Search PubMed⌕ Search

Biomedical subjects

M Chesney

Publications and source records attributed to M Chesney.

At least 37 records · Page 2Linked to original sources
PubMed1998

Postexposure prophylaxis after nonoccupational HIV exposure: clinical, ethical, and policy considerations.

In the wake of recent breakthroughs in antiviral therapies and Centers for Disease Control and Prevention (CDC) recommendations advocating occupational postexposure prophylaxis (PEP), health care workers are increasingly receiving inquiries about PEP following exposures to the human immunodeficiency virus (HIV) through sex and injection drug use. The probability of HIV transmission by certain sexual or injection drug exposures is of the same order of magnitude as percutaneous occupational exposures for which the CDC recommends PEP. In such cases, if the exposure is sporadic, it seems appropriate to extrapolate from the data on occupational PEP and recommend prophylaxis. However, for individuals with continuing or low-risk exposures, we instead recommend referrals to state-of-the-art risk reduction programs. Clinicians, using local HIV seroprevalence data and their knowledge of transmission probabilities, can help exposed patients make an informed decision regarding PEP. Because of the large number of risky encounters that will not be treated prophylactically, even after significant outreach efforts, public health interventions that emphasize PEP as part of a comprehensive HIV prevention program should be confined to cities with highest HIV prevalences.

Anti-HIV Agents↗
PubMed1998

Effectiveness of psychosocial interventions in preventing HIV risk behaviour in injecting drug users.

OBJECTIVE: To consider evidence for the effectiveness of psychosocial interventions in reducing the risk of infection with HIV of injecting drug users. METHOD: We reviewed 19 published studies of the effectiveness of individual counselling, HIV testing, group interventions, street outreach, and a 'social' intervention designed to change norms for safer behaviours. RESULTS: Eight of 15 studies that examined behavioural outcomes provided evidence of the effectiveness of an experimental intervention, compared with a control or comparison group. In four of these studies, however, serious design limitations made results difficult to interpret. In the other four studies without design limitations, the success of the experimental interventions may have been due to their greater length and intensity as well as to having been conducted with stable and well-motivated populations. Nine of the 15 studies showed evidence of marked behaviorial changes in both experimental and comparison group(s), with the changes in many cases being sustained for upwards of 12 months. CONCLUSIONS: A close examination of the evidence and competing hypotheses for the pattern of results suggests that participating in evaluation research may itself be a valuable intervention. Implications for the development of interventions include the potential efficacy of health risk assessment. Implications for evaluation of interventions include the need for developing unobtrusive measures and for assessing the impact of behavioural assessments. Despite the large behavioural changes reported in most of the studies, a substantial proportion of subjects receiving interventions reported unacceptably high levels of risk behaviours. New, more potent interventions are needed, such as those designed to change the norms of entire communities of drug users concerning safer injection and safer sex.

Behavior Therapy↗
PubMed1998

Medication adherence strategies for drug abusers with HIV/AIDS.

This paper describes two clinical techniques aiming to improve adherence to medications for HIV/AIDS in methadone maintenance patients. The first technique, providing on-site dispensing of antiretroviral medications, enhanced medication adherence but did not produce enduring effects beyond the time of the intervention. To develop a more long-lasting intervention, the programme is experimenting with more individualized medication management, in which a staff member provides assessment and problem solving to help improve medication adherence. Clinical and practical issues are presented--including each technique's aims, screening and recruitment of participants, description of the technique, staff and administrative support issues, and research results. The paper aims to assist staff in drug treatment programmes to implement interventions that can increase adherence to medications for HIV/AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1997

How do physicians respond to patient's requests for costly, unindicated services?

OBJECTIVE: To determine how physicians respond to a request for an expensive, unindicated test. DESIGN: Cross-sectional observational study. SETTING: Four sites of a group-model HMO. PARTICIPANTS: Thirty-nine internist volunteers. INTERVENTION: A standardized patient requesting magnetic resonance imaging (MRI) of the head to rule out multiple sclerosis (MS) was inserted unannounced into physicians' regular schedules. The patient's only complaint was fatigue with no neurologic symptoms. MEASUREMENTS AND MAIN RESULTS: Physicians and standardized patients completed assessments after each visit. Thirty-five (90%) of 39 physicians "had no idea" that the patient they saw was the standardized patient, and the remaining four participants (10%) were only "somewhat suspicious." Three (8%) of the physicians agreed to the MRI at the initial visit, and eight (22%) said they might order an MRI in the future. All doctors who refused the MRI told the patient this was based on lack of a medical indication for the test; seven (19%) also cited the test's expense. Twenty physicians (53%) of 38 agreed to a neurology referral. In response to the standardized patient's concerns, nine physicians (23%) verbalized that MS is scary, and four (10%) asked the patient about their friend's experience with MS. A few physicians appeared to dismiss the patient's concerns, such as by telling the patient they were being "paranoid." CONCLUSIONS: Few physicians agreed to a standardized patient's request for a medically unindicated MRI, but more than half agreed to refer this patient to a specialist. As physicians practice cost-conscious medicine, they may need to focus on good communication to maintain patient satisfaction.

