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Biomedical subjects

B Barrett

Publications and source records attributed to B Barrett.

At least 37 records · Page 2Linked to original sources
PubMed2000

Bridging the gap between conventional and alternative medicine.

BACKGROUND: The use of various forms of complementary and alternative medicine (CAM) has become widespread. We investigated this use in Madison, Wisconsin. METHODS: We conducted semistructured indepth interviews focused on the knowledge, attitudes, and behaviors of a random sample of 17 patients who had used both CAM and conventional therapies during the past year. Participants were recruited using telephone listings. Twenty alternative practitioners were selected to represent the major modalities. The topics discussed included healing philosophy, choices of therapeutic methods, and ideas concerning concurrent use of differing therapeutic modalities. An 8-member multidisciplinary team analyzed the transcripts individually and in group meetings. RESULTS: Four major themes emerged from the interview data: (1) holism, (2) empowerment, (3) access, and (4) legitimization. Both patients and providers distinguished between the socially legitimized and widely accessible but disempowering and mechanistic attributes of conventional medicine and the holistic and empowering but relatively less accessible and less legitimate nature of alternative healing. There was a strong call for integrating the best aspects of both. CONCLUSIONS: Practitioners and users of alternative therapies in the Madison area confirmed both the alternative and complementary natures of unconventional health care, called for more integrated and accessible health care, and provided insights that could be useful in bridging the gap between conventional and alternative medicine.

Attitude of Health Personnel↗
PubMed1999

Herbal remedies.

Explore the source record for details and available documents.

Clinical Trials as Topic↗
PubMed1999

Left ventricular mass index increase in early renal disease: impact of decline in hemoglobin.

Cardiovascular disease occurs in patients with progressive renal disease both before and after the initiation of dialysis. Left ventricular hypertrophy (LVH) is an independent predictor of morbidity and mortality in dialysis populations and is common in the renal insufficiency population. LVH is associated with numerous modifiable risk factors, but little is known about LV growth (LVG) in mild-to-moderate renal insufficiency. This prospective multicenter Canadian cohort study identifies factors associated with LVG, measured using two-dimensional-targeted M-mode echocardiography. Eight centers enrolled 446 patients, 318 of whom had protocol-mandated clinical, laboratory, and echocardiographic measurements recorded. We report 246 patients with assessable echocardiograms at both baseline and 12 months with an overall prevalence of LVH of 36%. LV mass index (LVMI) increased significantly (>20% of baseline or >20 g/m2) from baseline to 12 months in 25% of the population. Other than baseline LVMI, no differences in baseline variables were noted between patients with and without LVG. However, there were significant differences in decline of Hgb level (-0.854 v -0.108 g/dL; P = 0.0001) and change in systolic blood pressure (+6.50 v -1.09 mm Hg; P = 0.03) between the groups with and without LVG. Multivariate analysis showed the independent contribution of decrease in Hgb level (odds ratio [OR], 1.32 for each 0.5-g/dL decrease; P = 0.004), increase in systolic blood pressure (OR, 1.11 for each 5-mm Hg increase; P = 0.01), and lower baseline LVMI (OR, 0.85 for each 10-g/m2; P = 0.011) in predicting LVG. Thus, after adjusting for baseline LVMI, Hgb level and systolic blood pressure remain independently important predictors of LVG. We defined the important modifiable risk factors. There remains a critical need to establish optimal therapeutic strategies and targets to improve clinical outcomes.

Anemia↗
PubMed1999

Plateletpheresis efficiency: a comparison of the spectra LRS and AMICUS separators.

