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Biomedical subjects

T Joyce

Publications and source records attributed to T Joyce.

At least 19 recordsLinked to original sources
PubMed2003

[Tribologic investigation of a metacarpophalangeal prosthesis].

It is the goal of this paper to introduce modern tribological investigations into the development of a new finger prosthesis, with the particular aim of optimising the material component.A new, unconstrained metacarpophalangeal prosthesis restoring the anatomy of the joint has been developed in two versions (UHMWPE-metal and PEEK-metal). In order to determine the version having better wear behaviour, these two versions were tested on a Joyce finger simulator. As the UHMWPE-metal version showed a lower amount of wear in vitro, this version was chosen to conduct a clinical study. This investigation showed the importance of conducting an in vitro wear test before any clinical studies. Such tests allow the optimisation of the wear behaviour of the tested metacarpophalangeal prosthesis and therefore permit a minimisation of the possible risks to the patients.

Equipment Failure Analysis↗
PubMed2001

Medicaid eligibility and the incidence of ambulatory care sensitive hospitalizations for children.

In this study we investigate the effect of Medicaid on children's health, as measured by the incidence of ambulatory care sensitive (ACS) hospitalizations in the USA. The use of ACS hospitalizations is a unique contribution of our study. ACS discharges are known to be sensitive to better primary care and greater medical intervention and are objective measures of children's health. The results of this analysis were mixed. We found relatively robust evidence that the Medicaid expansions decreased the incidence of ACS hospitalizations among children age 2-6 from very low-income areas. For other groups of children, our results were less consistent. There was some evidence, although not uniform, that the Medicaid expansions improved the health of children age 2-6 from what we refer to as near-poor areas, areas with a median family income between $25,000 and 30,000. For older children, age 7-9, we found little evidence that the Medicaid expansions improved their health.

Ambulatory Care↗
PubMed2001

Challenging behaviour in community services.

The implementation of community care in the UK has led to the requirement that services should be able to meet the needs of adults with intellectual disability (ID) and additional needs in terms of challenging behaviour. However, the extent to which people with challenging behaviour are present in the community and the extent to which community services can support them effectively still requires significant research. The present study examines the prevalence of challenging behaviour amongst adults with ID residing in three London boroughs and the issues which arise from service delivery to this client group. All service providers and general practitioners in the area were contacted and asked to identify any individuals with ID and challenging behaviour. All responses were screened, and then key staff were interviewed for information on a range of demographic factors and on the Checklist of Challenging Behaviour. The reliability of the instrument was also assessed. Four hundred and forty-eight individuals were identified from a total borough population of 670 000. There was consistency in the types of behaviour which were frequently identified across the three boroughs. There were significant levels of self-injury as well as a range of behaviours of the 'hard to engage' type. Most individuals had more then one challenging behaviour and some individuals with seriously aggressive behaviour used local community services. Twenty-five per cent of the sample lived at home with their families and 50% were in community residential services. The boroughs differed in their ability to manage those with challenging behaviour in that one borough had many more people placed out-of-borough. Significant numbers of individuals with challenging behaviour were living in the community. The range and number of behaviours suggest that staff need to be very skilled in supporting such individuals, and that effective planning and support are essential if people with challenging behaviour are to be maintained in community settings.

Activities of Daily Living↗
PubMed2001

Paroxysmal supraventricular tachycardia: outcome after ED care.

The objective of this study was to investigate the outcome and rate of symptomatic recurrence of paroxysmal supraventricular tachycardia (PSVT) in an emergency department (ED) patient population, after ED management and disposition. A retrospective descriptive review of ED records and state death registry was performed. The study took place at a University hospital ED with 60,000 annual patient volume. The subjects were all patients presenting to the ED in PSVT from January 1993 to December 1996. One hundred eleven patients met entry criteria. The mean age was 53 years, 49% were men, and 51% were women. EMS was used by 47 (42%) patients. Ten of these patients who used the EMS system had an unstable event in the prehospital setting. Eleven patients had unstable events once in the ED. ED therapy given (with number of successes in parentheses) included: Adenosine 48 (41), vagal maneuvers 44 (22), calcium channel blockers 22 (14), beta-blockers 10 (4), and electrical cardioversion 5 (1). Twenty-six patients (23%) spontaneously converted to normal sinus rhythm (NSR). Seventy-nine (71%) patients were discharged from the ED. Mean age for this group was 49 years, and the mean ED stay for this group was 3.8 hours. Three patients (4%) in this group had a recurrence of their SVT after discharge. These patients all had recurrence within 24 hours, and none had an unstable event associated with their recurrence. Thirty-two (29%) patients were admitted to the hospital, with 3 (9%) going to a monitored floor, and 29 (91%) going to an intensive care unit. Mean age for this group was 65 years. Twenty-one of these 32 admitted patients (65%) required continued in-hospital therapy once admitted for their arrhythmia. Six of the 32 admitted patients (19%) had recurrent PSVT in the hospital, with 1 episode of instability. Recurrence of PSVT was more likely to occur among those admitted (P <.05), in older patients (P<.01), and in those with a history of cardiovascular disease (P <.01). No deaths were recorded in either group. Most patients with PSVT can be safely discharged from the ED after short-term observation if therapy produces prompt conversion to NSR. PSVT recurrence is relatively uncommon and usually occurs within 24 hours of ED presentation. PSVT recurrence occurs more often in the elderly and in those with established cardiac disease.

