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Biomedical subjects

C Johnsen

Publications and source records attributed to C Johnsen.

11 recordsLinked to original sources
PubMed2000

Management of malnutrition in the elderly and the appropriate use of commercially manufactured oral nutritional supplements.

The risk of protein calorie malnutrition among the community dwelling elderly is high. If undetected or untreated malnutrition can raise risks of morbidity and mortality. Therefore, improving screening, assessment and treatment of malnutrition, particularly in ambulatory settings that serve the elderly is imperative. The aim of this paper is to briefly detail the diagnostic criteria for protein calorie malnutrition and discuss the special considerations necessary in evaluating risk and causes of malnutrition in the elderly. We conclude with a review of current management options and discuss the cost effectiveness and potential inappropriate use of commercially manufactured oral nutritional supplements.

Aged↗
PubMed1998

Low dose linomide in Type I juvenile diabetes of recent onset: a randomised placebo-controlled double blind trial.

The quinoline-3-carboxamide, linomide, protects non-obese diabetic mice from diabetes. The effects of linomide on insulin needs and beta cell function were studied in recent juvenile Type I diabetes in a double-blind trial. Patients with recent onset diabetes were randomly assigned to treatment with a fixed dose of 2.5 mg linomide (42 patients) or placebo (21 patients) for 1 year, in addition to insulin and diet. Glycated haemoglobin was 10-15% lower at 9 months (p = 0.003) and 12 months (p < 0.05) in the linomide group. The insulin dose was 32-40% smaller in the linomide group at 3 (p < 0.03), 6 (p < 0.02), 9 (p < 0.001) and 12 months (p = 0.01). Insulin doses correlated negatively with C peptide values (p = 0.001-0.002). The trend for higher C peptide values in the linomide group did not reach significance. In a post hoc subgroup analysis performed in 40 patients (25 from the linomide group and 15 from the placebo group) who still had detectable residual beta cell function at entry, linomide was associated with 45-59% higher C peptide value at 6 months (p < 0.05), 9 months (p < 0.05) and 12 months (p < 0.05). The main adverse effects of linomide were mild transitory anaemia (45 vs 10% in the linomide and placebo groups), thrombocytopenia (24 vs 10%), and mild joint discomfort (45 vs 5%) with no clinical signs. In conclusion, low-dose linomide reduced the insulin needs in patients with juvenile Type I diabetes of recent onset and improved beta cell function in patients who still had detectable beta cell function at entry. These results support further clinical and experimental studies to define the effects of linomide in Type I diabetes provided the safety of linomide is reliably established.

Adjuvants, Immunologic↗
PubMed1995

Evaluation of two-step tuberculin testing in a Massachusetts correctional facility.

OBJECTIVES: To better identify inmates with tuberculosis infection at admission and to have more accurate estimates of conversion rates with annual retesting, I evaluated two-step tuberculin skin testing of newly admitted inmates at the Addiction Center of the Massachusetts Department of Corrections. METHOD: In a population of inmates admitted to the Addiction Center between January and May 1994, a second tuberculin skin test was performed 1 week after the first for those who initially had a negative response. RESULTS: There were 628 admissions during the study period; 51 of these inmates (8%) had a history of positive skin test results. Of the 570 initial tuberculin skin tests that were read, 12 (2.1%) had positive results. Five of 510 second tuberculin skin tests (1%) had positive results. CONCLUSION: I evaluated the feasibility and utility of two-step tuberculin skin testing among newly admitted inmates at a Massachusetts correctional facility. We identified 40% more inmates with positive tuberculin skin test results after conducting 510 additional skin tests. Unlike the Addiction Center inmates, newly admitted inmates at other reception facilities are subject to interfacility transfer, and the rate of reading initial tuberculin skin tests is significantly lower than the 99% obtained at the Addiction Center. I expect serial testing to increase the identification of tuberculosis infected inmates at all facilities; however, its implementation should be deferred until a higher reading rate is obtained for the initial skin test.

Adult↗
PubMed1994

The International (Ludwig) Breast Cancer Study Group Trials I-IV: 15 years follow-up.

