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Biomedical subjects

P Robinson

Publications and source records attributed to P Robinson.

At least 163 records · Page 9Linked to original sources
PubMed1995

Primary care physician use of cognitive behavioral techniques with depressed patients.

BACKGROUND: Although researchers are paying more attention to the treatment of depression in the primary care setting, little is known about the nature of psychotherapeutic interactions that occur between primary care physicians and their patients in the context of a visit for depression. In recent years, brief cognitive behavioral therapy has been demonstrated to be efficacious, and the public has become more familiar with these techniques through media exposure and self-help books. METHODS: Depressed primary care patients were surveyed regarding the extent to which cognitive behavioral (CB) techniques were suggested during the primary care visit in which antidepressant medication was initially prescribed. One hundred fifty-five patients completed responses to phone surveys 1 month and 4 months after the visit. Patients were also surveyed regarding the recommendation of counseling by the primary care physician. RESULTS: The majority of patients (61%) reported that their physician advised them to identify activities they were already doing that helped them feel better. Physician recommendations regarding planning pleasurable activities, problem solving, challenging depressive thoughts, and planning activities that boost confidence were reported by 22% to 40% of study patients. Older patients reported fewer interactions about CB strategies. Primary care physicians' suggestion of CB strategies was associated with both patient use of CB strategies in the months following the visit and better adherence to recommended medication therapy during the first month of treatment. CONCLUSIONS: Many patients seem to recognize the occurrence of psychotherapeutic interactions during visits to their primary care physician in which an antidepressant medication was prescribed, and patients' recognition of these interactions is associated with increased adherence to the recommended course of antidepressant prescriptions.

Adaptation, Psychological↗
PubMed1994

Dental visiting behaviour and experiences of men with HIV.

To ascertain the dental visiting behaviour and experiences of men with HIV infection but without AIDS, a self-complete questionnaire was administered to convenience samples of men attending two genito-urinary medicine clinics. A total of 146 men completed questionnaires between December 1991 and June 1992. Of these, 85% had been regular or occasional attenders before diagnosis, 16% had not been to a dentist since diagnosis and 51% had changed their dentist. Although 63% had been to a general dental practitioner (GDP) at least once since diagnosis, half of them had withheld their HIV status at some time to obtain treatment. Of the 33% who had told their GDP of the diagnosis, half had been refused or offered limited treatment. The most common reasons for changing dentist, not visiting or withholding HIV status were concerns about the attitudes of the dental team and about confidentiality. Although regular oral examinations are of special importance to people with HIV their access to dental care is limited by their perceptions of dentists and the reported behaviour of dentists.

Adolescent↗
PubMed1994

Nutritional support and prognosis in patients with head and neck cancer.

We retrospectively studied the relationship between nutritional status as indicated by the presence or absence of the cutaneous delayed hypersensitivity response and treatment-related morbidity, disease recurrence, and survival at 2 years in 67 consecutive patients with head and neck carcinoma. Serial nutritional assessments were conducted throughout the course of combined initial antineoplastic treatment and nutritional support. The presence of cell-mediated immunity at the end of treatment was associated with a 2-year survival rate of 100%, whereas patients who were anergic at the end of treatment had a 2-year survival rate of 48% (P < 0.01). Morbidity due to surgical therapy and tumor recurrence rates were also higher in the anergic group (P < 0.01). Prognosis in head and neck cancer is based on many factors, but vigorous nutritional support during initial treatment may have some effect on morbidity, tumor recurrence, and survival time.

Adult↗
PubMed1994

The predictors of persistence of depression in primary care.