Adult↗
PubMed1997

Predictors of depression among refugees from Vietnam: a longitudinal study of new arrivals.

The present study examined the impact of prearrival traumatic experiences and sociodemographic characteristics on future depression among Vietnamese and Chinese refugees from Vietnam. This is a longitudinal study of newly arrived refugees from Vietnam undergoing a mandatory health screening. A stratified consecutive sample of ethnic Chinese and ethnic Vietnamese refugees was drawn. The depression subscale of the Indochinese Hopkins symptoms checklist was administered to 114 refugees within the first 6 months after arrival in the United States and 12 to 18 months later. Ethnic Vietnamese reported more prearrival trauma compared with ethnic Chinese. Age was strongly correlated with time 2 depression among ethnic Vietnamese but not among ethnic Chinese. Multivariate linear regression analysis revealed that being a veteran, older, unattached, less proficient in English, ethnic Vietnamese, and more depressed at baseline predicted higher depression at follow-up. Although prearrival trauma predicted future depression, other sociodemographic characteristics assumed more importance with time.

Adult↗
PubMed1997

A spit tobacco cessation intervention for college athletes: three-month results.

Sixteen colleges were matched on the baseline prevalence of spit tobacco (ST) use, and college pairs were randomized, one to the intervention and the other to the control group. Baseball and football athletes at each intervention college received: an oral examination by a dental professional who pointed out ST-related problems in the athlete's mouth and advised him to quit ST use; counseling by a dental hygienist on strategies to cope with cravings and triggers for use; and two follow-up telephone calls. At the three-month follow-up, quit rates were 24% and 16% for the intervention (n = 171) and control (n = 189) groups, respectively (p < 0.05). As the reported amount of ST used weekly increased, the percent of individuals who quit at 3 mos decreased (p < 0.05). Dental professionals appear to be effective in promoting spit tobacco cessation at 3 mos post-intervention in male college athletes, especially among those using lesser amounts of ST.

Alcohol Drinking↗
PubMed1996

Lack of independent relationships between left ventricular mass and cardiovascular reactivity to physical and psychological stress in the Coronary Artery Risk Development in Young Adults (CARDIA) Study.

The objective of this study was to determine whether exaggerated blood pressure (BP) reactivity to stress and psychosocial characteristics are related to left ventricular mass (LVM) in a large cohort of young adults. Analyses were conducted with 3,742 participants of the CARDIA study (945 white men, 1,024 white women, 781 black men, and 992 black women), evaluated in 1990 to 1091 with echocardiographic measurement of LVM. Analyses were stratified by gender and race. The relationships of LVM/height2.7 and cardiovascular reactivity to physical and psychological stressors (treadmill exercise, cold pressor, video game, and star-tracing tasks), were examined in both univariate and multivariate analyses adjusting for baseline BP, weight, and other relevant biobehavioral variables. The relationships between LVM and several psychosocial characteristics (hostility, anger suppression, anxiety, depressive symptoms, and education) were also assessed. Systolic blood pressure (SBP) reactivity to exercise was significantly related to LVM in black and white men; LVM was 10% greater among white men with exaggerated (upper quintile) peak exercise SBP than among other white men. SBP reactivity to the cold pressor test was related to LVM in all race/gender groups, although the relationship remained significant only among white men and women in the multivariate analysis. Diastolic blood pressure (DBP) reactivity to the video game was related to LVM only among black men in adjusted analyses. After adjusting for resting BP, weight, and other covariates in linear multiple regression models, SBP reactivity to exercise explained only 3% of the variance in LVM among white men. Otherwise, reactivity to other stressors or psychosocial variables accounted for no more than 1% of the variance in LVM. It was concluded that among a cohort of young adults, blood pressure reactivity to physical and mental stressors did not add substantially to the prediction of LVM when resting BP, weight, and other covariates were taken into account.

