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Biomedical subjects

W Cunningham

Publications and source records attributed to W Cunningham.

At least 19 recordsLinked to original sources
PubMed2001

Underuse of primary Mycobacterium avium complex and Pneumocystis carinii prophylaxis in the United States.

BACKGROUND: Little is known about the rates of Mycobacterium avium complex (MAC) and Pneumocystis carinii (PCP) prophylaxis adherence to guidelines and how they have changed after introduction of effective antiretroviral therapy. OBJECTIVE: To determine rates of primary prophylaxis for MAC and PCP and to evaluate the influence of sociodemographic characteristics, region, and provider experience. DESIGN: National probability sample cohort of HIV patients in care. SETTING: One hundred sixty HIV health care providers. PATIENTS: A total of 2864 patients interviewed in 1996 to 1997 (68% response) and 2267 follow-up interviews, representing 65% of surviving sampled patients (median follow-up, 15.1 months). MEASUREMENTS: Use of prophylactic drugs, most recent CD4 count, sociodemographics, and regional and total HIV patients/providers. RESULTS: Of patients eligible for primary MAC prophylaxis (most recent CD4 count <50/mm(3) ), 41% at baseline and 40% at follow-up patients were treated. Of patients eligible for primary PCP prophylaxis (i.e., those with CD4 counts <200/mm(3) ), 64% and 72% were treated, respectively. MAC prophylaxis at baseline was less likely in African American (adjusted odds ratio [OR], 35; 95% confidence interval [CI], 0.20-0.59), Hispanic (OR, 27; 95% CI, 0.08-0.94) and less-educated (OR, 0.61; 95% CI, 0.36-1.0) patients and more likely in U. S. geographic regions in the Pacific West (OR, 4.9; 95% CI, 1.0-23) and Midwest (OR, 6.4; 95% CI, 1.2-33) and in practices with more HIV patients. CONCLUSIONS: Most eligible patients did not receive MAC prophylaxis; PCP prophylaxis rates were better but still suboptimal. Our results support outreach efforts to African Americans, Hispanics, the less educated, and those in the northeastern United States and in practices with fewer HIV patients.

AIDS-Related Opportunistic Infections↗
PubMed2001

Is food insufficiency associated with health status and health care utilization among adults with diabetes?

OBJECTIVES: Preliminary studies have shown that among adults with diabetes, food insufficiency has adverse health consequences, including hypoglycemic episodes and increased need for health care services. The purpose of this study was to determine the prevalence of food insufficiency and to describe the association of food insufficiency with health status and health care utilization in a national sample of adults with diabetes. METHODS: We analyzed data from adults with diabetes ( n =1,503) interviewed in the Third National Health and Nutrition Examination Survey. Bivariate and multivariate analyses were used to examine the relationship of food insufficiency to self-reported health status and health care utilization. RESULTS: Six percent of adults with diabetes reported food insufficiency, representing more than 568,600 persons nationally (95% confidence interval, 368,400 to 768,800). Food insufficiency was more common among those with incomes below the federal poverty level (17% vs 4%, P < or = .001). Adults with diabetes who were food insufficient were more likely to report fair or poor health status than those who were not (63% vs 43%; odds ratio, 2.2; P=.05). In a multivariate analysis, fair or poor health status was independently associated with poverty, nonwhite race, low educational achievement, and number of chronic diseases, but not with food insufficiency. Diabetic adults who were food insufficient reported more physician encounters, either in clinic or by phone, than those who were food secure (12 vs 7, P<.05). In a multivariate linear regression, food insufficiency remained independently associated with increased physician utilization among adults with diabetes. There was no association between food insufficiency and hospitalization in bivariate analysis. CONCLUSIONS: Food insufficiency is relatively common among low-income adults with diabetes and was associated with higher physician utilization.

Adult↗
PubMed2001

Self-reported oral dryness and HIV disease in a national sample of patients receiving medical care.

