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Biomedical subjects

B Forsyth

Publications and source records attributed to B Forsyth.

16 recordsLinked to original sources
PubMed2004

Integrating prevention of mother-to-child HIV transmission into antenatal care: learning from the experiences of women in South Africa.

In 1999, for the first time in South Africa, a Mother-to-Child HIV Transmission (MTCT) prevention programme was implemented at the routine primary care level and not as part of a research protocol. A total of 264 women attending prenatal care in these clinics were interviewed in Xhosa using a standardized questionnaire. All had been offered HIV testing, and 95% had accepted. Women who had not been tested were four times more likely to believe that in the community families reject HIV-positive women (p<0.005). Of women who tested, 19% were HIV positive and 83% had told their partner that they had taken the test. HIV-positive women who had not disclosed testing to their partners were three times more likely to believe that, in the community, partners are violent towards HIV-positive women (p<0.005); 86% stated that they would have taken AZT if found to be HIV positive. Only 11% considered that the use of formula feeding indicated that a woman was HIV positive. In conclusion, routine prenatal HIV testing and interventions to reduce perinatal HIV transmission are acceptable to the majority of women in a South African urban township, despite an awareness of discrimination in the community towards HIV-positive women.

Adult↗
PubMed2001

Initiation of osteoporosis treatment after bone mineral density testing.

The aim of the study was to describe initiation of osteoporosis drug therapy after bone mineral density (BMD) testing and to determine any association with BMD test results obtained, physician factors, or both. The setting was the Kaiser Foundation Health Plan (KFHP), a large health maintenance organization (HMO) in Northern California. Data were collected from bone densitometry centers at four KFHP medical centers sites in Sacramento, San Rafael, Fresno, and Oakland. We identified 17,290 women aged > or = 45 years who had BMD testing between January 1, 1997 and June 30, 1999. After excluding those for whom any osteoporosis drugs were prescribed in the year before testing, 8020 women were available for analysis. Using logistic regression, we examined the association between BMD diagnosis (i.e., osteoporosis or osteopenia versus normal) and initiation of drug therapy, for osteoporosis (including hormone replacement therapy (HRT), alendronate, etidronate, raloxifene and calcitonin) within 6 months after the test. Among the 8020 women, 1934 (24%) filled a prescription for an osteoporosis drug within 6 months after BMD testing. Compared with women who had a normal BMD test result, women diagnosed with osteopenia were nearly 4 times more likely (OR = 3.7; CI = 3.0-4.4), and women diagnosed with osteoporosis were 15 times more likely (OR = 15.0; CI = 12.5-18.1), to fill a prescription for an osteoporosis drug within 6 months after BMD testing. Women with high exposure to corticosteroid agents were twice as likely (OR = 2.1; CI = 1.7-2.7) to start osteoporosis drug therapy compared with women who were not similarly exposed; women diagnosed with recent osteoporotic fractures were 50% more likely (OR = 1.5; CI = 1.2-1.9) to begin therapy than women without such fractures. Despite the strong association between BMD and initiating treatment, nearly half the osteoporotic women did not initiate treatment. In addition, we found that age strongly influenced choice of osteoporotic drug. Compared with osteoporotic women aged 45-54 years, women aged 55-64 years who started drug therapy were 40% more likely (OR = 1.4; CI = 1.0-2.2) and women aged > or = 65 years were twice as likely (OR = 2.0; CI = 1.4-2.8) to start non-HRT drugs. BMD test results indicating osteoporosis were thus strongly associated with increased likelihood of beginning drug therapy, and half of such women initiated therapy. Drug initiation was also associated with other factors, including age, use of corticosteroid agents, recent fracture, and physician characteristics. However, these factors showed much weaker associations than those found for BMD. Health care providers must consider whether test results will influence treatment decisions, and our data indicate that results of BMD testing do influence management decisions regarding osteoporosis drug use for women.

Absorptiometry, Photon↗
PubMed1996

Delayed entry into health care for women with HIV disease.

