Biomedical subjects

Michael Boyle

Publications and source records attributed to Michael Boyle.

17 recordsLinked to original sources

PubMed2006

Growth trajectories of extremely low birth weight infants from birth to young adulthood: a longitudinal, population-based study.

We compared sex-specific growth attainment of a population-based cohort of 147/166 (89%) extremely low birthweight (ELBW < 1000 g) and 131/145 (90%) sociodemographically comparable normal birthweight (NBW) cohort at young adulthood, and examined the pattern of growth trajectories and correlates of growth at ages 1, 2, 3, and 8 y, and teen and young adulthood (mean age, 23.3 versus 23.6 y). The proportion considered small for gestational age was ELBW 25% versus NBW 3%; and 26% versus 2% had neurosensory impairments. Weight for age z-scores for ELBW showed substantial decline to age 3 y, with subsequent significant catch-up to adolescence and smaller gains to adulthood. Height for age z-scores showed both sexes of ELBW were disadvantaged at every age compared with NBW and their expected mid-parental height. The BMI z-scores for ELBW showed a sustained incline from age 3 to adulthood, where both sexes normalized to above zero, and were comparable to their peers. ELBW children showed growth failure during infancy, followed by accelerated weight gain and crossing of BMI percentiles at adolescence, a pattern that may increase the risk of insulin resistance and coronary heart disease. However, normalization of BMI for both sexes at adulthood suggests that final growth was proportionate.

Adult↗

PubMed2006

Approaches to screening for intimate partner violence in health care settings: a randomized trial.

CONTEXT: Screening for intimate partner violence (IPV) in health care settings has been recommended by some professional organizations, although there is limited information regarding the accuracy, acceptability, and completeness of different screening methods and instruments. OBJECTIVE: To determine the optimal method for IPV screening in health care settings. DESIGN AND SETTING: Cluster randomized trial conducted from May 2004 to January 2005 at 2 each of emergency departments, family practices, and women's health clinics in Ontario, Canada. PARTICIPANTS: English-speaking women aged 18 to 64 years who were well enough to participate and could be seen individually were eligible. Of 2602 eligible women, 141 (5%) refused participation. INTERVENTION: Participants were randomized by clinic day or shift to 1 of 3 screening approaches: a face-to-face interview with a health care provider (physician or nurse), written self-completed questionnaire, and computer-based self-completed questionnaire. Two screening instruments-the Partner Violence Screen (PVS) and the Woman Abuse Screening Tool (WAST)-were administered and compared with the Composite Abuse Scale (CAS) as the criterion standard. MAIN OUTCOME MEASURES: The approaches were evaluated on prevalence, extent of missing data, and participant preference. Agreement between the screening instruments and the CAS was examined. RESULTS: The 12-month prevalence of IPV ranged from 4.1% to 17.7%, depending on screening method, instrument, and health care setting. Although no statistically significant main effects on prevalence were found for method or screening instrument, a significant interaction between method and instrument was found: prevalence was lower on the written WAST vs other combinations. The face-to-face approach was least preferred by participants. The WAST and the written format yielded significantly less missing data than the PVS and other methods. The PVS and WAST had similar sensitivities (49.2% and 47.0%, respectively) and specificities (93.7% and 95.6%, respectively). CONCLUSIONS: In screening for IPV, women preferred self-completed approaches over face-to-face questioning; computer-based screening did not increase prevalence; and written screens had fewest missing data. These are important considerations for both clinical and research efforts in IPV screening. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00336297.

Adult↗

PubMed2006

The influence of child abuse on the pattern of expenditures in women's adult health service utilization in Ontario, Canada.

Childhood maltreatment is a common and serious problem for women, particularly in relation to impairment in adulthood. To our knowledge, no system-wide study has addressed the influence of childhood maltreatment on the cost of these women's adult health service utilization. This paper examines this relationship. The 1990 Ontario Health Survey (OHS) gathered information regarding determinants of physical health status and the use of health services. The 1991 Ontario Mental Health Supplement (OHSUP) examined a variety of childhood experiences as well as the prevalence of psychiatric disorders from a sample of OHS respondents. These were province-wide population health surveys of a probability-based sample of persons aged 15 years and older living in household dwellings in Ontario. The OHSUP randomly selected one member from each participating OHS household to be interviewed regarding personal experiences and mental health. This analysis used data from women aged 15-64 who participated in both the OHS and OHSUP. Self-reported health service utilization was collected in four groups of women--those who reported no history of child abuse, those with a history of physical abuse only, those who reported sexual abuse only, and those who reported both physical and sexual (combined) abuse. We hypothesized that a history of child abuse would result in greater adult health care costs. The results indicated that having a history of combined abuse nearly doubles mean annual ambulatory self-reported health care costs to 775 dollars (95% CI 504 dollars-1045 dollars) compared to a mean cost of 400 dollars with no abuse (95% CI 357 dollars-443 dollars). Median annual ambulatory self-reported health care costs were also increased in the combined abuse group, to 314 dollars (95% CI 220 dollars-429 dollars), compared to 138 dollars (95% CI 132 dollars-169 dollars) in those with no abuse. We conclude that child abuse in women is significantly associated with increased adult self-reported health care costs.