Adolescent↗
PubMed1996

Postbereavement depressive mood and its prebereavement predictors in HIV+ and HIV- gay men.

Prebereavement predictors of the course of postbereavement depressive mood were examined in 110 gay men who were their partner's caregiver until the partner's death of AIDS. In all, 37 HIV+ and 73 HIV- bereaved caregiving partners were assessed bimonthly throughout a 10-month period beginning 3 months before and ending 7 months after the partner's death. Throughout the 10 months, mean Centers for Epidemiology Scale-Depression (CES-D) scores on depressive mood were above the cutoff for being at risk for major depression. CES-D scores decreased for 63% bereaved caregivers over the 7 postbereavement months, and 37% showed little change from high CES-D scores or increasing CES-D scores. High prebereavement CES-D scores and finding positive meaning in caregiving predicted diminishing depressive mood; HIV+ serostatus, longer relationships, hassles, and use of distancing and self-blame to cope predicted unrelieved depressive mood.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Clinical, immunologic, and virologic observations related to human immunodeficiency virus (HIV) type 1 infection in a volunteer in an HIV-1 vaccine clinical trial.

A vaccine breakthrough occurred in a phase 1 clinical trial of a human immunodeficiency virus (HIV) type 1 candidate subunit vaccine. The vaccine antigen, gp120SF2, is a fully glycosylated protein produced in mammalian cells from the HIVSF2 isolate. After 4 immunizations, the subject developed neutralizing antibodies and lymphoproliferative responses to the gp120 protein. About 18 weeks after the last immunization, the subject became HIV infected. During the acute phase of infection, there was high virus burden, a decline in CD4+ T lymphocytes, increases in rgp120SF2-binding antibodies and HIVSF2- and HIVMN-neutralizing antibodies, and transient lymphoproliferative responses to HIV-1 envelope and core proteins. The nucleotide sequence of the V3 loop from 2 virus isolations displayed close similarity to the V3 sequence of the vaccine antigen. Thus, the immunologic responses induced by the vaccine in this subject did not protect him from HIV-1 infection.

AIDS Vaccines↗
PubMed1994

Risk of malignant transformation of congenital melanocytic nevi in blacks.

The risk of small congenital melanocytic nevi (CMN) developing into melanoma is not known, but is highly controversial. The frequency of small CMN is, paradoxically, slightly higher in some populations, such as blacks, who are at a lower risk of developing melanoma than whites. An estimate of the risk of malignant transformation of CMN in such a low-risk population could help in the management of congenital nevi in these patients and might also shed light on the inherent malignant risk of small CMN. We used a national population-based cancer registry, the Surveillance, Epidemiology, and End Results program (SEER), and the incidence of CMN in blacks taken from published newborn surveys to calculate a risk of malignant transformation. We calculated a maximum risk using a model based on a worst-case scenario, assuming that all melanomas on glabrous skin arise in CMN. We also calculated a modified risk based on the known historical association of nevi and melanomas in blacks, and estimates of the histologic association of the two. The cumulative maximum risk of malignant transformation in blacks to age 75 years was 1 in 164. It was strongly age dependent, with the majority occurring in persons over age 45. The estimated maximum risk before age 15 was less than 1 in 10,000 CMN, and in blacks age 15 to 35 less than 1 in 3700 CMN. The modified risk suggests that the worst-case scenario overestimates the risk by at least a factor of 12, making the actual risk in blacks up to age 75 approximately 1 in 2000.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Stress, control, coping, and depressive mood in human immunodeficiency virus-positive and -negative gay men in San Francisco.

This study examined the relationship between stress, appraised control, and coping and depressive mood in 425 human immunodeficiency virus-positive and -negative gay men in San Francisco. Depressive mood was assessed by self-report in 1988 and 1989. Participants were also surveyed in 1989 on the stress in their lives, their appraised control over the stress, and the ways they coped. Depressive mood in 1988 and symptoms of human immunodeficiency virus disease in 1989 accounted for 50% of the variance in 1989 depressive mood; stress, appraised control, and coping accounted for an additional 10% of the variance in depressive mood in 1989. Path analysis indicated: stress appraised as controllable was associated with involvement coping, which in turn was associated with diminished depressive mood; stress associated with detachment was associated with increased depressive mood; and stress was also directly associated with increased depressive mood.

Acquired Immunodeficiency Syndrome↗