Biomedical subjects

Brady West

Publications and source records attributed to Brady West.

5 recordsLinked to original sources

PubMed2006

A prospective study of early pregnancy loss in humans.

OBJECTIVE: To test two hypotheses: In spontaneous conceptions, early pregnancy loss (EPL) is associated with [1] inadequate luteal (ovarian) P, and/or [2] elevated follicular (adrenal) P. DESIGN: A population-based prospective study. SETTING: Thirty rural Bolivian communities. PATIENT(S): Women volunteers (n = 191), 19-40 years old, in stable sexual unions and not using contraception. INTERVENTION(S): Collection of serial saliva samples throughout sequential ovarian cycles and urine samples during late luteal phases. Collections continued throughout pregnancy for each detected conception. MAIN OUTCOME MEASURE(S): Occurrence of spontaneous conceptions and subsequent outcomes. Salivary concentrations of P. Test for elevated urinary human chorionic gonadotropin (hCG). RESULT(S): Luteal (through implantation) P levels were similar in pregnancies lost within 5 weeks after conception (EPL; n = 8) and those pregnancies that were maintained longer (sustained conceptions, SC; n = 32). Follicular P was significantly higher in EPL than in SC. CONCLUSION(S): [1] Elevated follicular P was associated with EPL in natural conceptions in healthy women. [2] Early pregnancy loss exhibits absolute luteal P levels comparable to SC, but lower luteal/follicular P ratios.

Abortion, Spontaneous↗

PubMed2006

Health beliefs and practices related to breast cancer screening in Filipino, Chinese and Asian-Indian women.

BACKGROUND: Cultural-appropriate strategies can be designed to promote cancer screening if the unique needs and characteristics of ethnic groups are identified. Most of the data available for Asian immigrants living in the U.S. has been aggregated under the Asian-American/Pacific Islanders (AAPI) ethnic category. METHODS: A total of 125 women completed self-administered questionnaires that assessed screening practices (i.e. breast self-exam, clinical breast exam, and mammography), related beliefs and knowledge. This paper reports examined cancer-related practices and beliefs among three subgroups of Asian-American women (47 Filipinos, 40 Chinese, and 38 Asian-Indians). RESULTS: The sample mean age was 50.2 years and majority of women (76%) were married. Their length of residence in the United States ranged from less than one year to 37 years, with an average length of residence of 18 years. Results from two-way analyses of variance (ANOVAs) showed the strong influence of ethnicity on perceptions of susceptibility [F(2, 95) = 5.11, p = 0.01] and seriousness [F(2, 99) = 4.85, p = 0.01] related to breast cancer, in addition to an interaction detected between ethnicity and income in terms of perceived barriers [F(5, 107) = 3.04, p = 0.01]. The results also indicated that three common barriers were reported in all three ethnic groups, and three unique barriers were more frequently identified by Chinese (i.e. do not need mammogram if I feel ok [OR = 5.450, 95%; CI = (1.643, 18.081)] and waiting time is too long [OR = 5.070, 95%; CI = (1.674, 15.351)]) and Asian-Indian women (i.e. do not know where to get a mammogram [OR = 9.237, 95%; CI = (3.153, 27.059)]). CONCLUSIONS: These findings can be used to develop interventions that are tailored to the special characteristics of immigrant women from different Asian groups.

Adult↗

PubMed2005

PSA testing in office-based clinics: are we testing as much as we think?

BACKGROUND: Self-report studies of widespread use of routine prostate-specific antigen (PSA) testing have fueled concerns about overuse and possible harm. The purpose of this study was to examine use of PSA testing during physician office visits in a national sample of prostate-cancer-free men ages 40 years and older. METHODS: Bivariate and multivariate logistic regression models of receiving a PSA test by prostate-cancer-free men ages 40 years and older were performed using the 2000 National Ambulatory Medical Care Survey. RESULTS: There were 2,709 primary care and urology office visits by prostate-cancer-free men 40 years of age and older, and 10.2% resulted in a PSA test. In a multivariate model, men in their 70s had considerably higher odds (odd ratio, 1.60; 95% CI, 1.11-2.32) and men with multiple medical comorbidities had considerably lower odds (odds ratio, 0.28; 95% CI, 0.10-0.65) of receiving a PSA test. CONCLUSIONS: We report lower use of PSA testing than previously published. Greater insight into use of PSA testing based on clinic and hospital administrative data are required to determine the impact of PSA testing on the cost of health care and prostate cancer incidence and mortality.