Aged↗
PubMed2001

Solar disinfection of drinking water protects against cholera in children under 6 years of age.

BACKGROUND AND AIMS: We have previously reported a reduction in risk of diarrhoeal disease in children who used solar disinfected drinking water. A cholera epidemic, occurring in an area of Kenya in which a controlled trial of solar disinfection and diarrhoeal disease in children aged under 6 had recently finished, offered an opportunity to examine the protection offered by solar disinfection against cholera. METHODS: In the original trial, all children aged under 6 in a Maasai community were randomised by household: in the solar disinfection arm, children drank water disinfected by leaving it on the roof in a clear plastic bottle, while controls drank water kept indoors. We revisited all households which had participated in the original trial. RESULTS: There were 131 households in the trial area, of which 67 had been randomised to solar disinfection (a further 19 households had migrated as a result of severe drought). There was no significant difference in the risk of cholera in adults or in older children in households randomised to solar disinfection; however, there were only three cases of cholera in the 155 children aged under 6 years drinking solar disinfected water compared with 20 of 144 controls. CONCLUSIONS: Results confirm the usefulness of solar disinfection in reducing risk of water borne disease in children. Point of consumption solar disinfection can be done with minimal resources, which are readily available, and may be an important first line response to cholera outbreaks. Its potential in chorine resistant cholera merits further investigation.

Child, Preschool↗
PubMed2001

Welfare reform and the perinatal health and health care use of Latino women in California, New York City, and Texas.

OBJECTIVES: This study analyzed changes in the financing of prenatal care and delivery, the use of prenatal care, and birth outcomes among foreign-born vs US-born Latino women following enactment of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) in August 1996. METHODS: We used a pre-post design with a comparison group. The sample consisted of resident Latinas in California, New York City, and Texas who delivered a live infant in 1995 or 1998. RESULTS: The proportion of births to Latinas that initiated prenatal care in the first 4 months of pregnancy increased for all foreign-born Latinas in California, New York City, and Texas between 1995 and 1998 (P <.05). Except for non-Dominicans in New York City, there was no increase in the proportion of low- or very-low-birthweight births among foreign-born vs US-born Latinas in the 3 localities between 1995 and 1996. CONCLUSIONS: There is little evidence from vital statistics in California, New York City, and Texas that PRWORA had any substantive impact on the perinatal health and health care utilization of foreign-born relative to US-born Latinas.

California↗
PubMed2001

Changes in prenatal care timing and low birth weight by race and socioeconomic status: implications for the Medicaid expansions for pregnant women.

OBJECTIVE: To conduct the first national study that assesses whether the Medicaid expansions for pregnant women, legislated by Congress over a decade ago, met the policy objectives of improved access to care and birth outcomes for poor and near-poor women. DATA SOURCES/STUDY SETTING: Data on 8.1 million births using the 1980, 1986, and 1993 National Natality Files. We use births from all areas of the United States except California, Texas, Washington, and upstate New York. METHODS: We conduct a before and after analysis that compares obstetrical outcomes by race and socioeconomic status for the periods 1980-86 and 1986-93. We examine whether women of low socioeconomic status showed greater improvements in outcomes during the 1986-93 period compared to the 1980-86 period. We analyze two obstetrical outcomes: the rate of late initiation of prenatal care and the rate of low birth weight. DATA COLLECTION: Natality data were aggregated to race, socioeconomic status, age, and parity groups. RESULTS: During the 1986-93 period, rates of late initiation of prenatal care decreased by 6.0 to 7.8 percentage points beyond changes estimated for the 1980-86 period for both white and African American women of low socioeconomic status. For some white women of low socioeconomic status, the rate of low birth weight was reduced by 0.26 to 0.37 percentage points between 1986 and 1993 relative to the earlier period. Other white women of low socioeconomic status and all African American women of low socioeconomic status showed no relative improvement in the rate of low birth weight during the 1986-93 period. CONCLUSIONS: The expansions in Medicaid lead to significant improvements in prenatal care utilization among women of low socioeconomic status. The emerging lesson from the Medicaid expansions, however, is that increased access to primary care is not adequate if the goal is to narrow the gap in newborn health between poor and nonpoor populations.

