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Biomedical subjects

P Franks

Publications and source records attributed to P Franks.

At least 55 records · Page 3Linked to original sources
PubMed1996

Methotrexate and misoprostol when surgical abortion fails.

OBJECTIVE: To describe the use of methotrexate and misoprostol to induce abortion in pregnancies up to 8 weeks when uterine or cervical anomalies make suction curettage difficult or impossible. METHODS: Four consecutive women, 8 weeks pregnant or less and with failed suction curettage, were given methotrexate 50 mg per square meter intramuscularly followed by a misoprostol 800-microgram suppository 72 hours later. A repeat dose of a misoprostol 800-microgram vaginal suppository was administered on day 4 if there was no bleeding, and an additional dose was given if the repeat beta-hCG titer had not decreased by at least 50%. Subjects were followed-up with serum or urine hCG assays. Complete abortion was defined by vaginal bleeding and a negative urine pregnancy test. Subjects completed a daily symptom log and a satisfaction questionnaire when the abortion was complete. RESULTS: The four women referred after failed suction curettage had the following anatomic problems: a uterus bicornis bicollis, a bicornuate uterus, uterine leiomyomas, and cervical stenosis resulting from previous laser surgery. All subjects had a complete abortion from methotrexate and misoprostol. Mild gastrointestinal side effects were reported by all four subjects: nausea (two subjects), vomiting (two), and diarrhea (two). The satisfaction questionnaire revealed that all subjects agreed with the statements that "Overall, the procedure went well" and "I would recommend this procedure over a surgical abortion." CONCLUSION: Methotrexate and misoprostol can induce an abortion when uterine or cervical anomalies make suction curettage difficult or impossible.

Abortifacient Agents, Nonsteroidal↗
PubMed1996

Assessing the health of the nation. The predictive validity of a preference-based measure and self-rated health.

Health-related quality-of-life (HRQOL) measures are becoming increasingly important for evaluating the effectiveness of medical interventions and assessing the health of populations. Preference-based instruments, a subset of HRQOL measures, allow comparisons of overall health status in populations and in clinical settings, and are suitable for economic analyses; but validity studies have used selected samples, mostly examining morbidity. This study compared the performance of a preference-based instrument with self-rated health in predicting subsequent self-rated health, hospitalization, and mortality in a national cohort. A version of the Health Utility Index (HUI), constructed from questions in the 1982 to 1984 National Health and Examination Survey I Epidemiologic Follow-up Study (NHEFS), was used to develop scores for the 1982 to 1984 survey sample. The relationship between both the NHEFS-HUI and self-rated health in 1982 to 1984, and subsequent decline in self-rated health, hospitalizations, and mortality experienced by 1987 were examined using survival analyses. The analyses adjusted for sociodemographic variables (age, sex, race, education, and income), medical conditions, and smoking status reported at the 1982 to 1984 NHEFS interview. Results indicated that NHEFS-HUI and self-rated health scores were worse in older persons, persons with one or more medical conditions, African Americans, and those with less education and lower incomes. The effects of all 19 chronic conditions and smoking were reflected in lower self-rated health scores, whereas the NHEFS-HUI did not capture the effects of two of the conditions or smoking status. Both measures made independent contributions to predicting hospitalizations and mortality by 1987; in addition, the NHEFS-HUI predicted decline in subsequent self-rated health. The NHEFS-HUI also predicted health outcomes in the subgroup of those in initial excellent or very good self-rated health. A preference-based instrument demonstrated predictive validity in three relevant domains of health status outcomes across all sociodemographic groups examined in this cohort. Self-rated health was better able to capture concurrent decrements in health associated with certain chronic illnesses and smoking. It is concluded that preference-based measures capturing both functional status and health perceptions should be incorporated explicitly into national surveys to assess the health of populations.

Adult↗
PubMed1996

Audit of maternal serum screening: strategies to augment counselling in response to women's views.

Women's opinion on the maternal serum screening programme offered at one maternity unit in East Northumberland (1991-1992) was evaluated. The responses from 1,774/2,633 women showed a general acceptance of the test but 722/1,774 (40%) wanted more information and a third, more explanation. Recommendations, which included a 'gold standard' protocol, a video to complement revised patient information literature and a coordinator to facilitate interdisciplinary communication and training with support for midwives, were introduced. The audit cycle was completed by a repeat questionnaire survey of 2,489 women from the postnatal ward (1992-1994) with a 67.3% response. An overall improvement in levels of satisfaction with reduction in, but not eradication of, the need for more information and explanation had occurred. These findings have relevance to the current controversy surrounding the counselling implications of maternal serum screening and have led to the formation of a network of professionals to develop the programme in our region.

