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Biomedical subjects

M Keller

Publications and source records attributed to M Keller.

310 records · Page 18Linked to original sources
PubMedDate not supplied

Factors predictive of maternal-fetal transmission of HIV-1. Preliminary analysis of zidovudine given during pregnancy and/or delivery.

OBJECTIVE: To assess maternal risk factors potentially influencing vertical transmission of human immunodeficiency virus, type 1 (HIV-1), including maternal CD4 cell count; presence of immune complex dissociated (ICD) p24 antigen; maternal zidovudine therapy during pregnancy and/or delivery; complications of pregnancy, such as preterm labor and birth; and obstetric events during labor and delivery, such as duration of labor, mode of delivery, chorioamnionitis, and maternal blood exposure. DESIGN AND SETTING: A nonrandomized prospective cohort study at a university medical center and two general hospital affiliates. PATIENTS: Sixty-three HIV-1-seropositive pregnant women and their 68 infants. INTERVENTION: Twenty-six mothers received zidovudine therapy during pregnancy and/or during labor and delivery. MAIN OUTCOME MEASURE: HIV-1 infection status of the infant. RESULTS: Thirteen of the 68 infants were vertically infected with HIV-1. Mothers with events involving fetal exposure to maternal blood were more likely to transmit infection (four [31%] of 13 vs three [5%] of 55, P = .02), as were women with plasma ICD p24 antigenemia at delivery (six [67%] of nine vs 11 [25%] of 44, P = .02). Zidovudine treatment was associated with a significant reduction in vertical transmission (one [4%] of 26 mothers treated with zidovudine vs 12 [29%] of 42 mothers not treated with zidovudine, P = .01). There was a significant protective effect of zidovudine treatment despite lower mean absolute CD4 cell counts (0.37 x 10(9)/L) in the 24 zidovudine-treated nontransmitters and in the nine non-zidovudine-treated transmitters (0.37 x 10(9)/L) than in the 24 non-zidovudine-treated nontransmitters (0.62 x 10(9)/L) (P = .008). CONCLUSION: Maternal-fetal HIV-1 transmission is multifactorial, with increased risk associated both with ICD p24 antigenemia at term and with intrapartum events that increase fetal exposure to maternal blood. Zidovudine therapy given during pregnancy and/or labor and delivery was associated with a significant reduction in vertical transmission. These data suggest that the beneficial effects of zidovudine therapy in reducing maternal-fetal HIV-1 transmission recently found in protocol 076 of the placebo-controlled Acquired Immunodeficiency Syndrome Clinical Trials Group Study may extend to women with lower CD4 cell counts and suggest that prolonged treatment of infants may not be necessary.

Adult↗
PubMedDate not supplied

Psychosocial care of breast cancer patients.

Research in the field of Psychooncology has yielded useful data that may be helpful in clinical practice and in minimising psychosocial distress among breast cancer patients and their families. After the initial crisis following the diagnosis, the majority of patients adjust fairly well by mobilizing personal resources and social support. Adjustment may be enhanced by promoting open communication, offering support to the patient as to the whole family, and by aiding them in decision making. Comparisons of mastectomy to breast conservation have not consistently favored one surgery for all women, therefore, patients should be given the option to choose their preferred type of surgery. Since 20-30% of patients experience long-standing distress, early identification of patients at risk for severe adjustment disorders is important to provide them with professional support. Various kinds of psychosocial interventions have proven to be effective in reducing distress and improving patients' quality of life.

Breast Neoplasms↗
PubMedDate not supplied

[Mutual stress and support in couples with one cancer patient].

Sources of distress and support were assessed in a prospective study covering 149 couples with a cancer patient on outpatient chemotherapy, with an overall equally high impact of disease. Distress levels in spouses were found as high as in patients, showing a moderate relation within couples. From multivariate regression analyses spouses' distress proved predominantly determined by characteristics of illness. When broken down according to gender, factors contributing to couples' distress varied. Couples' distress was found more closely related to each other with female patients, with spouses relying more on their ill wives, compared to couples with male patients. Whereas female patients' distress was determined by the degree of role limitations, male patients appeared more vulnerable to the psychological impact of illness. Though couples' estimated social support from various sources was estimated greatly helpful, no effects were found on patients' and spouses' distress, respectively. Conclusions in respect of family-oriented interventions are discussed.

Adaptation, Psychological↗