OBJECTIVES: We sought to analyze the relationship between self-reported oral dryness and the demographic, enabling, behavioral, clinical, and treatment characteristics among human immunodeficiency virus (HIV)-positive patients in medical care. STUDY DESIGN: The study group consisted of the HIV Cost and Services Utilization Study cohort, a nationally representative probability sample of HIV-infected adults receiving medical care in the contiguous United States. RESULTS: It was estimated that 29% of adults (64,947 individuals) with HIV infection receiving medical care in the United States have a complaint of dry mouth. A multivariate logistic analysis was carried out to explore the association between several covariates and dry mouth. It was shown that compared with whites, individuals of Hispanic ethnic origin were 61% more likely to report dry mouth (OR, 1.61; 95% CI, 1.04-2.50; P =.04). Those who were unemployed were 55% more likely to report the symptom of dry mouth than were subjects who were employed (OR, 1.55; 95% CI, 1.22-1.98; P =.001). In comparison with nonsmokers, current smokers were 36% more likely to report dry mouth (OR, 1.36; 95% CI, 1.04-1.79;P =.03). The use of antidepressant drugs and antituberculosis/anti-Mycobacterium avium (anti-TB/anti-MAC) medications had the strongest association with dry mouth complaint. Those taking antidepressants were 55% more likely to report dry mouth (OR, 1.55; 95% CI, 1.23-1.97; P =.0001); compared with nonusers, patients receiving anti-TB/MAC drugs were 46% more likely to report dry mouth (OR, 1.46; 95% CI, 1.03-2.06; P =.04]. In comparison with those with undetectable viral load, individuals with a viral load of more than 100,000/mm(3) were 151% more likely to report dry mouth (OR, 2.51; 95% CI,1.58-3.96; P =.0001). CONCLUSIONS: Our findings suggest that optimizing viral suppression, smoking cessation, and tailoring antidepressant and anti-TB/MAC medications may be promising interventions to decrease dry-mouth symptoms among HIV-infected individuals.

Adjuvants, Immunologic↗
PubMed2000

The effect on medical practice of disciplinary complaints: potentially negative for patient care.

AIM: To explore the personal and professional effect on general practitioners (GPs) of receiving a complaint against them to the (former) Medical Practitioners Disciplinary Committee, when the complaint did not proceed to a formal hearing. METHODS: Ten GPs were interviewed by telephone, following an enrollment procedure that protected identities from the interviewer. Qualitative (thematic) analysis of indepth interviews was used to categorise doctors' perceived effects of complaints on practice and to develop a theory on why such effects should occur. RESULTS: Receipt of a complaint had both short- and long-term effects on the doctor, and on their views of patients, society and the disciplinary process. There were immediate negative emotional responses that were sustained in the long-term in a way that adversely effected doctor-patient relationships beyond the relationship with the original complainant. Doctors reported short-term changes in their practice of medicine, with reduced ability to work confidently and decisively. Doctors also reported altered practice in the long-term in the direction of defensive medicine, by withdrawing from providing some services and avoiding perceived at-risk activities. CONCLUSION: The impact of a complaint on the self of the doctor suggests a shame response. There may be a need for the relevant professional college to establish a rapid response 'crash team' to minimize the negative personal and professional effects of a complaint, even when the complaint does not proceed to a formal hearing.

Attitude of Health Personnel↗
PubMed2000

Access to medical care reported by Asians and Pacific Islanders in a West Coast physician group association.

This study examines access to medical care for Asians and Pacific Islanders in the United States, using a survey of patients receiving care provided by a physician group practice association concentrated on the West Coast. Asians and Pacific Islanders who had used their health plan in the past year had worse access to health care than whites, blacks, Hispanics, and Native American or other ethnicities. The odds that Asians reported that they had adequate access ranged from about one quarter to three quarters that of whites, depending on the measure. Cultural differences and associated communication problems may explain the access problems experienced by Asians. Interventions need to be developed to address the problems with access to services, and better translation services may play an important role in improving access to care for Asians. Future studies need to clarify why Asians were more vulnerable to the access problems examined than other ethnic groups that might experience similar barriers.