Down Syndrome↗
PubMed1996

A neurochemical basis for the antipsychotic activity of loxapine: interactions with dopamine D1, D2, D4 and serotonin 5-HT2 receptor subtypes.

Loxapine is a typical neuroleptic that shows great structural and functional homology to the atypical antipsychotic clozapine. Chronic loxapine treatment is usually associated with extrapyramidal symptoms (EPS), whereas clozapine treatment is not. Conversely, loxapine does not produce the agranulocytosis that often results from protracted clozapine treatment. Earlier studies of loxapine have usually implicated D2 receptor blockade as the cause of the tardive dyskinesia that occurs with chronic treatment. More recently, loxapine's ability to potentiate serotonergic neurotransmission has also been implicated. In this study, the pharmacological affinities of loxapine for the dopamine D1, D2, D4, as well as serotonin-2 (5-HT2) and NMDA receptor subtypes, were investigated through direct radioreceptor assays. The findings indicate that loxapine displays an extremely strong binding affinity for dopamine D4 and serotonin 5-HT2 receptors, which suggests that both serotonergic and dopaminergic mechanisms contribute to the antipsychotic drug action and EPS associated with loxapine in the treatment of schizophrenia.

Antipsychotic Agents↗
PubMed1996

Use of care and subsequent mortality: the importance of gender.

OBJECTIVE: In light of recent discussions on access that have emphasized the need to relate access measures to outcomes, we examined the relationship between three self-reported utilization and access to care measures and the risk of subsequent mortality. DATA SOURCES AND DESIGN: A nationally representative sample from the first National Health and Nutrition Examination Survey that included adults 25-64 years of age without publicly funded health insurance was followed prospectively from initial interview in 1971 through 1975. DATA COLLECTION: Complete baseline and follow-up information was obtained on 4,491 persons (90 percent). Baseline access and use was assessed with answers to three questions: having a usual source of care, obtaining a general checkup, and not obtaining needed care (or forgone care). The relationships between the access and use measures and mortality by 1987 in men and women were examined using survival analyses. The analyses adjusted for race, and for baseline age, education, income, residence, insurance status, employment status, the presence of morbidity on examination, self-rated health, smoking status, leisure exercise, alcohol consumption, and obesity. PRINCIPAL FINDINGS: After adjusting for all other baseline variables, not obtaining a general checkup was associated with higher mortality in women (hazard ratio = 1.64 [95% confidence interval = 1.16, 2.32]), but not in men (hazard ratio = 1.07 [95% confidence interval = 0.80, 1.42]). Reporting a usual source of care and forgone care were not related to subsequent mortality in either women or men. CONCLUSIONS: Reporting a general checkup is an outcome-related utilization measure in women only. Further development of access and use indicators should address gender differences in health care use.

Adult↗
PubMed1996

Methotrexate and misoprostol for early abortion.

OBJECTIVES: This study examined the effectiveness of an abortion by methotrexate and misoprostol, including side effects, subjects' satisfaction, and optimal treatment strategies. METHODS: The study evaluated a prospective ongoing trial of women with an 8-week gestation or less wanting an abortion. Subjects received intramuscular methotrexate (50 mg per m2 of body surface area) on day 1. Subjects self-administered misoprostol 800 micrograms orally or as a vaginal suppository or vaginal tablets either on day 3 to 4 or day 5 to 7. Repeat misoprostol 800 micrograms doses were used vaginally if there was no significant bleeding and the gestation was less than 12 weeks. Subjects with continuing pregnancies had a surgical abortion. Subjects completed a daily symptom log and a satisfaction questionnaire. A successful medical abortion was defined by vaginal bleeding without surgical intervention and either a negative urine pregnancy test or a negative transvaginal ultrasound. RESULTS: Of the 282 subjects, 274 (97%) had a medical abortion. Eight (3%) subjects required surgical intervention--four for continued pregnancies and four for excessive bleeding. One hundred and sixty-two (57%) subjects required only one dose of misoprostol and started bleeding, on average, 6.2 hours later. One hundred and twelve subjects (40%) required an average of 2.5 misoprostol doses and started bleeding, on average, 12.4 days after initial methotrexate injection. Misoprostol was more effective vaginally than orally. Gastrointestinal side effects were common, mild, and brief. Eighty-eight percent of the subjects agreed that the procedure went well. Subjects monitored with ultrasound completed the study sooner than those followed by beta-hCG levels. CONCLUSION: Methotrexate and misoprostol were effective in inducing an abortion up to 8 weeks' gestation. The procedure is a promising alternative to surgical abortion.