Adult↗
PubMed2000

The stability of pregnancy intentions and pregnancy-related maternal behaviors.

OBJECTIVES: Our objectives were to characterize the stability of pregnancy intention and to examine whether stability is associated with the timing of prenatal care initiation, smoking during pregnancy, and breastfeeding. METHODS: We use a sample of women from the National Longitudinal Survey of Youth (NLSY) for whom information on pregnancy intention was collected both during pregnancy and after delivery. In bivariate analyses we compare outcomes and characteristics of women whose pregnancy intention changed between the prenatal and postpartum periods. With multivariate methods, we analyze the correlates of switching pregnancy intention as well as the association between switching and maternal behaviors. RESULTS: Women whose pregnancy intention changes between the two assessments are similar in marital status and socioeconomic background to those who report both during pregnancy and after delivery that the pregnancy is unintended. Disagreement during pregnancy between the parents' pregnancy intentions is the most important predictor of instability in the mother's pregnancy intention. Effects of unintended pregnancy on the timing of initiation of prenatal care, smoking during pregnancy, and breastfeeding based on reports after delivery are smaller than those based on reports during pregnancy, although differences are not statistically significant. Adverse effects of unintended pregnancy are greater when pregnancies reported by the mother to be unintended at either assessment are combined into a single category for unintended pregnancy. CONCLUSION: Unstable pregnancy intention may be a marker for adverse maternal behaviors related to infant health.

Adolescent↗
PubMed2000

Did recent expansions in Medicaid narrow socioeconomic differences in hospitalization rates of infants?

OBJECTIVE: To test whether socioeconomic differences in the ratio of infant hospitalizations to births, a proxy for infant hospitalization rates, and hospital lengths of stay for infants narrowed between 1988 and 1992: a period of large increases in the numbers of low-income infants enrolled in Medicaid. RESEARCH DESIGN: Before and after comparison of socioeconomic differences in the ratio of infant hospitalizations to births (ie, infant hospitalization rates) and lengths of stay between 1988 and 1992. By use of ICD-9 codes, hospitalizations were categorized as mandatory or discretionary. The difference between the 2 is that discretionary hospitalizations are potentially avoidable with appropriate primary care. Difference-in-differences techniques were used to assess the differential change in the rates of hospitalizations and lengths of stay for infants from low-income, compared with high-income, zip codes. SETTING AND PARTICIPANTS: Discharges of infants <2 years of age at 326 nonfederal, short-term, general, and other specialty hospitals in 8 states. OUTCOME MEASURES: Ratios of discretionary and mandatory hospitalizations to births (ie, hospitalization rates) and hospital lengths of stay of infants <2 years of age. RESULTS: Infants from the poorest zip codes had ratios of discretionary hospitalizations to births (discretionary hospitalization rate) that were 3.1% points higher than infants from the wealthiest zip codes and ratios of mandatory hospitalizations to births (mandatory hospitalization rates) that were 0.2% points higher. Poor versus nonpoor differences in lengths of stay were 0.3 and 1.9 days for discretionary and mandatory hospitalizations, respectively. No narrowing in the socioeconomic gradients about ratios of hospitalizations to births (ie, rates of hospitalization) or lengths of stay was observed. CONCLUSIONS: Expansions in the Medicaid program from 1988 to 1992 did not result in a decrease in ratios of discretionary hospitalizations to births (ie, discretionary hospitalization rate) or hospital length of stay for infants from low-income areas.

Child Health Services↗
PubMed2000

Mental health service use by elderly patients with bipolar disorder and unipolar major depression.

Symptoms, functioning, and mental health service use were compared in older out-patients with bipolar disorder and unipolar depression. Bipolar outpatients (n = 37, mean age = 69.7) had higher total symptom severity and positive symptom scores, more impaired community-living skills, and earlier age at onset of illness than patients with unipolar depression (n = 85, mean age = 70.9). Bipolar elderly patients used almost four times the total amount of mental health services and were four times more likely to have had a psychiatric hospitalization over the previous 6 months. These findings underscore the need for effective services for elderly patients with bipolar disorder, who account for a minority of patients with affective disorders, but use a disproportionate amount of costly services.