Adolescent↗

PubMed2006

Transition of extremely low-birth-weight infants from adolescence to young adulthood: comparison with normal birth-weight controls.

CONTEXT: Traditionally, educational attainment, getting a job, living independently, getting married, and parenthood have been considered as markers of successful transition to adulthood. OBJECTIVE: To describe and compare the achievement and the age at attainment of the above markers between extremely low-birth-weight (ELBW) and normal birth-weight (NBW) young adults. DESIGN, SETTING, AND PARTICIPANTS: A prospective, longitudinal, population-based study in central-west Ontario, Canada, of 166 ELBW participants who weighed 501 to 1000 g at birth (1977-1982) and 145 sociodemographically comparable NBW participants assessed at young adulthood (22-25 years). Interviewers masked to participant status administered validated questionnaires via face-to-face interviews between January 1, 2002, and April 30, 2004. MAIN OUTCOME MEASURES: Markers of successful transition to adulthood, including educational attainment, student and/or worker role, independent living, getting married, and parenthood. RESULTS: At young adulthood, 149 (90%) of 166 ELBW participants and 133 (92%) of 145 NBW participants completed the assessments at mean (SD) age of 23.3 (1.2) years and 23.6 (1.1) years, respectively. We included participants with neurosensory impairments (ELBW vs NBW: 40 [27%] vs 3 [2%]) and 7 proxy respondents. The proportion who graduated from high school was similar (82% vs 87%, P = .21). Overall, no statistically significant differences were observed in the education achieved to date. A substantial proportion of both groups were still pursuing postsecondary education (47 [32%] vs 44 [33%]). No significant differences were observed in employment/school status; 71 (48%) ELBW vs 76 (57%) NBW young adults were permanently employed (P = .09). In a subanalysis, a higher proportion of ELBW young adults were neither employed nor in school (39 [26%] vs 20 [15%], P = .02 by Holm's correction); these differences did not persist when participants with disabilities were excluded. No significant differences were found in the proportion living independently (63 [42%] vs 70 [53%], P = .19), married/cohabitating (34 [23%] vs 33 [25%], P = .69), or who were parents (16 [11%] vs 19 [14%], P = .36). The age at attainment of the above markers was similar for both cohorts. CONCLUSION: Our study results indicate that a significant majority of former ELBW infants have overcome their earlier difficulties to become functional young adults.

Achievement↗

PubMed2006

A pilot study of adjunctive family psychoeducation in adolescent major depression: feasibility and treatment effect.

OBJECTIVE: To obtain preliminary evidence of the feasibility and effectiveness of adjunctive family psychoeducation in adolescent major depressive disorder. METHOD: Participants were from outpatient clinics in Hamilton and London, Ontario. Over 24 months, 41 adolescents ages 13 through 18 years meeting major depressive disorder criteria were recruited (31 in Hamilton, 10 in London). Participants were randomized to usual treatment or usual treatment plus family psychoeducation. Outcome measures were readministered at 2 weeks, mid-treatment, posttreatment, and 3-month follow-up. Intent-to-treat analyses used chi2 and t tests and growth curve analysis. Standardized effects based on growth curve estimates were calculated for continuous outcomes. RESULTS: The London site was withdrawn because of poor participant retention. In Hamilton, no participant missed more than one assessment and there was good family psychoeducation adherence. Compared to controls, participants in the experimental group showed greater improvement in social functioning and adolescent-parent relationships (with medium standardized effect size > 0.5), and parents reported greater satisfaction with treatment. CONCLUSIONS: There were positive treatment effects on family and social functioning processes postulated to mediate the clinical course of major depressive disorder. The study provides support for further evaluation of family psychoeducation in this clinical population.

Adolescent↗

PubMed2006

Solutions to discrimination in work and housing identified by people with mental illness.