Adolescent↗
PubMed2000

Perceived unmet need for oral treatment among a national population of HIV-positive medical patients: social and clinical correlates.

OBJECTIVES: This study examines social, behavioral, and clinical correlates of perceived unmet need for oral health care for people with HIV infection. METHODS: Baseline in-person interviews with 2864 individuals were conducted with the HIV Cost and Services Utilization Study cohort, a nationally representative probability sample of HIV-infected persons in medical care. Bivariate and logistic regression analyses were conducted, with unmet need in the last 6 months as the dependent variable and demographic, social, behavioral, and disease characteristics as independent variables. RESULTS: We estimate that 19.3% of HIV-infected medical patients (n = 44,550) had a perceived unmet need for dental care in the last 6 months. The odds of having unmet dental needs were highest for those on Medicaid in states without dental benefits (odds ratio [OR] = 2.21), for others with no dental insurance (OR = 2.26), for those with incomes under $5000 (OR = 2.20), and for those with less than a high school education (OR = 1.83). Low CD4 count was not significant. CONCLUSIONS: Perceived unmet need was related more to social and economic factors than to stage of infection. An expansion of dental benefits for those on Medicaid might reduce unmet need for dental care.

Adult↗
PubMed2000

Access of vulnerable groups to antiretroviral therapy among persons in care for HIV disease in the United States. HCSUS Consortium. HIV Cost and Services Utilization Study.

OBJECTIVE: To employ the behavioral model of health services use in examining the extent to which predisposing, enabling, and need factors explain the treatment of the HIV-positive population in the United States with highly active antiretroviral therapy (HAART). DATA SOURCE: A national probability sample of 2,776 adults under treatment for human immunodeficiency virus (HIV) infection. STUDY DESIGN: The article uses data from the baseline and six-month follow-up surveys. The key independent variables describe vulnerable population groups including women, drug users, ethnic minorities, and the less educated. The dependent variable is whether or not a respondent received HAART by December 1996. DATA COLLECTION: All interviews were conducted using computer-assisted personal interview instruments designed for this study. Ninety-two percent of the baseline interviews were conducted in person and the remainder over the telephone. PRINCIPAL FINDINGS: A multistage logit regression shows that the predisposing factors that have previously described vulnerable groups in the general population with limited access to medical care also define HIV-positive groups who are less likely to gain early access to HAART including women, injection drug users, African Americans, and the least educated (odds ratios, controlling for need, ranged from 0.35 to 0.59). CONCLUSIONS: Those HIV-positive persons with the greatest need (defined by a low CD4 count) are most likely to have early access to HAART, which suggests equitable access. However, some predisposing and enabling variables continue to be important as well, suggesting inequitable access, especially for African Americans and lower-income groups. Policymakers and clinicians need to be sensitized to the continued problems of African Americans and other vulnerable populations in gaining access to such potentially beneficial therapies. Higher income, anonymous test sites, and same-day appointments are important enabling resources.

Adult↗
PubMed1996

Stability of herpes simplex virus DNA in cerebrospinal fluid specimens.

Polymerase chain reaction methods are becoming the standard for the diagnosis of herpes simplex virus (HSV) encephalitis. Little is known, however, about the stability of HSV DNA in cerebrospinal fluid (CSF) specimens. Our results demonstrate that HSV DNA is extremely stable in CSF specimens containing lymphocytes and monocytes. We observed little DNA degradation in specimens stored for 30 days at room temperature (20-23 degrees C), refrigerator temperature (2-8 degrees C), or freezer temperatures (-18 to -22 degrees C and -69 to -72 degrees C). Specimen storage conditions are therefore not so critical for HSV encephalitis detection as for other viral illnesses. It is therefore not necessary to perform a second lumbar puncture to obtain a fresh specimen for the detection of HSV DNA.