Aged↗
PubMed1999

Impact of augmented prenatal care on birth outcomes of Medicaid recipients in New York City.

I examine whether New York State's Prenatal Care Assistance Program (PCAP) is associated with greater use of prenatal services and improved birth outcomes. PCAP is New York State's augmented prenatal care initiative that became a part of the Medicaid program after expansion in income eligibility thresholds in January, 1990. Data are from the linkage of Medicaid administrative files with New York City birth certificates (N = 23,249). For women on cash assistance, I find PCAP is associated with a 20% increase in the likelihood of enrollment in WIC, an increase in mean birth weight of 35 g and a 1.3 percentage point drop in the rate of low birth weight. Associations between PCAP and improved birth outcomes for women on medical assistance are similar, but appear contaminated by selection bias. Reductions in newborn costs associated with PCAP participation are modest, between US$100-300 per recipient, and are insufficient to offset program expenditures.

Female↗
PubMed1999

Persistence and desistance of oppositional defiant disorder in a community sample of children with ADHD.

OBJECTIVE: To examine the developmental progression of comorbid oppositional defiant disorder (ODD) in a community sample of children with attention-deficit hyperactivity disorder (ADHD) with particular emphasis on persistence and desistance of ODD and the emergence of new cases of conduct disorder (CD). METHOD: A sample of disruptive children was identified from a multiple-gate epidemiological screen and stratified into diagnostic subgroups on the basis of a structured interview. A comparison sample of nondisruptive children was also identified. Group comparisons were performed on demographic, descriptive, family history, and clinical characteristics. Changes in rates of ODD symptoms and diagnostic subgroup membership were assessed after a 4-year longitudinal interval. Predictors of diagnostic group persistence were tested. RESULTS: Few differences distinguished diagnostic subgroups at baseline. Of the 43 children with baseline diagnoses of ADHD + ODD, only 1 (2.3%) was found to have developed CD at follow-up. Over time there was a 57% rate of ODD persistence and a 43% rate of ODD desistance. Negative parenting practices and mothers' psychiatric disorders predicted persistence of ODD. CONCLUSIONS: There was little evidence to show that ODD acted as a precursor to CD. However, when CD was diagnosed at baseline it was always associated with or preceded by ODD (i.e., prodrome). For a subgroup of children with ADHD, comorbid ODD symptoms are relatively unstable and may represent transient developmental perturbations that have little prognostic significance. For a larger subgroup of children with ADHD, ODD symptoms persist into the adolescent years and are associated with adverse parenting practices.

Adolescent↗
PubMed1999

Solar disinfection of water reduces diarrhoeal disease: an update.

349 Maasai children younger than 6 years old were randomised by alternate household to drink water either left in plastic bottles exposed to sunlight on the roof of the house or kept indoors (control). The trial was run in Maasai by Maasai community elders. Children drinking solar disinfected water had a significantly lower risk of severe diarrhoeal disease over 8705 two weekly follow up visits; two week period prevalence was 48.8% compared with 58.1% in controls, corresponding to an attributable fraction of 16.0%. While this reduction is modest, it was sustained over a year in free living children. It confirms solar disinfection as effective in vivo as a free, low technology, point of consumption method of improving water quality. The continuing use of solar disinfection by the community underlines the value of community participation in research.

Child, Preschool↗
PubMed1998

Conserved elements containing NF-E2 and tandem GATA binding sites are required for erythroid-specific chromatin structure reorganization within the human beta-globin locus control region.

Proper expression of the genes of the human beta-globin gene locus requires the associated locus control region (LCR). Structurally, the LCR is defined by the presence of four domains of erythroid-specific chromatin structure. These domains, which have been characterized as DNase I hypersensitive sites (HSs), comprise the active elements of the LCR. The major focus of this research is to define the cis -acting elements which are required for the formation of these domains of unique chromatin structure. Our previous investigations on the formation of LCR HS4 demonstrated that NF-E2 and tandem, inverted GATA binding sites are required for the formation of the native HS. Similarly arranged NF-E2 and tandem GATA sites are present within the core regions of the other human LCR HSs and are evolutionarily conserved. Using site-directed mutagenesis of human HSs 2 and 3 we have tested the hypothesis that these NF-E2 and GATA sites are common requirements for the formation of all LCR HSs. We find that mutation of these elements, and particularly the GATA elements, results in a decrease or complete loss of DNase I hypersensitivity. These data imply the presence of common structural elements within the core of each LCR HS which are required for erythroid-specific chromatin structure reorganization.