Several studies have examined the breadth and depth of the impact of the stigma and discrimination associated with mental illness. This study examines perceived solutions to discrimination in housing and employment situations. We expected identification of solutions to be positively associated with disease insight and personal empowerment. One hundred people with serious mental illness completed measures of perceived solutions to discrimination exhibited by an employer or a landlord. They also completed measures of empowerment and insight. Results showed high frequency solutions included looking for a job or apartment elsewhere, or seeking help from family and friends. Insight was significantly associated with number of endorsed solutions, while the interaction between insight and empowerment described a nonsignificant trend. Implications of these findings for stigma change are discussed.

Adult↗

PubMed2004

Dose escalation of docetaxel concomitant with hypofractionated, once weekly chest radiotherapy for non-small-cell lung cancer: a phase I study.

Hypofractionated chest radiotherapy has been used as an alternative when standard fractionated schedules are neither practical nor feasible. To explore docetaxel as radiosensitizer in a hypofractionated chest irradiation schedule, a docetaxel dose escalation study was conducted in which 26 patients with advanced non-small-cell lung cancer (NSCLC) (stages III and IV) were enrolled. Docetaxel was administered 24 hours prior to irradiation (starting dose 10mg/m2; escalating in 5mg/m2 increments). Radiation was administered at 500 cGy (one fraction) once/wk for 10 consecutive weeks (5000 cGy total). The docetaxel dose was escalated up to 45 mg/m2/wk. The treatment was well tolerated over 10 consecutive weeks without requiring dose reductions or interruptions. Toxicities were mainly docetaxel related. One of 19 evaluable patients had a complete radiographic response within the radiation treatment port, 13 had a partial response, and 5 had stable disease. No patient recurred within the radiation field. Three patients who underwent surgical resection following treatment were pathologically down staged to stage I. This trial of a small group of patients supports, in selected patients, synchronous administration of effective hypofractionated, radiosensitized radiation therapy and optimized systemic chemotherapy.

Adult↗

PubMed2003

Stress, social support and depression in single and married mothers.

BACKGROUND: This study examined the effect of stress and social support on the relationship between single-parent status and depression. METHOD: A secondary data analysis of the 1994-95 National Population Health Survey was conducted. Single and married mothers who participated in the survey were derived from the general sample (N = 2,921). Logistic regression techniques were used to assess the mediating and moderating effects of stress and social support on the relationship between family structure and depression. RESULTS: Bivariate analyses showed that, compared to married mothers, single mothers were more likely to have suffered an episode of depression (12-month prevalence), to report higher levels of chronic stress, more recent life events and a greater number of childhood adversities. Single mothers also reported lower levels of perceived social support, social involvement and frequency of contact with friends and family than married mothers. The results of the multivariate analyses showed that, together, stress and social support account for almost 40% of the relationship between single- parent status and depression. We also found a conditional effect of stress on depression by family structure. Life events were more strongly related to depression in married than in single mothers. CONCLUSIONS: A substantial part of the association between single-parent status and depression can be accounted for by differences in exposure to stress and social support. Our results suggest that it is important to examine multiple sources of stress, as exposure to both distal and proximal stressors were higher among single mothers. Limitations and directions for future research are discussed.

Adolescent↗

PubMed2003

Does low reading achievement at school entry cause conduct problems?

Conduct problems place children at increased risk for a broad array of negative health and social outcomes that include conduct disorder, injuries and violence, school failure, substance abuse, depression, and suicide. Prevention interventions have the potential to interrupt the chain of events linking early conduct problem symptoms to future negative life outcomes, but have received much less emphasis than interventions designed to treat established cases of disorder. Reading problems are a well-established correlate of conduct disorder. However, whether or not reading problems cause conduct disorder continues to be debated. If they are in fact a causal risk factor this would justify the design and evaluation of interventions designed to enhance reading skills and/or remediate problems. In this paper we use logistic regression techniques to evaluate the relation between reading achievement at school entry and conduct problems 30 months later, in a representative, non-clinic sample of kindergarten and grade one children, in Ontario, Canada. The findings show that an eight point increase in reading scores (equivalent to an moderate effect size of 0.5) would result in a 23 per cent decrease in the risk of conduct problems 30 months later, after controlling for gender, income and baseline conduct problem symptoms. We conclude that reading problems may contribute to the early onset of conduct disorder. Randomized experimental studies designed to evaluate the effects of reading programmes in non-clinic samples of children are needed to: (i) establish whether the link between reading problems at school entry and conduct disorder is causal; and (ii) determine whether reading intervention programmes are an effective conduct disorder prevention strategy.

Achievement↗

PubMed2003

What happens to patients' psychotropic prescriptions after discharge from a state psychiatric hospital?

