

Adolescent↗
PubMed1996

Minimal residual disease may predict bone marrow relapse in patients with hairy cell leukemia treated with 2-chlorodeoxyadenosine.

Minimal residual disease (MRD) can be detected in bone marrow core biopsies of patients with hairy cell leukemia (HCL) after treatment with 2-chlorodeoxyadenosine (2-CdA) using immunohistochemical (IHC) techniques. The purpose of this study was to determine whether the presence of MRD predicts bone marrow relapse. We studied paraffin-embedded bone marrow core biopsies from 39 patients with HCL in complete remission (CR) 3 months after a single cycle of 2-CdA. Biopsies performed 3 months posttherapy and annually thereafter were examined by routine hematoxylin and eosin (H&E) staining and IHC using the monoclonal antibodies (MoAbs) anti-CD45RO, anti-CD20, and DBA.44. At 3 months after therapy, 5 of 39 (13%) patients had MRD detectable by IHC that was not evident by routine H&E staining. Two of the five patients (40%) with MRD at 3 months have relapsed, whereas only 2 of 27 (7%) patients with no MRD and at least 1 year of follow up relapsed (P = .11). Over the 3-year follow-up period, two additional patients developed MRD. Overall, three of six (50%) patients with MRD detected at any time after therapy have relapsed, whereas only 1 of 25 (4%) patients without MRD has relapsed (P = .016). These data suggest that the presence of MRD after treatment with 2-CdA may predict relapse.

Antibodies, Monoclonal↗
PubMed1996

Accelerating children's risk for injury: mothers' decisions regarding common safety rules.

Although safety rules are one of the primary preventative tactics used by parents to avoid childhood injury, very little is known about how rules are applied within families. In this preliminary study in the area of application of family safety rules, we found that mothers tended to impose rules consistently more often than inconsistently, and where they were inconsistent, they tended to regard a risky behavior as unacceptable, even if there was no family rule outlawing the behavior. The number of rules was negatively related to the number of injuries, suggesting that rules may indeed have the preventative properties that parents believe them to have. The importance of understanding how rules may prevent or fail to prevent injuries is underlined and future research challenges are described.

Adult↗
PubMed1996

Methodological considerations in participant event monitoring of low-base-rate events in health psychology: children's injuries as a model.

The present article outlines the advantages of the participant event monitoring methodology for the investigation of unpredictable, low-base-rate events in children. Several methods for assessing the quality of participant event monitoring data are advanced with a data set showing participant event monitoring of children's minor injuries by 61 children and their mothers. Child-mother correspondence and debriefing data suggest good accuracy for frequency estimates. Home- and laboratory-based simulations illustrate the participant event monitors' accuracy for major details. Traditional measures of data quality show good overall coder and test-retest reliability, and cross-observer reports show acceptable estimates of validity for objective aspects of the events and the expected lower estimates for the more subjective aspects. Conceptual and pragmatic difficulties of the method are considered, and suggestions for future research are advanced.

Accident Prevention↗
PubMed1996

Quantifying tissue damage from childhood injury: the minor injury severity scale.

Described an instrument designed to quantify the extent of tissue severity damage following a minor childhood injury event. Few tools exist to allow objective assessment of injury and those which do exist are oriented toward major injuries necessitating medical intervention. The Minor Injury Severity Scale (MISS) does not require specialized medical experience to apply. It yields a 0-7 score which indexes objective parameters such as depth and length of lesion for 22 different kinds of injuries. The data reported here suggest good coder reliability, excellent test-retest stability, and acceptable correspondence between mothers' and children's reports. Data are presented on divergent validity to show that tissue damage is related to but is not the same as injury outcomes such as pain, fear, and disability. Limitations of the scale and challenges to future research are also discussed.

Child↗
PubMed1996

Rabbit articular cartilage defects treated with autologous cultured chondrocytes.

Adult New Zealand rabbits were used to transplant autologously harvested and in vitro cultured chondrocytes into patellar chondral lesions that had been made previously and were 3 mm in diameter, extending down to the calcified zone. Healing of the defects was assessed by gross examination, light microscope, and histological-histochemical scoring at 8, 12, and 52 weeks. Chondrocyte transplantation significantly increased the amount of newly formed repair tissue compared to the found in control knees in which the lesion was solely covered by a periosteal flap. In another experiment, carbon fiber pads seeded with chondrocytes were used as scaffolds, and repair significantly increased at both 12 and 52 weeks compared to knees in which scaffolds without chondrocytes were implanted. The histologic quality scores of the repair tissue were significantly better in all knees in which defects were treated with chondrocytes compared to knees treated with periosteum alone and better at 52 weeks compared to knees in which defects were treated with carbon scaffolds seeded with chondrocytes. The repair tissue, however, tended to incomplete the bonding to adjacent cartilage. This study shows that isolated autologous articular chondrocytes that have been expanded for 2 weeks in vitro can stimulate the healing phase of chondral lesions. A gradual maturation of the hyalinelike repair with a more pronounced columnarization was noted as late as 1 year after surgery.

Animals↗
PubMed1996

Effect of glucose on uptake of radiolabeled glucose, 2-DG, and 3-O-MG by the perfused rat liver.

In the transition from the fasting to the fed state, plasma glucose levels rise, and the liver converts from an organ producing glucose to one of storage. To determine the effect of glucose on hepatic glucose uptake, radiolabeled glucose, 2-deoxyglucose, and 3-O-methylglucose were injected into perfused rat livers during different nontracer glucose levels, and the concentrations in the outflow were measured. A mathematical model was developed that described the behavior of the injected compounds as they traveled through the liver and was used to simulate and fit the experimental results. The rates of membrane transport, glucokinase, glucose-6-phosphatase, and the consumption of glucose 6-phosphate were estimated. Membrane transport for all of the tracers decreased as nontracer glucose increased, demonstrating competitive inhibition of the glucose transporter. In contrast, the consumption of injected [2-14C]glucose increased when glucose was elevated, demonstrating that glucose caused an activation of enzyme activity that overcame the competitive inhibition of transport and phosphorylation. When glucose was elevated, the rate coefficient of glucokinase did not decrease, indicating that glucokinase was stimulated by glucose. Both changes would lead to the increased glycogen synthesis and decreased glucose production rate observed in vivo during the fasted-to-fed transition.

3-O-Methylglucose↗