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Biomedical subjects

C A Berry

Publications and source records attributed to C A Berry.

At least 19 recordsLinked to original sources
PubMed1999

Decreased physical function in juvenile rheumatoid arthritis.

OBJECTIVE: To assess the extent of physical disability in juvenile rheumatoid arthritis (JRA), classified according to subtype, and whether synovitis or flexion contractures are present on examination. METHODS: This retrospective study included 88 JRA patients and 50 controls without musculoskeletal disease. The outcome measure was the disability index (DI) derived from the Childhood Health Assessment Questionnaire (CHAQ). RESULTS: DI scores for JRA patients with synovitis (mean 0.49, range 0-1.88) and without synovitis (mean 0.37, range 0-1.75) were significantly higher (P < 0.001 for both groups) than for controls (mean 0.06, range 0-0.75, P < 0.001), but not significantly different from one another. Similarly, DI scores for JRA patients with and without any flexion contractures were higher than for controls, but not significantly different from one another. DI scores for JRA patients with both synovitis and flexion contractures were significantly higher than DI scores for JRA patients with neither, but were not distinguishable from JRA patients with synovitis only or flexion contractures only. Likewise, DI scores for JRA patients lacking synovitis and flexion contractures were not significantly different than those for JRA patients with one or the other. DI scores for systemic and polyarticular patients were higher than for pauciarticular patients, and DI scores for all 3 subtypes were higher than for controls. CONCLUSION: Our findings suggest that many JRA patients, including those with pauciarticular JRA, have problems with physical function, even when synovitis and flexion contractures are not present. Further attention and research is needed to elucidate the causes or origins of disability in JRA patients with seemingly well-controlled disease. We recommend that health status instruments like the CHAQ be more widely used for JRA patients to complement other assessments, especially in planning occupational and physical therapy.

Activities of Daily Living↗
PubMed1999

The impact of residency training on physicians' AIDS-related treatment practices: a longitudinal panel study.

PURPOSE: To determine the effects of aspects of residency training on AIDS-related treatment practices. METHOD: The authors conducted a nationwide longitudinal panel study of 394 physicians who graduated in 1989 from six medical schools in New York State. Data were collected during the participants' fourth year of medical school, their third year of residency training, and six years after they had graduated from medical school. Questionnaires sought information about AIDS-related practice behaviors, including avoiding invasive procedures, minimizing contact, emphasizing AIDS prevention and education, and volume of people with AIDS treated. RESULTS: Aspects of residency training had a sustained impact on how the physicians cared for patients with AIDS but not on the numbers of patients they treated. Determinants of treatment practices included aspects of the residency environment (e.g., emphasis on problem solving, student orientation; p < .01), characteristics of the faculty (e.g., commitment to teaching, tolerance of varied viewpoints), cynicism about patient care (p < .001), social biases (homophobia and aversion to intravenous drug users; p < .001), and AIDS-related attitudes (p < .01). CONCLUSIONS: Fundamental changes to residency training, all of which are associated with learner-centered education, can improve physicians' treatment of their patients with HIV and AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Validation of the Brief Pediatric Asthma Screen.

STUDY OBJECTIVES: The purpose of this study was to confirm the validity of a brief screen for pediatric asthma in schools. BACKGROUND: Asthma is the most common chronic disease of childhood, yet the frequency with which this condition is recognized among school-aged children varies widely. Several methods are used to increase the accuracy of detection of asthma, but many are cumbersome and difficult to apply on a large scale. DESIGN: We elected to validate a five-question instrument, the Brief Pediatric Asthma Screen (BPAS), to screen for the presence of asthma among children attending school in Region 5 of the Chicago school district, where the schools report a 2.7% frequency of asthma. The questionnaire was distributed to the parents of grade-school children at the time of report-card pick-up. SETTING: A clinical assessment was performed on a selected group of children whose parents completed the questionnaire in a school and in a hospital outpatient clinic. PARTICIPANTS: Of 4,147 questionnaires that we distributed, 1,796 (43%) were returned. We excluded 341 children (19% of the total sample) whose parents reported that they had been diagnosed with asthma. The remaining pool indicated that the children of 183 responders (10%) had symptoms suggestive of asthma, while 1,272 parents (71%) indicated that their children did not have symptoms of asthma. MEASUREMENTS AND RESULTS: We selected 90 of the respondents who did not indicate that their children had a diagnosis of asthma. Of this group, 81 completed the validation, in which their responses suggested symptoms of asthma (n = 34) or no asthma symptoms (n = 47). The children of these respondents were given a blinded clinical evaluation consisting of history, physical examination, and spirometry. The survey demonstrated a sensitivity of 75% and a specificity of 81.2% for the presence of asthma among those who were unaware of the diagnosis. CONCLUSIONS: The BPAS is brief, can be filled out by parents, and appears accurate in detecting asthma.