Abortifacient Agents, Nonsteroidal↗
PubMed1995

Combined methotrexate and misoprostol for early induced abortion.

OBJECTIVE: To determine the effectiveness and side effects of and subject satisfaction with an induced abortion by administration of methotrexate and intravaginal misoprostol. SUBJECTS AND DESIGN: Prospective trial of 100 consecutive pregnant women aged 18 years or older at 8 weeks' gestation or less and wanting an abortion. INTERVENTIONS: Intramuscular administration of 50 mg of methotrexate per square meter of body surface area on day 1 and a misoprostol 800-micrograms vaginal suppository on day 3. Administration of misoprostol was repeated the following day if no bleeding occurred after the first dose. PROTOCOL: After pregnancy dating by clinical criteria, subjects were followed up with serum beta-human chorionic gonadotropin (beta-hCG) determinations on days 1, 7, and 14 and a high-sensitivity urine hCG test every 2 weeks until the value was less than 10 IU/L. Subjects completed a daily symptom log and satisfaction questionnaire on day 14. MAIN OUTCOME MEASURES: Complete abortion as defined by vaginal bleeding and a beta-hCG value of less than 10 IU/L without surgical intervention, complications and side effects, and patient satisfaction. RESULTS: Ninety-seven subjects had a complete abortion and one subject had vaginal bleeding and a 94% decrease of her beta-hCG value on day 7 but was subsequently unavailable for follow-up. Two subjects required surgical procedures: one with a continued pregnancy and one for excessive bleeding. No failures or complications occurred in early gestations prior to 45 days from the last menstrual period. Seventy-three percent responded to misoprostol treatment with bleeding within 12 hours and had a mean decrease of 90% in their beta-hCG value on day 7. Twenty-seven percent had no immediate bleeding response to misoprostol administration, began bleeding on day 10 (SD, 8 days), and had a mean decrease of 10% in their beta-hCG value on day 7. Seventy percent reported nausea; 46%, diarrhea; and 23%, vomiting. Ninety-three percent agreed that the procedure was acceptable and 95% would recommend the procedure. CONCLUSIONS: Methotrexate and misoprostol were effective in inducing an abortion up to 8 weeks. Home administration of a compounded misoprostol vaginal suppository was successful. Although gastrointestinal tract side effects were common, women found the procedure and its side effects acceptable.

Abortion, Induced↗
PubMed1995

Nest defense and survival of offspring in highly aggressive wild Canadian female house mice.

Nest defense behavior was examined in wild female house mice (Mus domesticus) that were derived from a stock initially trapped in Alberta, Canada. The first objective was to determine whether behavior toward pups prior to mating was related to the intensity of postpartum aggression in a variety of social situations. Therefore, prior to the experiments we screened virgin females for their behavior toward a newborn pup [60% of the females exhibited infanticide and 40% were noninfanticidal: 7% were parental (retrieved and hovered over the pup) and 33% ignored the pup]. Infanticidal and noninfanticidal females were then mated with males and used in four experiments. In Experiment 1 the females were housed individually prior to deliver, while in Experiment 2 the females were allowed to remain with their mates; in both situations all females successfully reared litters of similar sizes. Male and female intruders (that had all exhibited infanticide when previously tested with a pup) were placed separately into a test cage containing a lactating female during the first four days after delivery. Regardless of the presence of the stud male, previously infanticidal females were more aggressive (exhibited more attacks per min) toward both male and female intruders than were previously noninfanticidal females; infanticidal females also exhibited more of both forms of attack (offensive and defensive) and also attacked with greater intensity than did noninfanticidal females. The number of attacks toward intruders of both sexes increased for both infanticidal and noninfanticidal females between Day 1-4 postpartum, but very high rates of attack were observed on all days by the lactating females, including the day of delivery. In Experiments 3 and 4 only the most aggressive (previously infanticidal) females were tested. In Experiment 3, two unrelated, unfamiliar females were mated separately and then were housed together just prior to delivery, which was planned to occur 3-4 days apart. In 5 of the 15 cages, all pups disappeared on the day of delivery of the second female to deliver her litter. In the remaining 10 cages, it appeared that none of the pups produced by the 20 females were killed. Thus, in this experiment, 66% of pups survived to Day 4 postpartum. In Experiment 4, two previously infanticidal female siblings, which had been housed together since birth, were placed together with a stud male. In all 9 cages only one female became pregnant and delivered pups, but only 3 litters survived to Day 4 (no litters were observed being attacked during intruder tests).(ABSTRACT TRUNCATED AT 400 WORDS)

Aggression↗
PubMed1993

Health insurance and mortality. Evidence from a national cohort.