164 patients in primary care who were recognized as depressed by their physicians and started on antidepressants were interviewed at 1 and 4 months after initiation of treatment. Ten factors hypothesized to be related to persistence of depressive symptoms were entered into a multivariate analysis to determine predictors of persistence of affective symptoms. Patients with minor depression were significantly older, more likely to be married or cohabitating, more likely to have serious medical illness, and had significantly less comorbid panic disorder, recurrent depression and lower neuroticism scores compared to patients with major depression. Approximately half of the patients in this primary care sample with major depression and one-third of those with minor depression were still distressed at 4 months, although few met criteria for major depression. Severity of depression and high neuroticism scores were the best predictors of persistent depressive symptoms.

Adolescent↗
PubMed1994

Raw nerves.

Explore the source record for details and available documents.

Humans↗
PubMed1994

B-cell non-Hodgkin's lymphoma of the paranasal sinuses.

Primary nasal, paranasal, oral and pharyngeal (NPOP) lymphoma, thought to be a distinct entity among childhood lymphomas, may present with a wide variety of common ENT symptoms such as nasal obstruction, rhinorrhoea, epistaxis or sinusitis. The diagnosis may only be recognized when the disease results in symptoms such as visual loss, facial paraesthesia or lymphadenopathy, or systemic symptoms, such as fatigue, bone pain or abdominal pain. Full radiological assessment plays a vital part in making the diagnosis and planning treatment. Computerized tomography (CT) gives excellent bony detail but magnetic resonance imaging (MRI) using T2-weighted images, allows differentiation of mucosal thickening and retained sinus secretions from the tumour. Extension into the surrounding spaces and the cranial fossa is best assessed by coronal and sagittal T2 images. MRI is the best technique for follow-up because no radiation is involved and better soft tissue delineation improves the distinguishing of tumour from fibrosis.

Child, Preschool↗
PubMed1994

Smoking, the environment and meningococcal disease: a case control study.

This case control study investigated environmental factors in 74 confirmed cases of meningococcal disease (MD). In children aged under 5, passive smoking in the home (30 or more cigarettes daily) was associated with an odds ratio (OR) of 7.5 (95% confidence interval (CI) 1.46-38.66). ORs increased both with the numbers of cigarettes smoked and with the number of smokers in the household, suggesting a dose-response relationship. MD in this age group was also significantly associated with household overcrowding (more than 1.5 persons per room) (OR 6.0, 95% CI 1.10-32.8), with kisses on the mouth with 4 or more contacts in the previous 2 weeks (OR 2.46, 95% CI 1.09-5.56), with exposure to dust from plaster, brick or stone in the previous 2 weeks (OR 2.24, 95% CI 1.07-4.65); and with changes in residence (OR 3.0, 95% CI 1.0-8.99), marital arguments (OR 3.0, 95% CI 1.26-7.17) and legal disputes in the previous 6 months (OR 3.10, 95% CI 1.24-7.78). These associations were independent of social class. Public health measures to lower the prevalence of cigarette smoking by parents of young children may reduce the incidence of MD. The influence of building dust and stressful life events merits further investigation.

Adolescent↗
PubMed1994

The satisfaction of men with HIV infection attending a dedicated dental clinic: a controlled study.

A self-complete questionnaire to assess satisfaction with dental care was administered to two groups of dental patients: men with asymptomatic HIV infection attending a dedicated dental clinic and men, presumed to be HIV negative, attending a general dental practice. Both settings were staffed by the same dentist. Men attending the dedicated clinic expressed satisfaction with the technical competence of their treatment and the affective behaviour of their dentist comparable with satisfaction expressed by participants at the general dental practice. However, men at the dedicated clinic expressed dissatisfaction with the availability of treatment. This may be related to the staffing level at the clinic. Men with asymptomatic HIV infection wanted more dentists who specialized in their needs and thought there was not enough information available on oral health.

Adolescent↗
PubMed1994

Expression of classical and non-classical MHC class I antigens in murine hair follicles.

