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Biomedical subjects

T Barker

Publications and source records attributed to T Barker.

17 recordsLinked to original sources
PubMed2000

Treatment of sialorrhea with glycopyrrolate: A double-blind, dose-ranging study.

OBJECTIVE: To determine the safety and efficacy of glycopyrrolate in the treatment of developmentally disabled children with sialorrhea. DESIGN: Placebo-controlled, double-blind, crossover dose-ranging study. SETTING: Outpatient facilities in 2 pediatric hospitals. PATIENTS: Thirty-nine children with both developmental disabilities and excessive and bothersome sialorrhea. MAIN OUTCOME MEASURES: Parent and investigator evaluation of change in sialorrhea and adverse effects. RESULTS: Glycopyrrolate in doses of 0.10 mg/kg per dose is effective at controlling sialorrhea. Even at low doses, 20% of children may exhibit adverse effects severe enough to require discontinuation. CONCLUSIONS: Glycopyrrolate is effective in the control of excessive sialorrhea in children with developmental disabilities. Approximately 20% of children given glycopyrrolate may experience substantial adverse effects, enough to require discontinuation of medication. Arch Pediatr Adolesc Med. 2000;154:1214-1218.

Adolescent↗
PubMed2000

Metaplastic carcinoma of the breast arising within complex sclerosing lesion: a report of five cases.

AIMS: This study presents a series of five cases in which metaplastic carcinoma, predominantly low-grade adenosquamous carcinoma, of the breast is seen arising within a background of a complex sclerosing lesion. This association has been recognized previously but has not been documented in detail. This study describes the characteristics of the components present in each case and discusses the existing literature. This observation adds further evidence to support an association between some types of invasive breast carcinoma and sclerosing lesions of the breast. METHODS AND RESULTS: Four of these cases were received as referral cases for opinion. The fifth was received as part of the routine surgical workload within our own institution. Two patients presented following mammographic screening and three symptomatically; their mean age was 62 years (range 49-68). The mean lesion size was 16 mm (range 7-24). All five lesions showed features of a complex sclerosing lesion/radial scar in the form of central sclerosis with elastosis and radiating benign entrapped tubules. One had associated benign papillary structures and two had focal benign squamous metaplasia. Four cases showed coexisting but distinct areas of low-grade adenosquamous carcinoma with glandular and squamous epithelial differentiation in a spindle cell background. One case had associated undifferentiated spindle cell carcinoma. Detailed immunophenotypic characteristics of two cases are presented. CONCLUSIONS: This series illustrates a postulated but previously unconfirmed association between an unusual form of metaplastic breast carcinoma (adenosquamous carcinoma) and complex sclerosing lesions. The mechanisms of induction of breast carcinoma are poorly understood but these observations further emphasize the potential for sclerosing lesion of the breast to be associated with, and possibly give rise to, invasive carcinoma of different types. The precise nature of the interaction between the pathological processes remains unclear.

Aged↗
PubMed1999

Patient motivation.

This paper addresses the important issue of patient motivation. Research indicates that non-compliance is a major problem for healthcare professionals, with between a third and a half of all patients failing to comply with recommended healthcare instructions. The paper outlines some of the misconceptions associated with motivation and discusses six factors, together with some brief additional factors, which it is hoped will contribute to a deeper understanding of the subject and the improved dental health of patients.

Communication↗
PubMed1997

Sex, drugs and HIV counseling and testing: a prospective study of behavior-change among methadone-maintenance clients in New England.

OBJECTIVES: To determine whether changes in injecting drug use and sexual behavior over a 12-month follow-up are associated with HIV counseling and testing (C and T) of injecting drug users in methadone maintenance treatment programs (MMTP) in Massachusetts and Connecticut. METHODS: Clients were invited to participate in a longitudinal study involving five interviews. Data were also obtained by ethnographers and from clinical records. Behavioral outcomes of interest were number of drug injections, sharing of unclean 'works' (injecting equipment), number of unprotected sex partners, and number of unprotected sexual episodes. Data analyses included multiple regression, odds ratios, and quantitative analysis of text-based data. RESULTS: Subjects reported reductions in both injecting drug use and sexual behavior Primary associations with reduced injecting drug use were remaining in the MMTP and attending HIV-positive support groups. A reduction in high-risk sexual behavior was associated with an HIV-positive test result and duration of HIV counseling in the MMTP. Increase in drug injecting use was associated with an HIV-positive test result. Inconsistent condom use was associated with enrollment in the MMTP where condoms were available only upon request and abstinence and monogamy between uninfected partners were promoted. CONCLUSIONS: Injecting drug users who self-select to participate in MMTP and HIV C and T, two public health HIV-prevention interventions, reduce their HIV-risk behaviors. Clients should be encouraged to remain in MMTP and HIV-infected clients should attend support groups for HIV-positive persons. MMTP staff should promote a variety of safer sex behaviors and provide condoms without request.

Adult↗
PubMed1997

Investigating the relationship between economic status and HIV risk.