Base Sequence↗
PubMed1997

The impact of Mississippi's mandatory delay law on abortions and births.

CONTEXT: Beginning August 8, 1992, a woman in the state of Mississippi had to wait 24 hours after in-person receipt of state-mandated information regarding abortion and birth complications, fetal development, and alternatives to abortion before an abortion could be performed. OBJECTIVE: To analyze the effect of the law on the abortion and birth rates of Mississippi residents. DESIGN: A retrospective analysis of abortion and birth rates before and after the law in Mississippi as contrasted with abortion and birth rates in 2 comparison states, Georgia and South Carolina. Neither Georgia nor South Carolina enforced a mandatory delay law, but both states began enforcement of parental notification statutes during the study period. PATIENTS: Female residents of reproductive age in Mississippi, Georgia, and South Carolina between 1989 and 1994. MAIN OUTCOME MEASURES: We compared birth rates, abortion rates, the percentage of late abortions, and the percentage of abortions performed outside the state of residence for all women and then by age and race before and after August 1992 among women of Mississippi, Georgia, and South Carolina. RESULTS: We found that rate ratios (RRs) of resident abortion rates (rate after law implementation/rate before law implementation) declined 12% more in Mississippi than in South Carolina (95% confidence interval [CI], 8%-15%) and 14% more in Mississippi than in Georgia (95% CI, 10%-17%) in the 12 months after the law went into effect. Rate ratios for white adults declined 22% more in Mississippi than in South Carolina (95% CI, 17%-27%) and 20% more in Mississippi than in Georgia (95% CI, 15%-25%). Changes among nonwhite adults and white teens were more modest but also statistically significant (P<.05). For all women, RRs of the percentage of abortions performed after 12 weeks' gestation increased 39% more in Mississippi than in either South Carolina or Georgia (P<.05); the increase in the percentage of abortions after 12 weeks' gestation was observed for white and non-white adults (P<.05). We also show that the percentage of abortions performed out of state increased 42% more among women in Mississippi relative to women in South Carolina after the law (95% CI, 34%-50%). CONCLUSION: The timing of the decline in abortion rates in Mississippi, the lack of similar declines in comparison states, the rise in percentage of late abortions and abortions performed out of state and the apparent completeness of abortion reports suggest that Mississippi's mandatory delay statute was responsible for a decline in abortion rates and an increase in abortions performed later in pregnancy among residents of Mississippi. The effect of delay laws in other states will likely depend on whether statutes require 2 separate visits to the abortion provider (ie, clinics, hospitals, or physicians' offices where abortions are performed) and the availability of abortion services.

Abortion, Legal↗
PubMed1997

The hospital cost of congenital syphilis.

OBJECTIVE: To determine the hospital cost of caring for newborn infants with congenital syphilis. STUDY POPULATION: All live-born singleton neonates with birth weight greater than 500 gm at an inner-city municipal hospital in New York City in 1989. METHODS: We compared the characteristics of 114 infants with case-compatible congenital syphilis with those of 2906 infants without syphilis. Cost estimates were based on New York State newborn diagnosis-related groups (DRG) reimbursements adjusted for length of stay, birth weight, preterm delivery, and selected maternal risk factors, including infection with the human immunodeficiency virus, cocaine use during pregnancy, and history of injected drug use. RESULTS: For infants with congenital syphilis, the unadjusted mean cost ($11,031) and the median cost ($4961) were more than three times larger than those for infants without syphilis (p < 0.01). After adjustment, congenital syphilis was associated with an additional length of hospitalization of 7 1/2 days and an additional cost of $4690 (both p < 0.01) above mean study population values (7.13 days, $3473). CONCLUSIONS: Based on the number of reported cases (1991 to 1994), the average annual national cost of treating infants with congenital syphilis is approximately $18.4 million (1995 dollars). This estimate provides a benchmark to assess the cost-effectiveness of strategies to prevent, diagnose, and treat the disease.

Adult↗
PubMed1996

State reproductive policies and adolescent pregnancy resolution: the case of parental involvement laws.

State laws regulating abortion have increased markedly in the wake of recent Supreme Court decisions. We test whether laws that require minors to notify or obtain consent from a parent before receiving an abortion affect the likelihood that a pregnancy will be terminated. We use individual data on births and abortions from three southern states, South Carolina, Tennessee, and Virginia. We find that South Carolina's parent consent statute is associated with a decline of 10 percentage points in the probability of abortion among non-black minors of 16 years of age. We find no effect for any other age or racial group and conclude that the impact of parental involvement laws on the pregnancy resolution of minors is not large.

Abortion, Legal↗