BACKGROUND: Optimizing the yields of plateletpheresis by increasing collection efficiencies may provide several benefits: to patients, by increasing the dose in single-donor platelet (SDP) units; to the collection center, by increasing the percentage of components that may be split into double units; and/or to the donor, by reducing the duration of donation. STUDY DESIGN AND METHODS: A prospective, randomized study was undertaken to compare the efficiency of platelet collection in paired donations by 21 donors on two cell separators (Spectra LRS, version [v] 5.1; and AMICUS, v2.37). The order of donation was randomly assigned; donations were performed at least 2 weeks apart. A fixed blood volume (4000 mL) was processed by utilizing standard protocols. Findings were confirmed in a retrospective, matched study that compared the two separators by using fixed collection times (90 min). RESULTS: The AMICUS and Spectra LRS separators consistently produced white cell-reduced (<1 x 10(6) white cells) components. The AMICUS harvested 32 percent more platelets on average (median, 4.9 x 10(11); range, 1.5-8.7 x 10(11)) than the Spectra LRS (median, 3.7 x 10(11); range, 2.1-7.7 x 10(11)) (p = 0.03), with mean times of 71.5 and 66.0 minutes (p = 0.03), respectively, to process 4000 mL. Mild donor reactions tended to be more common on the AMICUS separator, which used significantly more ACD (median 482 mL vs. 389 mL; p<0.0001) than on the Spectra LRS. CONCLUSIONS: The AMICUS separator harvested more platelets per unit of blood volume processed than the Spectra LRS. Possible benefits include increased dose in each single-donor unit, increased double-unit harvests, and/or shorter donation time.

Cell Separation↗
PubMed1999

Assessing the risks and benefits of herbal medicine: an overview of scientific evidence.

The use of herbal medicine is widespread and growing, with as many as 3 in 10 Americans using botanical remedies in a given year. Because many herbal medicines have significant pharmacological activity, and thus potential adverse effects and drug interactions, healthcare professionals must be familiar with this therapeutic modality. This article summarizes the history and current use of plant-based medicine and highlights the evidence of the risks and benefits associated with 6 plants: echinacea, garlic, ginger, ginkgo, St John's wort, and valerian. Therapies outside the medical mainstream tend to suffer from a dearth of research and critical evaluation. Critics and supporters alike note the conceptual and practical difficulties in studying many complementary and alternative therapies such as acupuncture, homeopathy, and meditation. Herbal medicine, however, lends itself well to standard evaluation methods. This article summarizes and evaluates evidence from randomized controlled trials and meta-analyses. We present the results of meta-analyses and subsequent randomized controlled trials for garlic and St John's wort; a comprehensive critical review and subsequent randomized controlled trials for ginkgo; and summaries of all identified randomized controlled trials for echinacea, ginger, and valerian.

Ericales↗
PubMed1999

Echinacea for upper respiratory infection.

OBJECTIVES: To review the evidence regarding the effectiveness of orally ingested Echinacea extracts in reducing the incidence, severity, or duration of acute upper respiratory infections (URIs). SEARCH STRATEGIES: Information from a wide range of sources was used as background material. More than 100 articles, books, and book chapters were reviewed for content and further references. Database searches, bibliographic reviews, and conversations with experts were carried out iteratively from January 1997 to February 1999. SELECTION CRITERIA: Published or unpublished reports of all blinded placebo-controlled randomized trials of any Echinacea formulation used as a treatment or for the prevention of URIs. DATA COLLECTION AND ANALYSIS: Review considerations included randomization, blinding, power, validity and clinical relevance of outcome measurements, inclusion and exclusion criteria, indistinguishability of treatment and placebo, and appropriateness of conclusions for the data presented. MAIN RESULTS. Nine treatment trials and 4 prevention trials fitting the selection criteria were found. Eight of the treatment trials reported generally positive results, and 3 of the prevention trials reported marginal benefit. Methodologic quality of the majority of the trials was modest. CONCLUSIONS: Evidence from published trials suggests that Echinacea may be beneficial for the early treatment of acute URIs. The influence of publication bias on those results is unknown. Echinacea preparations vary widely in composition, and are often found in combination with other potentially active constituents, making specific dose recommendations problematic. There is very little evidence supporting the prolonged use of Echinacea for the prevention of URIs.