Although anecdotal information suggests that there is a relationship between socioeconomic status and HIV risk, there have been few investigations of that possible relationship. Understanding that relationship can have important implications for designing and implementing prevention programs. This study investigated the relationship between indicators of socioeconomic status and HIV prevalence in Massachusetts using seroprevalence data from publicly funded test sites. HIV seroprevalence was found to differ depending on demographic groups and the health care insurance/provider. Those who had no insurance or were Medicaid recipients had higher rates of HIV infection. Homeless individuals were also at higher risk. Further, low-income ZIP codes in Massachusetts were four times more likely to have high seroprevalence rates among residents voluntarily testing for HIV. Thus, HIV seroprevalence appears to be associated with socioeconomic status in this group of voluntarily tested individuals.

Adolescent↗
PubMed1996

Cytokine regulation of HIV replication induced by dendritic cell-CD4-positive T cell interactions.

It has been established that human immunodeficiency virus (HIV) replication occurs throughout the course of disease in the lymphoid tissue. We have developed a model system to study the effect of cytokines and other agents on HIV replication using cocultures of DCs and T cells that reflect the cell-to-cell interactions that occur in the microenvironment of lymphoid tissue. Dendritic cells from peripheral blood, when pulsed with small amounts of HIV, induce infection in autologous, unstimulated CD4-positive T cells. Using this system, cytokines, anti-cytokine antibodies, and inhibitors of cellular activation were added to cultures and the effects on cellular proliferation and activation and HIV production were measured. Cytokines that increased T cell proliferation, such as IL-2 and IL-4, enhanced HIV replication, while the effect of IL-12 was more complex. HIV production was inhibited by blocking endogenously produced IL-2, as well as by adding IL-10, which blocks IL-2 secretion, antigen-presenting cell function, and T cell activation. Proinflammatory cytokines induced modest enhancement of viral replication in cocultures of HIV-pulsed DCs and CD4-positive T cells. Thus, using a model of HIV replication that more closely mimics the in vivo microenvironment of lymphoid tissue may allow a better analysis of the effect of cytokines and cytokine networks, as well as agents that modify immune activation on HIV replication.

B-Lymphocytes↗
PubMed1994

Role of health beliefs in patient compliance with preventive dental advice.

Lack of patient compliance with health recommendations is a well known fact. What is less well understood are the reasons why. This study used the Health Belief Model (HBM) to investigate the role of patients' health beliefs in patient compliance with preventive dental advice. A questionnaire was constructed to explore the four beliefs of "seriousness", "susceptibility", "benefits" and "self-efficacy" and this was administered to 43 adult patients attending the conservation department of a large teaching hospital for routine examination. Patients were seen twice, 1 month apart. At visit one, plaque was disclosed and plaque and bleeding scores were recorded. Patients were taught the modified Bass technique of plaque removal. Plaque and bleeding scores were repeated on visit two, 1 month later. Compliance was defined as any reduction in these scores at visit two. The health belief of "benefits" taken as a single variable showed a significant correlation with compliance and the combined beliefs of "susceptibility" and "benefits" were also found to be significantly related to compliance.

Adolescent↗
PubMed1992

Public perceptions of the funding of NHS dental services.

A survey was carried out of 102 members of the general public, asking for their views of the recent changes in the government funding of NHS dentistry. Approximately 80% of those surveyed had heard about the changes. The majority thought that the implications of the change would be a rise in costs to patients and a fall in the number of NHS dentists.

Adolescent↗
PubMedDate not supplied

Retention in methadone maintenance treatment programs, Connecticut and Massachusetts, 1990-1993.

The goal of this study was to identify factors associated with six- and 12-month retention in methadone maintenance treatment programs (MMTPs) in Massachusetts and Connecticut. Data was obtained from 674 participants, clinic records, and clinic staff. Ethnographic and logistic regression analyses were conducted. Overall, 69% and 48% of the clients remained in treatment at six months and 12 months, respectively. The MMTPs were categorized as either a 12-Step, case management, or primary care model. Factors independently associated with retention in treatment at six months were each one-year increase in age of client (OR 1.05), injecting at three months (OR 0.47), and enrollment in the primary care model (OR 2.10). The same factors were associated with 12-month retention in treatment. To retain clients in MMTPs-which should, in turn, help reduce drug use and prevent HIV transmission among IDUs-younger IDUs and clients still injecting at three months after entering drug treatment may need additional services from the staff, or alternative treatment regimens. MMTP directors should consider differences between these programs and, if appropriate, make changes to increase retention in treatment.

Adult↗
PubMedDate not supplied

Caries prediction and indicators using a pediatric risk assessment teaching tool.

The goals of this study were to determine both predictability and risk indicators in a young pediatric population seen in a dental school clinic using a Caries Risk Assessment teaching tool. Assigned risk categories and factors for 140 patients were analyzed for relationships with future caries development using Logistic Regression (p < 0.01) and Chi-square analysis (p < 0.05). Among the group developing caries, variables and disease were analyzed using ANOVA Independent Samples Test (p < 0.05). Assigned-risk categories were significantly predictive with odds ratios (OR) of Moderate- and High-risk developing new caries being 5.41 and 28.64 respectively when compared with Low-risk. Significant risk indicators were diet, oral hygiene and the presence of caries and decalcifications. The risk assessment tool used in this study predicted future caries development. Through this method of assessment, caries risk indicators in the population studied were determined to be diet, oral hygiene and past caries experience.

Analysis of Variance↗