OBJECTIVE: To examine the relationship between lacking health insurance and the risk of subsequent mortality. DESIGN: Adults older than 25 years who reported they were uninsured or privately insured in the first National Health and Nutrition Examination Survey, a representative cohort of the US population, were followed prospectively from initial interview in 1971 through 1975 until 1987. PARTICIPANTS: Complete baseline and follow-up information was obtained on 4694 (91%) persons of the 5161 who reported not receiving publicly funded insurance at baseline. MAIN OUTCOME MEASURE: The relationship between insurance status and subsequent mortality was examined using Cox proportional hazards survival analysis. The analysis adjusted for gender, race, and baseline age, education, income, employment status, the presence of morbidity on examination, self-rated health, smoking status, leisure exercise, alcohol consumption, and obesity. The effects of interactions between insurance and all other baseline variables were also examined. RESULTS: By the end of the follow-up period, 9.6% of the insured and 18.4% of the uninsured had died. After adjustment for all other baseline variables, the hazard ratio for lacking insurance was 1.25 (95% confidence interval [CI], 1.00 to 1.55). The effect of insurance on mortality was comparable to that of education, income, and self-rated health. There were no statistically significant (P < .05) interactions. CONCLUSIONS: Lacking health insurance is associated with an increased risk of subsequent mortality, an effect that is evident in all sociodemographic health insurance and mortality groups examined.

Adult↗
PubMed1993

Postpartum factors related to mother's attraction to newborn infant odors.

Hedonic responses to a variety of infant (general body, urine, and feces) and noninfant (lotion, cheese, and spice) odorants were compared in four groups of subjects: new mothers, mothers a 1-month postpartum, and female and male nonparents. Using standard scaling procedures, subjects rated each of the odorants twice on a scale from extremely unpleasant (-20.5) to extremely pleasant (+20.5). In addition, all subjects completed a set of attitude questionnaires, and mothers also answered a childbirth questionnaire and were observed while feeding their infants.

Adult↗
PubMed1993

Physician gender bias in clinical decisionmaking: screening for cancer in primary care.

There has been increasing interest in gender disparities in clinical decisionmaking. Few studies have examined this issue in nationally representative samples or focussed on primary care. In addition, few of the studies have examined the role of physician gender. The 1987 National Medical Expenditure Survey was used to examine the relationship between physician gender and screening deficiency in women for three gender-sensitive tests (breast examinations, Papanicolaou tests, and mammograms) and one gender-neutral test (blood pressure checks). Women reporting a female physician as their usual provider compared with those reporting a male physician were less likely to be deficient for Papanicolaou tests and mammograms. There was a smaller, but nonsignificant similar trend for breast examinations. No gender bias was evident for blood pressure checks. These results persisted after multivariate adjustment for patient age, race, education, income, insurance status, subjective health status, other health behaviors, and attitude toward health care and health insurance. The results confirm the existence of physician gender bias in clinical decision making and represent one area for quality improvement.

Adult↗
PubMed1993

Health insurance and subjective health status: data from the 1987 National Medical Expenditure survey.

OBJECTIVES: The relationship between health insurance and subjective health status was investigated. It was hypothesized that persons without health insurance would have lower levels of subjective health status than those with health insurance and that this relationship would hold for both poor and nonpoor persons. METHODS: Data from the 1987 National Medical Expenditure Survey were analyzed to examine the relationship between health insurance and self-reported health status. The analysis controlled for sociodemographic and attitudinal variables and medical conditions. RESULTS: Persons without health insurance had significantly lower levels of subjective health status than did persons with insurance. This adverse effect persisted after adjustments were made for the effects of age, sex, race, income, attitude toward the value of medical care and health insurance, and medical conditions. The detrimental effect of lacking health insurance on subjective health status was present for persons at all income levels and was greater than the effect on subjective health status found for 2 of the 11 reported medical conditions. CONCLUSIONS: Lacking health insurance is associated with clinically significant lower levels of subjective health status in both poor and non-poor persons.