Acute Disease↗
PubMed1998

Efficiency of institutional long-term care and annual demands for placement.

The objective of this study was to determine the efficiency of and annual demands for institutional long-term care placement in the St. John's region. The study population comprised all applicants assessed for institutional long-term care through the Community Health St. John's Region Single Entry System in 1995-96. The outcome measures used for the study included estimates of client resource utilization employing the RUGs III and Alberta Resident Classification System; hospital beds occupied; time to placement; and annual demands on long-term care. The study concludes that objective criteria for admission to supervised care and nursing home care may help reduce the number of inappropriate placements (thus maximizing the use of existing nursing home beds) and decrease annual demands. Investment in alternatives to nursing home care for those with modest disability is suggested.

Activities of Daily Living↗
PubMed1998

Hmong/medicine interactions: improving cross-cultural health care.

BACKGROUND AND OBJECTIVES: There are now more than 100,000 Hmong (Southeast Asian) refugees in the United States. This study examined interactions between Hmong patients and their health care providers and identified specific factors that either enable or obstruct health care delivery. METHODS: We used semistructured interview techniques to investigate patients' and providers' experiences, looking for attitudes, ideas, or behaviors that could be modified to improve health care delivery. Interviews with 23 Hmong patients, 18 health care providers, and six translators were audiotaped, transcribed, and analyzed by a multidisciplinary team. Methods included text analysis, theme identification, rank ordering, participant observation, immersion-crystallization, and open-ended discussion. RESULTS: Hmong patients and their US-trained health care providers have different health belief systems. Both linguistic and cultural translation were seen as problematic. Additionally, an overwhelming number of patients identified kindness, caring, and a positive attitude as important provider characteristics. Providers noted difficulties in understanding Hmong conceptions of acute versus chronic diseases, illness prevention, and pain, both physical and psychological. Many respondents gave suggestions for improvement: 1) learn more about each other's cultures, 2) be patient, kind, and positive, 3) avoid negative statements or predictions, 4) improve translation quality, 5) explain medical terms using visual aids, 6) respect Hmong family-centered decision making, 7) increase the time allotted for translated clinical encounters, and 8) train Hmong health care providers. CONCLUSIONS: Many basic issues in relations between clinicians and Hmong patients must be addressed to improve health care communication.

Asia, Southeastern↗
PubMed1997

State health care reforms: how they affect children and adolescents with emotional disorders and their families.

This article reports on the Health Care Reform Tracking Project, a national study designed to describe and analyze state health care reforms and their impact on children and adolescents with emotional disorders and their families. It summarizes the results of the baseline survey of states conducted in 1995, exploring the nature and extent of the reforms in which states are engaged, most of which involve applying managed care technologies to their Medicaid programs. Trends across states are identified with respect to mental health service delivery, particularly with respect to children and adolescents. The article concludes with a discussion of issues and concerns related not only to mental health service delivery for children and adolescents with emotional disorders and their families but also to the systems of care that have been developing over the past decade to serve them. Some of these concerns include the lack of pilots or demonstrations, limited mental health coverage in some reforms, the lack of integration between mental health and substance abuse systems, the lack of special provisions for children, the need for more reliable bases for deriving capitation rates, the limited incorporation of systems of care, the need to incorporate interagency treatment planning and service delivery approaches, the lack of outcome measures specific to and appropriate for children, and the need for greater family involvement in the planning and implementation of these reforms.

Adolescent↗
PubMed1997

Identity, ideology and inequality: methodologies in medical anthropology, Guatemala 1950-1995.

