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Biomedical subjects

M Mulvihill

Publications and source records attributed to M Mulvihill.

45 records · Page 3Linked to original sources
PubMed1977

Thymus and breast cancer--plasma androgens, thymic pathology, and peripheral lymphocytes in myasthenia gravis.

Plasma androgen sulfates were measured in 92 patients with myasthenia gravis. Plasma androgen sulfates were strongly associated with thymic pathology. The presence of germinal centers was associated with decreased androgen levels. A weak but significant positive correlation existed between androgen sulfates and lymphocyte counts. Low lymphocyte counts in patients with germinal centers were associated with subnormal androgen concentrations. Plasma androgen sulfate levels decreased immediately after thymectomy, but overall no significant differences were found between prethymectomy and post thymectomy levels. A trend toward higher concentrations of plasma androgens was noted 5 or more years post thymectomy. Plasma androgen sulfate levels in myasthenia gravis patients with breast cancer were markedly depressed. The lowest androgen sulfate levels were observed in patients who had previous bilateral breast cancer and those who, subsequent to the determination of the steroid sulfates, developed a second primary lesion of the breast.

Adult↗
PubMed1975

The public seminar as a nutrition education approach. An evaluation.

A health seminar seemed to modify knowledge, attitudes, and reported behavior of a self-selected audience which was already well informed and motivated to change. Therefore, the health seminar appears to be a useful educational approach in this context. The question remains: How can those who are neither informed nor motivated be reached? This study suggests that the public seminar may not be an efficient vehicle for this purpose.

Attitude to Health↗
PubMedDate not supplied

Barriers to follow-up of abnormal Papanicolaou smears in an urban community health center.

OBJECTIVE: To determine factors predictive of failure to return for colposcopy among women with significant abnormalities on Papanicolaou smears in a high-risk clinical population. DESIGN: Telephone survey. SETTING: An urban community health center. PARTICIPANTS: Two hundred seventy-nine women randomly selected from all women seen at the health center with abnormal Papanicolaou smears requiring colposcopy during 1993 to 1994. Six (2%) refused participation, and 19% could not be reached for inclusion. Subjects were mostly minority women receiving Medicaid. MAIN OUTCOME MEASURE: Completion of colposcopy. RESULTS: Of the 279 selected women, 79% were interviewed. The rate of adherence with colposcopy was 75% for the respondents. Women who did not know the results of their smear or who incorrectly understood their results were significantly less likely to return for colposcopy (P = .001). Younger women, especially teenagers, were less likely to return (P = .02). Socioeconomic status, education, primary language, health beliefs, fear of cancer, and clinician's gender or discipline were not associated with rate of follow-up. Barriers involving transportation, child care, and insurance also did not predict follow-up. CONCLUSIONS: Effective communication of results is the most important factor related to follow-up after abnormal Papanicolaou smear in this setting. In other settings, other factors may be of greater importance.

Adolescent↗
PubMedDate not supplied

Barriers to completion of health care proxies: an examination of ethnic differences.

BACKGROUND: Advance directives have not been uniformly used by different segments of the US population and studies have consistently shown a lower prevalence of advance directives among African Americans and Hispanics compared with non-Hispanic whites. OBJECTIVE: To examine barriers to completion of health care proxies for different ethnic groups. METHODS: One hundred ninety-seven subjects aged 65 years or older self-identified as African American (n = 65), Hispanic (n = 65), or non-Hispanic white (n = 67) attending a geriatrics and internal medicine outpatient clinic of a large New York City teaching hospital were administered a questionnaire. Questionnaires were developed to examine potential barriers to completion of health care proxies. Barriers were drawn from the literature and from focus groups. RESULTS: Significant predictors of proxy completion using logistic regression analysis included knowledge of health care proxies, availability of a health care agent, exposure to mechanical ventilation, age, and self-reported health status as fair to poor. Subjects who believed that a health care agent was irrelevant in the setting of involved family were significantly less likely to have completed a health care proxy. Although there were significant differences in the baseline completion rates of health care proxies for the 3 ethnic groups, ethnicity did not predict prior appointment of a health care agent in multivariate analysis. CONCLUSIONS: Differences in health care proxy completion rates across white, African American, and Hispanic elderly individuals in this New York City population seem to be related to potentially reversible barriers such as lack of knowledge and the perceived irrelevance of advance directives in the setting of involved family. Enhanced educational efforts of both health care personnel and patients could increase the rate of formal health care proxy appointment.