Asthma↗
PubMed1998

A new measure of contemporary life stress: development, validation, and reliability of the CRISYS.

OBJECTIVE: To develop and validate a measure of contemporary life stressors. STUDY SETTING: Three interview studies: Study 1 (pilot), 32 caregivers receiving case management services for a child with chronic illness; Study 2 (validation), 311 caregivers of children receiving general pediatric care at a university clinic; Study 3 (reliability), 17 caregivers of children with a complex medical diagnosis. STUDY DESIGN: Study 1: item development via discussions with case managers; piloted with caregivers. Study 2 examined psychometric properties of the measure and correlated it with the CES-D, a measure of depressive symptomatology and the PRQ85-Part 2, a measure of perceived social support, to establish its convergent construct validity. Study 3 established the test-retest reliability of the measure over two weeks by correlating two administrations of the index. DATA COLLECTION: Face-to-face interviews in homes (Study 1) or in clinic waiting rooms (Studies 2 and 3) and by telephone (Study 3 retest). PRINCIPAL FINDINGS: The CRISYS is a flexible, multidimensional tool that demonstrates strong face, content, and construct validity, and excellent test-retest reliability. The format is easy to use and well accepted by respondents and is suitable for low-income populations. CONCLUSIONS: Researchers will find the CRISYS useful when evaluating the success of a clinical model or a healthcare system, and the effectiveness of an insurance plan or a government program. Clinicians may also find that the CRISYS is an effective screen for family needs.

Adult↗
PubMed1997

Reproducibility of retardation measurements with the nerve fiber analyzer II.

PURPOSE: To evaluate the reproducibility of a scanning laser polarimeter, the Nerve Fiber Analyzer II (NFA II, Laser Diagnostic Technologies, San Diego, CA, U.S.A.). METHODS: Five independent retardation maps of the peripapillary retina of five normal eyes were acquired by three experienced operators (including V.S.G.) on each of three separate days for a total of 45 retardation maps per patient. Two methods of image processing, one using a baseline image and another using the individual scans, were used to compare the reproducibility of three summary measures, average retardation, integral, and retardation ratio. RESULTS: The average standard deviation (and its 95% confidence interval) of average retardation within a 10-pixel-width-band of the 9 baseline images was 0.43 degree (0.36-0.51 degree) with a mean coefficient of variation of 4.2% (3.8-4.5%). In a random effects model, each of the three retinal nerve fiber layer (RNFL) summary measures varied significantly by patient (p < 0.016), but not by operator (p > 0.19), or operator by patient interaction (p > 0.524). In addition, there was small, but statistically significant day-by-operator-within-patient (intraobserver) variation in the random effects model. CONCLUSIONS: These results suggest that the NFA II provides reproducible measurements and that, on average, measurements obtained by separate operators on different days are similar.

Adult↗
PubMed1996

Alpha 1-adrenergic control of chloride transport in the rat S1 proximal tubule.