Continuity of pharmacotherapy was examined between a state psychiatric hospital and an urban community mental health center. Anecdotal reports from administrators as well as limited empirical research suggested that there would be breaks in the continuity of pharmacotherapy across the two agencies and that the high cost of newer medications would contribute to poor continuity. Clinical chart reviews of 242 discharges over a 5-year period revealed that less than 11% of atypical prescriptions and less than 20% of all psychotropic prescriptions were altered beyond dosage level changes after discharge from a state hospital. Analysis of reasons given (reported) for altering the medication regimen revealed a consistent pattern of changes based on clinical evidence or consumer choice.

Adult↗

PubMed2003

Influence of season and latitude in a community sample of subjects with bipolar disorder.

OBJECTIVE: To report on the prevalence of seasonal bipolar disorder (BD) and the impact of latitude in a community sample in the province of Ontario. METHOD: This study used the telephone-administered Depression and Seasonality Interview. Exact latitude was determined for each participant. RESULTS: Overall, 14 of 62 (22.6%) subjects with BD had the seasonal subtype of BD. Latitude did not appear to influence the proportion of subjects with the seasonal subtype. CONCLUSIONS: We identified a seasonal pattern of illness in a proportion of subjects with BD.

Adult↗

PubMed2003

Psychopathology and social competencies of adolescents who were extremely low birth weight.

BACKGROUND: We have previously shown that infants who were extremely low birth weight (ELBW) are particularly vulnerable to problems related to inattention and hyperactivity at school age. It is not known whether these problems persist to adolescence. OBJECTIVE: To explore and compare the levels of psychopathology in a regional cohort of ELBW infants and sociodemographically matched term controls as reported by teens and their parents. DESIGN/METHODS: Cross-sectional cohort study/geographically defined region. PARTICIPANTS: TEENS: ELBW 141/169 (83%) and control 122/145 (84%), aged 12 to 16 years. PARENTS: ELBW 143/169 (85%) and control 123/145 (85%). Both cohorts and their parents completed the Ontario Child Health Study-Revised questionnaire with 6 behavioral subsca1es: conduct disorder, oppositional defiant disorder, attention-deficit/hyperactivity disorder (ADHD), overanxious, separation anxiety, and depression. RESULTS: By teen self-report, there were no significant differences between ELBW and control teens on any of the 6 subscale scores. However, parents of ELBW teens reported significantly higher scores than parents of control for depression and ADHD based on 2-way analysis of variance (group x gender). Comparison within teen/parent dyads showed that both cohorts of teens reported significantly higher scores than their parents. Multivariable analyses on behavioral subscale scores demonstrated a number of variables that were significant predictors by parent report: group (ELBW vs control), gender, family function, developmental quotient, maternal mood, and socioeconomic status; no predictors were significant by teen report. There were no statistically significant interaction effects for any of the models. These models explained a greater percent of the variance in behavioral scores for parents than for teens (12.5%-22.0% vs 3.4%-8.2%). Results were similar when teens with neurosensory impairment were excluded. CONCLUSIONS: This study is unique in the inclusion of both parent and teen self-report of behaviors. Significant differences were apparent only by parent report for ADHD and depression among ELBW teens. Significant predictors of behavioral scores for parents include group, gender, family function, developmental quotient, maternal mood, and socioeconomic status.

Adaptation, Psychological↗

PubMed2002

Multiattribute and single-attribute utility functions for the health utilities index mark 3 system.

BACKGROUND: The Health Utilities Index Mark 3 (HUI3) is a generic multiattribute preference-based measure of health status and health-related quality of life that is widely used as an outcome measure in clinical studies, in population health surveys, in the estimation of quality-adjusted life years, and in economic evaluations. HUI3 consists of eight attributes (or dimensions) of health status: vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain with 5 or 6 levels per attribute, varying from highly impaired to normal. OBJECTIVES: The objectives are to present a multiattribute utility function and eight single-attribute utility functions for the HUI3 system based on community preferences. STUDY DESIGN: Two preference surveys were conducted. One, the modeling survey, collected preference scores for the estimation of the utility functions. The other, the direct survey, provided independent scores to assess the predictive validity of the utility functions. MEASURES: Preference measures included value scores obtained on the Feeling Thermometer and standard gamble utility scores obtained using the Chance Board. RESPONDENTS: A random sample of the general population (> or =16 years of age) in Hamilton, Ontario, Canada. RESULTS: Estimates were obtained for eight single-attribute utility functions and an overall multiattribute utility function. The intraclass correlation coefficient between directly measured utility scores and scores generated by the multiattribute function for 73 health states was 0.88. CONCLUSIONS: The HUI3 scoring function has strong theoretical and empirical foundations. It performs well in predicting directly measured scores. The HUI3 system provides a practical way to obtain utility scores based on community preferences.