Not all keratinocytes in human and rat hair follicles express MHC class I antigens (MHC I). In the present study, we report the first immunohistological profile of classical and non-classical MHC I expression in the skin of adolescent C57 BL-6 mice during the induced hair cycle. MHC I immunoreactivity (H-2b, H-2Db) is absent in the matrix and inner root sheath of growing (= anagen) hair follicles, and the dermal papillae are H-2b negative during catagen and telogen. This lack of normal MHC I expression may serve to sequester potentially damaging autoantigens from immune recognition. In addition, we present the first evidence of non-classical MHC class I antigen expression in normal mammalian skin: during the entire hair cycle, the distal hair follicle shows strong Qa-2 immunoreactivity, which appears to be restricted to an epithelial follicle compartment densely populated by gamma-delta T cells with which Qa-2 molecules may interact as part of a primitive antibacterial defense system of the follicle. The murine hair cycle is an attractive model for dissecting the functional roles of H-2b and Qa-2 molecules in hair biology and in related tissue-interaction systems.

Animals↗
PubMed1994

Validity of a patient-administered questionnaire for routine otolaryngology admissions.

In this study the accuracy of a questionnaire filled in by 109 parents of children admitted for routine ENT surgery was compared with the well recognized verbal clerking. A major problem in communication between doctors and parents was highlighted, as just 44% of the parents were able to state the operation their children were admitted for. The study also showed that it is impossible to rely on parents to give the information required in the form of replies to questionnaires as the sensitivity of the questions designed to recognize risk factors was poor.

Adenoidectomy↗
PubMed1994

T lymphocyte reactivity of leprosy patients and healthy contacts from a leprosy-endemic population to delipidified cell components of Mycobacterium leprae.

In this study, we measured in vitro proliferative responses of peripheral blood mononuclear cells from both leprosy patients across the clinical spectrum and also healthy contacts from a leprosy-endemic population to delipidified cell components of Mycobacterium leprae (DCC) and Dharmendra lepromin. Dharmendra lepromin was poor in inducing in vitro T cell proliferation in all the study groups, even though it elicited marked in vivo skin test reaction in tuberculoid leprosy patients and healthy contacts. In contrast, Dharmendra preparation of BCG induced marked T-cell response in tuberculoid as well as bacterial index negative lepromatous patients. DCC induced a significantly higher lymphoproliferative response than Dharmendra lepromin in all study groups. A significant positive correlation was observed between the lymphoproliferative responses to DCC and BCG. The present study, based on a large number of leprosy patients and healthy contacts, clearly demonstrates that DCC, depleted of glycolipids and lipopolysaccharides, is a good antigenic preparation for evaluating T-cell reactivity to M. leprae.

Adolescent↗
PubMed1994

New dimensions in behavioral health/primary care integration.

The case is made for the integration of primary care and behavioral health services in the HMO. Key features of a successfully integrated behavioral health service are offered, along with brief reports of integration efforts at a number of HMOs across the United States. The author believes that better value and cost efficiencies result from integration.

Continuity of Patient Care↗
PubMed1994

Early molecular signals induced by antibodies to GPI-anchored proteins.

We have examined intracellular biochemical and metabolic changes induced by antibodies specific for glycosylphosphatidylinositol (GPI)-anchored cell surface molecules. In lymphoid cells the earliest detectable responses are phosphorylation of intracellular substrates. The GPI-linked target antigens are also rapidly redistributed into patches and caps on the cell surface and then internalised. Between two and five hours later, cytokine receptors are expressed. Later, cells become metabolically active and begin to proliferate and express endogenous cytokines, thus promoting autocrine growth. Very early events, such as kinase activity, are induced by antibody binding alone and are characteristic of the cell surface molecule recognised by antibodies. Thus, the initial events in the activation cascade are critical in selecting the metabolic route. Progression down the activation cascade requires further signals such as cross-linking antibodies, exogenous cytokines, phorbol esters, or accessory cells. Once in cycle, cells no longer display evidence of their original route of activation. Activated T lymphocytes acquire resistance to cleavage by GPI-specific phospholipase C, suggesting a possible feedback mechanism to limit cell proliferation.

Animals↗