Adult↗
PubMed1993

Racial differentials in the identification of hypercholesterolemia.

BACKGROUND: African Americans have higher rates of cardiovascular disease than white Americans. To address this differential, barriers to cardiovascular risk reduction need to be identified. This study examines the association of race with the likelihood of screening for and diagnosis of hypercholesterolemia. METHODS: Possible associations between demographic variables and screening for and diagnosis of hypercholesterolemia were examined on data gathered in a prospective fashion in an office-based family medicine residency training program in Rochester, New York. A consecutive sample of all patients seen between December 15, 1988, and April 15, 1990, about whom there was complete data collection (age, sex, insurance, race, and other cardiovascular risk factors) were included in the multivariate analyses (N = 4256). RESULTS: After controlling for age, sex, insurance status, socioeconomic status, number of visits, and other cardiovascular risk factors, it was found that minorities were less likely to have been screened for cholesterol levels than whites (adjusted odds ratio [AOR] = 0.84, 95% confidence interval [CI] = 0.98 to 0.72). The mean cholesterol level did not differ by race (mean cholesterol for whites, 204 mg/dL [5.28 mmol/L], and for minorities, 203 mg/dL [5.25 mmol/L], t = 0.7, P = .47). Among those screened, minorities were less likely than whites to have been diagnosed with hypercholesterolemia (AOR = 0.62, 95% CI = 0.86 to 0.44; and 0.47 (95% CI = 0.28 to 0.78] in those with a cholesterol level greater than 240 mg/dL [6.2 mmol/L]). CONCLUSIONS: Our data suggest that provider behavior in diagnosing hypercholesterolemia varies by the race of the patient.

Adult↗
PubMed1992

Social relationships and health: the relative roles of family functioning and social support.

The associations between social relationships and health have been examined using two major research traditions. Using a social epidemiological approach, much research has shown the beneficial effect of social supports on health and health behaviors. Family interaction research, which has grown out of a more clinical tradition, has shown the complex effects of family functioning on health, particularly mental health. No studies have examined the relative power of these two approaches in explicating the connections between social relationships and health. We hypothesized that social relationships (social support and family functioning) would exert direct and indirect (through depressive symptoms) effects on health behaviors. We also hypothesized that the effects of social relationships on health would be more powerfully explicated by family functioning than by social support. We mailed a pilot survey to a random sample of patients attending a family practice center, including questions on depressive symptoms, cardiovascular health behaviors, demographics, social support using the ISEL scale, and family functioning using the FEICS scale. FEICS is a self-report questionnaire designed to assess family emotional involvement and criticism, the media elements of family expressed emotion. Eighty-three useable responses were obtained. Regression analyses and structural modelling showed both direct and indirect statistically significant paths from social relationships to health behaviors. Family criticism was directly associated (standardized coefficient = 0.29) with depressive symptoms, and family emotional involvement was directly associated with both depressive symptoms (coefficient = 0.35) and healthy cardiovascular behaviors (coefficient = 0.32). The results support the primacy of family functioning factors in understanding the associations among social relationships, mental health, and health behaviors. The contrasting relationships between emotional involvement and depressive symptoms on the one hand and emotional involvement and health behaviors on the other suggest the need for a more complex model to understand the connections between social relationships and health.

Adult↗
PubMed1991

Methylene chloride exposure and birthweight in Monroe County, New York.

This study examined the relationship between birthweight and exposure to emissions of methylene chloride (DCM) from manufacturing processes of the Eastman Kodak Company at Kodak Park in Rochester, Monroe County, New York. County census tracts were categorized as exposed to high, moderate, low or no DCM based on the Kodak Air Monitoring Program (KAMP) model, a theoretical dispersion model of DCM developed by Eastman Kodak Company. Birthweight and information on variables known to influence birthweight were obtained from 91,302 birth certificates of white singleton births to Monroe County residents from 1976 to 1987. No significant adverse effects of exposure to DCM on birthweight were found. Adjusted birthweight in high exposure census tracts was 18.7 g less than in areas with no exposure (95% confidence interval for the difference between high and no exposure - 51.6, 14.2 g). Problems inherent in the method of estimation of exposure, which may decrease power or bias the results, are discussed. Better methods to estimate exposure to emissions from multiple industrial point sources are needed.

Air Pollutants↗