To identify in vivo the specific alpha-adrenergic receptor mediating direct neural control of chloride transport in the rat S1 proximal convoluted tubule (PCT), the major effector site of neural regulation, microperfusion was employed in conjunction with the alpha 1- and alpha 2-adrenergic receptor antagonists, prazosin and rauwolscine. Using a glomerular ultrafiltrate-like perfusate, prazosin markedly inhibited chloride transport by -42% (302 +/- 10 to 176 +/- 5 peq.mm-1.min-1, P < 0.0001). Using a sodium chloride perfusate, which measures the active component of chloride absorption (J(Cl)act) (control, 153 peq.mm-1.min-1) plus a constant passive (479 peq.mm-1.min-1) component, both prazosin and acute renal denervation reduced J(Cl)act by -38% and -44% (-58 and -67 peq.mm-1.min-1, each P < 0.05). In contrast, rauwolscine caused no significant change in J(Cl)act using either perfusate. Prazosin regulates chloride transport via protein kinase C (PKC), since preactivation of PKC by phorbol abolished inhibitory impact of prazosin. Inhibition of J(Cl)act by prazosin (-58 peq.mm-1.min-1) was fully additive to either the stimulation or inhibition (losartan) of angiotensin II (55 or -49 peq.mm-1.min-1), which uses the adenosine 3',5'-cyclic monophosphate (cAMP) second messenger system [observed changes, not significantly different from 0 and -99 peq.mm-1.min-1; expected changes, not significantly different from 0 and -107 peq.mm-1.min-1]. In conclusion, neural control of S1 PCT chloride absorption in vivo is mediated by alpha 1-adrenergic receptors, which can selectively regulate J(Cl)act by altering PKC activity, independently of the cAMP second messenger system.

Absorption↗
PubMed1996

Changes in physicians' attitudes toward AIDS during residency training: a longitudinal study of medical school graduates.

Understanding the impact of training on the development of physicians' attitudes toward AIDS is important to furthering our knowledge of the mechanisms through which socialization affects professional outlook, as well as promoting an adequate supply of providers to treat people with AIDS (PWAs). This prospective panel study collected data on 383 physicians at two critical stages: as fourth-year medical students and as third-year residents. Aspects of residency training (e.g., residents' morale and positive faculty role models) were the most powerful predictors of increase in willingness to treat PWAs. Decline in willingness was primarily a product of negative social attitudes-homophobia and IVDU-phobia (aversion to intravenous drug users). Cynicism toward patient care acted as a trigger, activating the negative effects of IVDU-phobia; having an acquaintance who is HIV positive mediated the negative impact of homophobia. Notably, cynicism was associated with basic aspects of training (specific characteristics of the faculty and of the educational milieu). The findings support a view of socialization as a pervasive process implicating intrinsic aspects of training and having an impact on a broad spectrum of outlooks. Accordingly, interventions must address structural characteristics that transcend AIDS-specific concerns.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Chloride transport in the rat S1 proximal tubule.

In vivo microperfusion was used to elucidate the modes and regulation of the powerful chloride transport system resident in the rat early (S1) proximal convoluted tubule (PCT). From a complete, glomerular ultrafiltrate-like perfusate, omission of organic solutes reduced chloride absorption by 93 peq.mm-1.min-1 (302 +/- 10 to 209 +/- 24, P < 0.001). From a high-chloride perfusate (a relatively pure NaCl solution devoid of bicarbonate and organic solutes), luminal addition of the active transport inhibitor cyanide reduced chloride absorption by 153 peq.mm-1.min-1 (632 +/- 17 to 479 +/- 9, P < 0.001). Active transport was also estimated directly as 121 +/- 4 peq.mm-1.min-1 using a solution in which sodium isethionate isosmotically replaced bicarbonate and organic solutes, preventing development of a chloride gradient. Intravenous angiotensin II caused a stimulation of chloride absorption from a high-chloride perfusate by 55 peq.mm-1.min-1 (632 +/- 17 to 687 +/- 14, P < 0.05), which was partially cyanide-sensitive (510 +/- 6 peq.mm-1.min-1). In conclusion, the components of the normal S1 PCT chloride reabsorption (approximately 300 peq.mm-1.min-1) from the glomerular ultrafiltrate consist of the following: active transport (40-50%), which can be regulated by angiotensin II; sodium-coupled organic solute transport (30%); and passive, chloride concentration gradient-driven transport (20-25%).

Absorption↗
PubMed1995

Flow dependence of chloride transport in rat S1 proximal tubules.