This paper sketches the history of medical anthropology in Guatemala, focusing on how investigations carried out during the 1950s served as methodological and ideological foundations for subsequent work. Problematic examples from the literature and from the author's experience are used to provide insight into the nature of the anthropologist's role in applied research and development. For example, medical anthropologists are often hired to help navigate the gulf between the ideological identities of indigenous peoples and those of biomedical researchers and international development specialists. Instead of recognizing the inherently ethical nature of this work and acting accordingly, many anthropologists have adopted a detached, "scientific" and impossibly value-free perspective. This paper proposes a transformation of this role into one that (1) maintains an independent and critical relationship to mainstream science, (2) elaborates and advocates the indigenous agenda, and (3) adopts an explicitly value-filled ideology, methodology and theoretical framework.

Anthropology↗
PubMed1996

Integrated local health systems in Central America.

This paper describes a few Central American experiences related to the development of integrated, participatory health care systems. Theory and analytic method center on the tensions inherent in the dichotomies of professional/popular, center/periphery and biomedical/traditional. Using a framework rooted in the World Health Organization's 1978 call for 'health for all' based on community-oriented primary care, this paper concludes that the underlying conditions necessary for truly integrated local health systems have not yet developed. Except for the cases of Costa Rica during 1978-1982 and Nicaragua during 1979-1990, the political will to create and support such systems has not existed. Perhaps more importantly, the cultural milieu in which Central Americans interact with their society fosters an individualistic, commercial, and paternalistic citizen/society relationship rather than the cooperative, community-oriented and democratic spirit needed for successful development of integrated local health systems. Nevertheless, there are a number of positive examples from which we can learn, and a growing tradition of citizen participation which may lead toward appropriate, sustainable, and truly integrated local health systems.

Central America↗
PubMed1996

Incidence of rheumatoid arthritis is not related to indicators of socioeconomic deprivation.

OBJECTIVE: To evaluate the role of socioeconomic factors in susceptibility to rheumatoid arthritis (RA). METHODS: A prospective population based register of inflammatory joint disease (NOAR) recruited 687 adults between 1990 and 1992, of whom 50% satisfied ARA criteria for RA at presentation. Using census data, social class specific incidence rates were calculated for both sexes. A correlation analysis was undertaken examining the association between incidence rates and 5 indicators of socioeconomic status. RESULTS: There was no trend of increasing incidence with declining social class. None of the 5 indicators examined showed any evidence of association with incidence (rs range 0.0-0.3). CONCLUSION: In contrast to the data on factors influencing outcome in established RA, the socioeconomic status variables examined did not explain susceptibility patterns in the population studied.

Adult↗
PubMed1995

Plasmid profiles and resistance to antimicrobial agents among Salmonella enteritidis isolates from human beings and poultry in the midwestern United States.

In the study reported here, 121 Salmonella enteritidis isolates from human beings and 467 isolates from nonhuman sources were analyzed for plasmid pattern and susceptibility to a panel of antimicrobial agents commonly used as biologic markers. A significant (P < 0.05) number of isolates from nonhuman sources were resistant to beta-lactam antibiotics and tetracycline. Resistance to aminoglycosides, quinolones, and trimethoprim/sulfamethoxazole was uncommon. Of the 588 isolates, 445 (76%) were resistant to 2 or more antimicrobial agents. Sixty of 121 (50%) S enteritidis isolates from human beings were susceptible to all 12 antimicrobial agents, but 425 of 467 (91%) S enteritidis isolates from nonhuman sources expressed resistance to 1 or more of the antimicrobial agents used in the study. Analysis of plasmid profiles revealed that significantly (P < 0.05) more isolates from nonhuman sources had high molecular weight plasmids than did isolates from human beings. Isolates from ceca of chickens were associated with patterns of low molecular weight plasmids. Analysis of results of the study revealed similarities among S enteritidis from human beings and eggs, as determined on the basis of plasmid profiles and antibiotic susceptibility patterns, which may implicate eggs as one of the potential sources for infection of human beings. In addition, periodic monitoring of a substantial number of Salmonella isolates to detect drug resistance may be a prudent practice for use in revising the list of antimicrobial agents commonly used in human beings and other animals.

Aminoglycosides↗