OBJECTIVE: The primary objective was to evaluate factors that might influence delayed entry into health care for women with HIV. Implications of time of diagnosis for early medical intervention was a focused aspect. PROCEDURE: Structured clinical interviews were conducted with HIV-positive women (n = 48); these data were supplemented by medical chart reviews. MEASURES: Delayed entry into health care was operationalized as a difference of more than 3 months between diagnosis and entry into care. Measures of race, social class, risk behavior circumstances of HIV testing, and health status were included. RESULTS: Of women, 58% delayed entry into care following an HIV diagnosis. Upon entry into health care, 65% of women were symptomatic and 40% were severely immunocompromised (CD4 cells/mm3 < 200). Results from the logistic regression indicated that those who learned their HIV status prenatally were four times more likely to delay entry into care compared to those who self-referred for HIV testing, even after controlling for symptom status. CONCLUSIONS: HIV diagnosis is not enough to ensure that women with HIV will get adequate and timely health care. Counseling and testing recommendations should highlight the intrinsic value of early diagnosis.

Adolescent↗
PubMed1992

Identification and management of psychosocial and developmental problems in community-based, primary care pediatric practices.

The importance of psychological and social issues for children's well-being has long been recognized and their importance in the practice of pediatrics is well documented. However, many of the studies looking at this issue have emphasized psychiatric problems rather than issues commonly referred to as the new morbidity. The goal of this research was to refocus interest on the problems of the new morbidity. This study examined the rates and predictors of psychological problems in 19 of 23 randomly chosen pediatric practices in the greater New Haven area. Families of all 4- to 8-year-old children were invited to participate and to complete the Child Behavior Checklist prior to seeing a clinician. Clinicians completed a 13-category checklist of psychosocial and developmental problems based on a World Health Organization-sponsored primary care, child-oriented classification system. Of the 2006 eligible families, 1886 (94%) participated. Clinicians identified at least one psychosocial or developmental problems in 515 children (27.3%). Thirty-one percent of the children with problems received no active intervention, 40% received intervention by the clinician, and 16% were referred to specialty services. Not surprisingly, children whose problems were rated as moderate or severe were twice as likely to be referred compared with children with mild problems. Recognition of a problem was related to four characteristics: if the visit was for well child rather than acute care; if the clinician felt he or she knew a child well; if the child was male; and if the child had unmarried parents (all P less than or equal to .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1989

The effect of lead on thyroid function in children.

Exposure to inorganic lead has been associated with impaired uptake of iodine by the thyroid as well as depressed estimated free thyroxine levels in occupationally exposed adults. Consideration of the serious consequences of impaired thyroid function in young children prompted investigation of the effects of lead on thyroid function in children. Blood lead determinations and thyroid function tests were performed on 68 children examined at a hospital outpatient pediatric clinic. Serum thyroxine (T4) and free thyroxine (FT4) levels were within the normal range for all patients. No statistically significant relationship was found between lead levels and T4 or FT4 levels. We conclude that lead is unlikely to have a clinically significant effect on thyroid function in children exposed in inner cities at prevailing levels.

Child↗
PubMed1989

Jaundice, terminating breast-feeding, and the vulnerable child.

Jaundice is the most commonly treated condition of otherwise well newborns. Although recommended treatments are thought to be safe and effective, the impact of jaundice and therapy on maternal attitudes and behavior is unknown. It was hypothesized that, in contrast to comparison mothers, mothers of jaundiced infants would be more likely to stop breast-feeding in the first month of life, have more separation difficulties with their infant, and be greater users of health care. Both groups of mothers were surveyed in the hospital and 1 month after discharge. Mothers were eligible if their infants were born at Yale-New Haven Hospital after February 1987 and were in the regular nursery. Jaundiced infants had a total serum bilirubin concentration greater than or equal to 205 mmol/L (12 mg/dL); control infants were not jaundiced. Of those who agreed to participate, 84% (85/101) of mothers of jaundiced infants and 80% (124/155) of control mothers completed the 1-month questionnaire. There were no substantial differences between the control and jaundiced groups, respectively, with regard to maternal age (29.1 years vs 29 years) education (66% vs 60% some college), or race (86% vs 82% white). Breast-feeding was more common in the jaundiced group (61% vs 79%, P less than .05). By 1 month, more mothers of jaundiced infants had completely stopped breast-feeding (19% vs 42%, P less than .01). They were more likely to have never left the baby with anyone else (including the father) or left the baby at most one time for less than 1 hour (15% vs 31%, P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Medically unnecessary hospital use in children seropositive for human immunodeficiency virus.