These studies examined whether the luminal flow dependency of chloride absorption in the S1 proximal tubule during glomerulotubular balance was due to change in active and/or passive transport of chloride. Using in vivo microperfusion in the Munich-Wistar rat and an essentially pure sodium chloride perfusate (devoid of bicarbonate and organic solutes), we found that an increase in luminal perfusion rate from 30 to 45 nl/min caused stimulation of total chloride absorption (active plus passive) by 87 peq.mm-1.min-1 (632 +/- 17 to 719 +/- 11, P < 0.001). When cyanide was added to this perfusate to eliminate active transport, the flow-induced change in passive transport was 58 peq.mm-1.min-1 (479 +/- 9 to 537 +/- 11, P < 0.001). The cyanide-inhibitable active transport component was therefore 29 peq.mm-1.min-1. With elimination of the transepithelial chloride gradient and, hence, passive transport by isethionate substitution, active transport increased by 63 peq.mm-1.min-1 (121 +/- 4 to 184 +/- 7, P < 0.001) as flow rate rose from 30 to 45nl/min. Removal of organic solutes from a glomerular ultrafiltrate-like perfusate had a minimal effect on flow-induced change in chloride transport (190 vs. 207 peq.mm-1.min-1). In conclusion, flow-dependent active and passive chloride transport in the S1 proximal tubule may both contribute to normal glomerulotubular balance.

Absorption↗
PubMed1993

Role of Na-dependent Cl/HCO3 exchange in basolateral Cl transport of rabbit proximal tubules.

To analyze the rate of basolateral Cl exit and the magnitude and relative contributions of KCl cotransport and Na-dependent and -independent Cl/HCO3 exchange to Cl exit across the basolateral membrane (BLM) during transcellular Cl absorption, rabbit proximal convoluted tubules (PCT) were perfused with high-Cl, low-HCO3 plus formate solutions and bathed with plasma ultrafiltrate-like plus formate solutions. The initial rates of intracellular Cl activity (AiCl) reduction following bath Cl removal were compared when bath Cl was 0, when bath Na and Cl were 0, and when bath HCO3 and Cl were 0. The initial rate of AiCl reduction following bath Cl removal was 4.4 +/- 0.4 mM/s. After bath Na and Cl removal, this rate was reduced to 25.1 +/- 5.0%. After bath HCO3 and Cl removal, it was reduced to 18.0 +/- 4.8%. The difference between bath Na and Cl removal and bath HCO3 and Cl removal was not significant. Cl efflux following bath HCO3 and Cl removal may be due to a KCl symporter. The contribution of a KCl symporter was examined by raising bath K to 20 mM, thus eliminating the chemical driving force for KCl exit. After bath K increase, the initial rate of AiCl increase was 0.057 +/- 0.005 mM/s. These data suggest that Cl efflux at BLM of rabbit PCT is 1) large enough to explain transcellular Cl transport, 2) predominately due to an Na-dependent Cl/HCO3 exchanger, and 3) negligibly due to an Na-independent Cl/HCO3 exchanger or a KCl symporter.

Animals↗
PubMed1993

Impact of employment-based health insurance on home attendants.

This study examines 253 newly hired home attendants to measure the degree to which employment-based health insurance can affect health status and utilization of health care services among a working poor population that has little experience with health insurance and may face other significant barriers to care. Physician contacts increased after benefits were received; attendants who had no coverage during the prior year experienced the greatest average increase. More attendants also reported using emergency rooms. Neither hospitalizations nor health status were affected. These findings indicate that insurance benefits may substantially improve access to care for many working poor persons, regardless of other barriers they may face.

Female↗
PubMed1993

Physician's attitudes toward AIDS at different career stages: a comparison of internists and surgeons.