DNA, Viral↗
PubMed1988

Emergency department protocol for the diagnosis and evaluation of geriatric abuse.

As the number of elderly persons in the United States continues to increase, geriatric abuse has become the most recent manifestation of domestic violence seen in the emergency department. Recent data suggest that 1 million elderly persons are battered, neglected, or exploited each year by family members or caretakers. This maltreatment may be more difficult to identify than child or spouse abuse because of the relative isolation of the victims and their reluctance to report abuse. Many of these cases involve only subtle signs and have a great potential to pass undetected. We summarize the current literature on geriatric abuse and describe an ED protocol for identifying and reporting suspected victims. We retrospectively reviewed the medical records of 36 elderly patients hospitalized with documented abuse or neglect. Physical maltreatment was evident in 29 patients (80%), and 16 of the cases (44%) involved psychological abuse. Key points in the history, physical examination, and psychosocial evaluation were analyzed to identify specific criteria used in the development of the protocol. This framework will aid the emergency physician in the crucial first steps of identifying abuse, obtaining evidence, and providing immediate treatment and crisis intervention. Awareness that the problem exists and improved detection and intervention procedures are needed to prevent abuse of elderly persons from becoming more widespread.

Aged↗
PubMed1986

Minimal spinal hyperostosis with low-dose isotretinoin therapy.

Skeletal abnormalities have been reported on numerous occasions in patients who have received high doses of vitamin A and its derivatives. Recently, a new derivative, isotretinoin (Accutane, Hoffman-LaRoche, Inc.), has become available for the treatment of cystic acne. Ninety-six patients treated for a minimum of four months with low doses of this drug at two University centers have shown overall good to excellent clinical responses. However, ten of these patients have developed small pointed excrescences on the anterior margins of cervical, thoracic, or lumbar vertebral bodies. The findings are of unknown clinical significance but show some similarities to the spinal findings in DISH syndrome. Follow-up studies will be obtained, but, at the present time, the drug still can be recommended for patients who have severe cystic acne because of the excellent clinical response.

Acne Vulgaris↗
PubMed1984

Endosonic endodontics: the ultrasonic synergistic system.

A biotechnological approach using ultrasound has led to the development of a method of root canal therapy in which effective debridement, shaping, irrigation and disinfection of the root canal are easily and quickly completed. This is achieved by a handpiece and a file both energized by ultrasound. A flow-through component enables an irrigation solution to pass along the file into the canal system. The ultrasonically energized file activates the irrigant facilitating solvent, cleansing and disinfecting actions within the root canal system. The energized file is able to debride the canal wall with great facility in an extremely rapid and simple fashion. Progress in metallurgical bonding has enabled a diamond coated file to be developed which gives efficient and rapid preparation of the root canal. Use of this combination of ultrasound, flow-through irrigation and diamond-coated files enables the dentist to perform endodontic treatment expeditiously while adhering to biologic principles.

Anti-Infective Agents↗
PubMed1981

Implications of cultural patterning for the delivery of alcoholism services. Case studies.

The significance of culturally patterned attitudes and behaviors in "alcoholic families" has rarely been acknowledged by researchers or by clinicians. This paper has described a specific population of families at high risk for alcohol problems, and has presented specific directives for the planning and delivery of services. The findings suggest that to understand the role of alcohol use in this population and to plan and implement effective clinical services to meet critical needs, historical and cultural features must be taken into account. Detailed knowledge of family life-style is characteristically not gathered by care providers within the traditional clinical context. Thus a model for a multidisciplinary team constituted by an anthropologist-researcher and clinician is suggested in such very complex and problematic areas of health concern as alcohol misuse. In this manner sociocultural information may contribute significantly to more effective efforts in the planning and delivery of services.

Alcohol Drinking↗