Adult↗

PubMed2005

Differences in prescription opioid analgesic availability: comparing minority and white pharmacies across Michigan.

UNLABELLED: Little is known about physical barriers to adequate pain treatment for minorities. This investigation explored sociodemographic determinants of pain medication availability in Michigan pharmacies. A cross-sectional survey-based study with census data and data provided by Michigan community retail pharmacists was designed. Sufficient opioid analgesic supplies was defined as stocking at least one long-acting, short-acting, and combination opioid analgesic. Pharmacies located in minority ( or=70% white residents) zip code areas were randomly selected by using a 2-stage sampling selection process (response rate, 80%). For the 190 pharmacies surveyed, most were located in white areas (51.6%) and had sufficient supplies (84.1%). After accounting for zip code median age and stratifying by income, pharmacies in white areas (odds ratio, 13.36 high income vs 54.42 low income) and noncorporate pharmacies (odds ratio, 24.92 high income vs 3.61 low income) were more likely to have sufficient opioid analgesic supplies (P < .005). Racial differences in the odds of having a sufficient supply were significantly higher in low income areas when compared with high income areas. Having a pharmacy located near a hospital did not change the availability for opioid analgesics. Persons living in predominantly minority areas experienced significant barriers to accessing pain medication, with greater disparities in low income areas regardless of ethnic composition. Differences were also found on the basis of pharmacy type, suggesting variability in pharmacist's decision making. PERSPECTIVE: Michigan pharmacies in minority zip codes were 52 times less likely to carry sufficient opioid analgesics than pharmacies in white zip codes regardless of income. Lower income areas and corporate pharmacies were less likely to carry sufficient opioid analgesics. This study illustrates barriers to pain care and has public health implications.

Adult↗

PubMed2005

Pediatric short bowel syndrome: redefining predictors of success.

OBJECTIVE: To determine predictors of survival and of weaning off parenteral nutrition (PN) in pediatric short bowel syndrome (SBS) patients. SUMMARY BACKGROUND DATA: Pediatric SBS carries extensive morbidity and high mortality, but factors believed to predict survival or weaning from PN have been based on limited studies. This study reviews outcomes of a large number of SBS infants and identifies predictors of success. METHODS: Multivariate Cox proportional hazards analysis was conducted on 80 pediatric SBS patients. Primary outcome was survival; secondary outcome was ability to wean off PN. Nonsignificant covariates were eliminated. P < 0.05 was considered significant. RESULTS: Over a mean of 5.1 years of follow-up, survival was 58 of 80 (72.5%) and 51 weaned off PN (63.8%). Cholestasis (conjugated bilirubin > or =2.5 mg/dL) was the strongest predictor of mortality (relative risk [RR] 22.7, P = 0.005). Although absolute small bowel length was only slightly predictive, percentage of normal bowel length (for a given infant's gestational age) was strongly predictive of mortality (if <10% of normal length, RR of death was 5.7, P = 0.003) and of weaning PN (if > or =10% of normal, RR of weaning PN was 11.8, P = 0.001). Presence of the ileocecal valve (ICV) also strongly predicted weaning PN (RR 3.9, P < 0.0005); however, ICV was not predictive of survival. CONCLUSIONS: Cholestasis and age-adjusted small bowel length are the major predictors of mortality in pediatric SBS. Age-adjusted small bowel length and ICV are the major predictors of weaning from PN. These data permit better prediction of outcomes of pediatric SBS, which may help to direct future management of these challenging patients.

Child Nutritional Physiological Phenomena↗