Advance Care Planning↗
PubMedDate not supplied

Evaluation of a risk assessment questionnaire used to target tuberculin skin testing in children.

CONTEXT: Universal tuberculin skin testing of children has been shown to be costly and inefficient. In response, several authorities have recommended targeted screening based on epidemiological risk. In 1996, the New York City Department of Health (NYCDOH) developed questions to identify children who require a tuberculin skin test. OBJECTIVE: To determine the sensitivity, specificity, and predictive validity of the NYCDOH tuberculosis risk assessment questionnaire. DESIGN: Prospective criterion standard study in which tuberculin skin tests and the NYCDOH questionnaire were administered simultaneously between August 1996 and January 1998. Specific questions asked about contact with a tuberculosis case, birth in or travel to endemic areas, regular contact with high-risk adults, and human immunodeficiency virus infection in the child. SETTING: Ambulatory clinic in South Bronx, New York, NY. PARTICIPANTS: Consecutive sample of 2920 children aged 1 to 18 years. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive and negative predictive values of the questionnaire, and odds ratio (OR) of reactive skin test results. RESULTS: The NYCDOH questionnaire identified 413 children (14%) as having at least 1 risk factor. Of these, 23 (5.6%) had a positive skin test result; 4 (0.16%) of the 2507 without risk factors had a positive result. Results for the full NYCDOH questionnaire were sensitivity, 85.2%; specificity, 86.0%; negative predictive value, 99.8%; positive predictive value, 5.4%; and OR, 35.2 (95% confidence interval, 12.1-102.4). CONCLUSION: The NYCDOH questionnaire is a valid instrument for identifying children for tuberculin skin testing.

Adolescent↗
PubMedDate not supplied

Orthostatic change in blood pressure in non-demented, ambulatory nursing home patients.

While postural hypotension was present in almost 20% of ambulatory patients of this long-term institution, associated symptoms were infrequent. A comparison of the groups with and without a history of falls in the prior year revealed no relationship to the presence of postural hypotension and no relationship to a number of medications which have been reported to be associated with orthostatic hypotension. Blood pressure readings should be obtained at 1,3 and 5 min after assuming the erect position as significant falls in blood pressure were found at each interval.

Journal Article↗
PubMedDate not supplied

The prevalence of eye disease in nursing home and non-nursing home geriatric populations.

The objective of this study was to determine whether rates of eye disease among the elderly are higher for residents of nursing homes than for persons who reside elsewhere. Articles reporting the prevalence of eye disease in geriatric populations (classified as nursing home or non-nursing home) were identified through a Medline search and a search of articles' bibliographies. Identified articles were reviewed, and the relevant data compared with prevalence rates obtained from 738 residents of two nursing homes in New York City. Each of the nursing home residents received an ocular examination upon admission that determined the presence or absence of four varieties of eye disease-i.e. cataracts, age-related macular degeneration, glaucoma, and diabetic retinopathy. Demographic data were obtained through chart review. Results indicate that prevalence rates of eye disease found in geriatric nursing home populations are generally higher than those found in other geriatric populations. With the exception of the rates for diabetic retinopathy, the rates found in the combined nursing home population sampled in this study were much higher than those reported in any previous study. It is concluded that eye disease is a more serious problem for elderly residents of nursing homes than for the elderly who reside in the community. Possible reasons for this are discussed.

Journal Article↗
PubMedDate not supplied

Aging and bereavement.

This paper compares the grief responses of widows and widowers of different age groups over the 1st year of bereavement. The results strongly suggest that older widows and widowers perceive themselves as adjusting better to their loss and suffering from less depression and fewer anxiety symptoms than their younger counterparts. Furthermore, the oldest widows/widowers demonstrate the most consistent improvement in their levels of distress over time. Thus, when it comes to coping, older persons are not at the disadvantage that certain stereotypes and "clinical wisdoms" have previously suggested. Seniors are every bit as adaptive and able to cope with the severest forms of stress as anyone else, and they are, if anything, less prone to depression than are younger individuals.

Adaptation, Psychological↗