Physicians' responses to AIDS at different career stages and in different specialties were studied by surveying house staff (N = 438), faculty (N = 363), and applicants (N = 487) at six residency programs in internal medicine and six in surgery. House staff had more negative outlooks than senior medical students and faculty, reporting greater fear of exposure to AIDS and greater unwillingness to treat AIDS patients. Surgeons were more negative than internists on these dimensions. For all groups, concern about possible negative educational consequences of treating AIDS patients was largely a function of their amount of contact with AIDS patients. Comparing willingness to treat AIDS and nine other conditions, AIDS consistently ranked low, along with Alzheimer's disease, alcoholism, and drug dependency. The findings have practical implications for hospitals and training programs. In addition, they raise issues concerning the impact of training on professional socialization, and call into question physicians' commitment to the professional norm of treating all patients regardless of provider self-interest, patient social characteristics, or medical uncertainty.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Cloning and expression of a human 14-3-3 protein mediating phospholipolysis. Identification of an arachidonoyl-enzyme intermediate during catalysis.

The major phospholipase A2 activity in sheep platelets is mediated by at least three chromatographically resolvable isoforms of a 30-kDa dimeric polypeptide which are responsive to physiologic increments in calcium ion and possess a dramatic substrate selectivity (Loeb, L. A., and Gross, R. W. (1986) J. Biol. Chem. 261, 10467-10470). Herein, we describe the cloning and expression of the human equivalent of one such isoform and demonstrate that it catalyzes the cleavage of the sn-2 fatty acid of choline and ethanolamine glycerophospholipids through the formation of a stable acyl-enzyme intermediate. Transesterification of the sn-2 acyl group of phosphatidylcholine to the recombinant 30-kDa polypeptide is over 50-fold selective for arachidonic acid, is augmented by calcium ion, and results in the formation of an arachidonoyl-thioester intermediate. Homology analysis demonstrated that the polypeptide mediating this transesterification is one member of a family of proteins collectively designated as 14-3-3 proteins. These results demonstrate that at least one intracellular mammalian phospholipase A2 employs a catalytic strategy distinct from that utilized by extracellular phospholipases A2 (i.e. formation of an acyl-enzyme intermediate by nucleophilic attack versus activation of a water molecule) and that arachidonic acid in endogenous phospholipid storage depots can, in principle, be sequentially transferred through an acyl-enzyme intermediate without the prior obligatory release of free arachidonic acid.

14-3-3 Proteins↗
PubMed1992

Do the sources of the urban elderly's social support determine its psychological consequences?

This article examines whether the psychological impact of different kinds of social supports varies according to who provides them. Data on 82 older adults' social relationships, measured as social provisions (Weiss, 1974), were used to evaluate whether the relationship between social provisions and emotional well-being varied when kin and, alternatively, nonkin, made the provisions. Findings showed that, although most social provisions were valuable regardless of their source, reassurance of worth was distinctly more beneficial when provided by nonkin than by kin, and reliable alliance, or instrumental assistance, was more strongly related to well-being when provided by kin than by nonkin. Analysis of social network structure showed that "multiplexity" was negatively related to well-being, and having duplicate providers for a given social provision was uniquely important in offsetting negative affect.

Activities of Daily Living↗
PubMed1992

Health status and health care utilization among New York City home attendants: an illustration of the needs of working poor, immigrant women.

In this paper, the health needs and health care utilization patterns of home attendants and their families have been studied as an illustration of those likely to be found among working poor, immigrant women and their children. Despite tremendous growth in the number of immigrants, studies to date provide only limited information regarding the specific health needs and patterns of health care utilization among such women and their children. As part of a longitudinal study on the impact of insurance on health status and health care utilization, 387 female, immigrant home attendants were interviewed. Data were also gathered on 355 of their minor children. These women and children were found to be less likely than other Americans to make use of basic health services, despite the fact that they are more likely to indicate fair or poor health status. This is true even in comparison to poor or uninsured Americans. Immigrant attendants in fair or poor health report an average annual visit rate of 4.1 ambulatory care visits for themselves and 2.2 for their children, as compared to 8.4 for poor adults and 4.4 for poor children in national samples. These findings illustrate the likelihood that poor, immigrant women make limited use of American medical care, and face barriers to health care that appear even greater than those faced by the uninsured and the poor.

Adult↗
PubMed1991

Mechanism of proximal NaCl reabsorption in the proximal tubule of the mammalian kidney.