Stimulated by reports that some children who are seropositive for human immunodeficiency virus (HIV+) have been abandoned in the hospital, we studied the extent of, and reasons for, medically unnecessary hospital use at Yale-New Haven (Conn) Hospital among HIV+ children. We reviewed inpatient stays for all HIV+ children hospitalized through Oct 31, 1987. Hospital days were judged to be unnecessary if they failed to meet any of the criteria on the Pediatric Appropriateness Evaluation Protocol. Among 34 children eligible for the study, 54% of their hospital days were judged medically unnecessary; 59% of the children had at least one such day. Unnecessary use was 100% for one-day stays (all for gamma-globulin infusions) and 58% for stays longer than three weeks, with 94% of those unnecessary days being secondary to placement problems. The rate of unnecessary days has declined from 64% of all hospital days in 1983 and 1984 to 30% in 1987 as a result of improved outpatient services and access to foster care. Improved medical and social services could substantially reduce the cost of medically unnecessary hospital care in HIV+ children.

Child↗
PubMed1987

Galactoside-binding lectin in human tissues.

Lactose-inhibitable lectin activity has been analyzed by hemagglutination assay in a variety of human tissues and cells obtained at surgery and autopsy. The lectin activity was detected in surgically removed melanoma, sarcoma, colon carcinoma, breast carcinoma, adjacent non-malignant tissues, non-malignant tissues obtained at autopsy and in cells isolated from malignant effusions. Although, on average, malignant tissue had a higher hemagglutinating titer than non-malignant tissue, similar tissues from different individuals varied widely in their apparent lectin content. The lectin was isolated from lung by affinity chromatography and was found to have a native molecular mass of 31,000 daltons and a subunit molecular mass of 14,000 daltons. Utilizing rabbit anti-lung lectin serum in an immunohistochemical assay, the lectin was found to be distributed throughout the cytoplasm of lung epithelial cells. Ouchterlony immunodiffusion analysis confirmed the presence of this lectin in a variety of tissues and in some body fluids. In vitro metabolic radiolabelling experiments showed that the presence of lectin in tissues was most likely due to endogenous synthesis rather than absorption from body fluids. Lectin isolated from several tissues was found to bind to human buffy coat cell receptors.

Electrophoresis, Polyacrylamide Gel↗
PubMed1987

Do mothers overestimate the seriousness of their infants' acute illnesses?

The purpose of this study was to determine if mothers generally perceive their infants as more ill than do pediatricians, and if the presence of fever has an impact on the perceptions of either the mother or pediatrician. One hundred eighty-seven mothers and their infants, from a primary care clinic (n = 109) and private practice (n = 78), were enrolled at the 2-week well-child visit and were asked to contact a physician participating in the study whenever their infants became acutely ill. The mothers were asked to rate the severity of their infants' illness according to a 3-point scale, first at home and then simultaneously, but independently, with a physician in the office. In general, mothers rated their infants equally as ill at home as in the office (kappa = 0.59). However, both their home ratings (kappa = 0.15) and office ratings (kappa = 0.29) were in poor agreement with the ratings of the physicians. The mothers consistently rated their infants as more ill than did the pediatricians (p less than 0.0001). Both the mothers and physicians perceived infants with higher temperatures (greater than or equal to 38.9 degrees C) as significantly (p = 0.0004) more ill than infants with lower temperatures (less than 38.9 degrees C). We conclude that mothers generally perceive their infants as more ill than do pediatricians, and that it is important for pediatricians to address the perceptions of mothers in order to establish effective communication with them.

Acute Disease↗
PubMed1967

Music therapy.

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Education of Persons with Intellectual Disabilitie↗