Adolescent↗

PubMed2002

Attention-deficit hyperactivity disorder: critical appraisal of extended treatment studies.

We undertook a systematic review of the literature on the long-term treatment of attention-deficit hyperactivity disorder (ADHD). We used systematic strategies to identify randomized treatment studies in which treatment was administered for 12 weeks or more. We included 14 studies involving 1379 subjects. Because of the limited number of high-quality studies and the heterogeneity of outcome measures, we did not perform meta-analysis. We rated 5 studies as adequate for methodological quality. Five studies followed children for more than 26 weeks. Pharmacologic interventions were studied more frequently than non-pharmacologic ones. Six studies permitted evaluation of the effects of combined drug and behavioural intervention. Twenty-five different outcomes were measured using 26 different tests. Stimulant medication appears to reduce ADHD (7 studies), dysfunctional social behaviour (6 studies), and internalizing symptoms (2 studies). Available studies provide little evidence for improved academic performance with stimulants (3 studies). Medications other than stimulants have not been studied extensively (3 studies). Only 1 study showed that combination therapy adds to the effects of medication. Rigorous treatment research among representative samples of ADHD individuals is needed.

Attention Deficit Disorder with Hyperactivity↗

PubMed2002

Stoma complications: a multivariate analysis.

Construction of a gastrointestinal stoma is a frequently performed surgical procedure. We sought to analyze a large cohort to document the frequency and types of ostomy complications and the risk factors associated with them. The charts of patients undergoing a procedure which resulted in ostomy during a 3-year period were reviewed. Demographics, indication, ostomy type/location, perioperative risk factors, and complications were recorded. Case-control methodology was used to determine crude odds ratios and multiple logistic regression was used to calculate adjusted odds ratios. A P value of less than 0.05 was considered significant. An ostomy was constructed in 204 patients and records were available for 164. Forty-one patients (25.0%) had ostomy complications. Sixteen of these complications (39.0%) occurred within one month of the procedure. Complications included prolapse in nine (22%), necrosis in nine (22%), stenosis in seven (17%), irritation in seven (17%), infection in six (15%), bleeding in two (5%), and retraction in two (5%). Gender, cancer, trauma, diverticulitis, emergency surgery, ileostomy, and ostomy location/type were not associated with a stoma complication. Significant predictors of ostomy malfunction are presented as odds ratios (ORs) with 95 per cent confidence intervals (CIs) and include inflammatory bowel disease (OR = 4.49; 95% CI = 1.16-17.36) and obesity (OR = 2.66; 95% CI = 1.15-6.16). The care of an enterostomal nurse was found to prevent complications (OR = 0.15; 95% CI = 0.03-0.69). We conclude that ostomies have a high risk of complication, which is not related to stoma location or type. Obesity and inflammatory bowel disease predispose to complications. Enterostomal nursing may be instrumental in preventing complications.

Adolescent↗

PubMedDate not supplied

Pancreatic sarcoidosis: unusual presentation resembling a periampullary malignancy.

Sarcoidosis involving the pancreas is a rare occurrence. Isolated cases of localized or diffuse involvement of the pancreas have been reported in the literature. The preoperative diagnosis of this entity is a clinical challenge, and surgical intervention is usually needed to make a definitive diagnosis. We report a patient that presents with a preoperative evaluation suggestive of cholangiocarcinoma. Surgical management involved pancreaticoduodenectomy, which revealed pancreatic sarcoidosis with regional lymph node involvement. An extensive literature review of sarcoidosis of the pancreas is provided, which cites all reported cases in which the presentation warranted surgical intervention.

Ampulla of Vater↗

PubMedDate not supplied

Home intravenous antibiotic therapy and allergic drug reactions: is there a case for routine supply of anaphylaxis kits?

This study aimed to estimate the risk of an allergic reaction for patients receiving home intravenous antibiotics, and to identify the potential advantages and disadvantages of providing injectable epinephrine in this patient population. In this study, 770 patients received 1000 courses of home intravenous therapy with 25 different antibiotics for 37 conditions. The patients in the program experienced 28 allergic reactions. The mean time to allergic reaction was 19.6 days. No episodes of anaphylaxis were observed. These results, coupled with the potential disadvantages of issuing epinephrine to all patients receiving home antibiotic therapy, suggest that this strategy may not provide a net benefit.

Adolescent↗