In the mammalian proximal tubule NaCl reabsorption occurs by both passive and active transport processes. Passive NaCl reabsorption occurs in the presence of a high luminal chloride and a low luminal bicarbonate concentration. These anion gradients provide the driving forces for diffusive Na and Cl movement. Na is driven by the lumen positive PD effected by the greater permeability of the tubular wall to Cl than to HCO3. Cl is driven by its high tubular concentration. Passive NaCl reabsorption accounts for only about 10% to 15% of total proximal NaCl transport. The remaining proximal NaCl is reabsorbed by active transport processes and occurs both in the presence or absence of anion gradients reabsorption. Two mechanisms of active NaCl reabsorption participate in active NaCl reabsorption along the proximal tubule. Firstly, active NaCl reabsorption is electrogenic. In the early proximal tubule Na enters to cell coupled to organic solute transport. This Na reabsorption generates a lumen negative PD and effects "coupled" electrogenic NaCl reabsorption. This mechanism is limited by the supply of organic solutes and is blunted by the greater Na than Cl permeability in the proximal tubule; it probably can account for no more than 10% of proximal NaCl reabsorption. In the terminal proximal tubule, the proximal straight tubule, the apical membrane appears to possess a channel for Na entry. This Na reabsorption also generates a lumen negative PD and effects "simple" electrogenic NaCl reabsorption. This mechanism is limited by the low transport capacity of this segment and probably accounts for no more than 5% to 10% of total proximal NaCl reabsorption. The great bulk of proximal NaCl reabsorption occurs along the entire proximal tubule by active, transcellular electroneutral NaCl reabsorption. The precise cellular transport mechanisms responsible for this process are only recently being defined. At the apical membrane parallel ion exchangers are responsible for NaCl entry into the cell. Na enters via the apical membrane Na-H antiporter. Cl most likely crosses the apical membrane by some combination of Cl-OH and Cl-HCO2 exchangers but not via a Cl-HCO3 exchanger. The relative contributions of Cl-OH and Cl-HCO2 exchange have not been defined. There are two important considerations in this question. First is the availbility of OH versus HCO2. Although there is an infinite supply of OH and a small equilibrium supply of HCO2, it is possible that the luminal concentration of HCO2 could be increased by an USL that raises the concentration of HCO2 to a degree sufficient to supply H2CO2 recycling for physiological transcellular Cl transport rates.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1990

Chloride transport across the basolateral membrane of rabbit proximal convoluted tubules.

To examine the basolateral Cl transport mechanisms of proximal convoluted tubules (PCT), intracellular Cl activity (AiCl) was measured with double-barreled Cl-selective microelectrodes. When rabbit PCT were perfused in vitro with high Cl, low HCO3, and bathed with ultrafiltrate-like solutions, AiCl was 29.9 +/- 0.4 mM and basolateral membrane voltage (Vbl) was -47.7 +/- 0.4 mV (n = 247). Possible basolateral Cl transport mechanisms that we examined were as follows: Cl conductance, KCl cotransport, and Na-dependent Cl-HCO3 exchange. Cl conductance was negligible, since the voltage clamp of Vbl to 30 mV above and below the spontaneous Vbl did not change AiCl even in the absence of luminal Cl. KCl cotransport was suggested by 1) increasing bath K, increased AiCl, and 2) decreasing bath K decreased AiCl. KCl cotransport was Na independent and 4-acetamido-4'-isothiocyanostilbene-2,2'-disulfonic acid (SITS), barium, and furosemide insensitive. Na-dependent Cl-HCO3 exchange was suggested by 1) bath HCO3 reduction increased AiCl, which was greatly inhibited by bath Na removal or bath SITS, and 2) bath Na removal increased AiCl, which was completely blocked by bath SITS. We conclude that 1) Cl conductance is negligibly small at the basolateral membrane and 2) SITS-insensitive KCl cotransport and SITS-sensitive Na-dependent Cl-HCO3 exchange are present at the basolateral membrane.

4-Acetamido-4'-isothiocyanatostilbene-2,2'-disulfo↗