BACKGROUND: Adjuvant systemic therapy prolongs disease-free and overall survival in both pre- and postmenopausal patients. Available data shown benefit from multi-agent chemotherapy, prolonged tamoxifen treatment, and ovarian ablation, and that the combination of chemo- and endocrine therapy might be advantageous. In 1978 the International (Ludwig) Breast Cancer Study Group (IBCSG) initiated four complementary randomized controlled clinical trials to evaluate the roles of chemo-endocrine combinations or endocrine therapy alone in specific populations defined by risk (for pre- and perimenopausal patients) or by age (for postmenopausal patients). The results at 10 and 13 years' median follow-up for these trials are summarized in this report and are compared to those of the Overview meta-analysis with regard to chemo-endocrine or endocrine therapy combinations. Furthermore, types of first relapses by sites and second malignant diseases are reported. PATIENTS AND METHODS: 1601 evaluable patients with node positive disease were included into the studies I-IV. In Trial I (491 premenopausal patients with 1-3 positive axillary nodes) we studied the addition of low-dose continuous prednisone (p) to a cyclophosphamide-methotrexate-fluorouracil (CMF) combination. In Trial II 327 premenopausal patients with four or more positive axillary nodes were randomized to one year CMFp or to a surgical oophorectomy followed by CMFp. In Trial III (463 postmenopausal patients 65 years old or younger), combined chemoendocrine therapy (one year of CMFp plus tamoxifen (T)) was compared to endocrine therapy (1 year of p + T) or to surgery alone. In Trial IV 320 postmenopausal patients 66 to 80 years old were treated either by surgery alone or by surgery followed by 1 year prednisone and tamoxifen. RESULTS: In Trial I the addition of prednisone allowed a higher dose of cytotoxics to be administered compared with CMF alone. Despite this increased dose intensity, 13-year disease-free survival (DFS) and overall survival (OS) were similar for the two treatment groups (49% vs. 52% DFS, 59% vs. 65% OS for CMFp vs. CMF). In Trial II the addition of surgical oophorectomy to CMFp yielded an improved outcome which approached statistical significance for the subset of 107 patients known to have estrogen receptor-positive tumors (DFS, 23% vs. 15%, p = 0.13; OS, 41% vs. 30%, p = 0.12). In Trial III combined chemoendocrine therapy improved DFS and OS compared with endocrine therapy alone (p + T) given for the same duration, or no adjuvant treatment (DFS, 35% vs. 25% vs. 14%, p < 0.0001; OS, 48% vs. 36% vs. 32%, p = 0.01). In Trial IV p + T improved DFS compared with no adjuvant therapy (27% vs. 15%, p = 0.004). Despite competing risks for this elderly population, OS was also improved but the result was not statistically significant (34% vs. 22%, p = 0.08). CONCLUSIONS: The overall results of these four trials indicate that the continuation of investigations on combined chemo-endocrine therapies is warranted. The prognosis of the patients, all node-positive, treated with the most effective adjuvant treatment is such that there is a large potential for improvement.

Aged↗
PubMed1993

Tuberculosis contact investigation: two years of experience in New York City correctional facilities.

BACKGROUND: An increasing incidence of tuberculosis has been observed in the New York City correctional system. METHODS: The diagnosis of active tuberculosis in persons within the correctional setting results in an investigation, with the identification and screening of contacts. RESULTS: Thirty-four such investigations in the past 2 years in the New York City correctional system, where all inmates are screened for tuberculosis on admission, have resulted in an overall tuberculin skin test conversion rate of 6.74% in 1306 inmates. In 21 of these investigations the index had both smears and cultures positive for Mycobacterium tuberculosis and the conversion rate was 7.37% in 719 contacts tested. In seven investigations the index patient had a culture only positive for M. tuberculosis and the conversion rate was 6.58% in 243 inmates. In six investigations in which the index patients were subsequently found to have nontuberculous pneumonia or mycobacteria other than M. tuberculosis the conversion rate was 5.52% in 344 inmates. These rates are not statistically different. CONCLUSIONS: Whether the observed conversions in these events or in any of the contact investigations are due to intramural spread, anergy on admission, the booster phenomenon, or incubation of disease on admission is not known. The 5.5% conversion rate in those exposed to inmates confirmed not to have tuberculosis suggests the influence of booster phenomenon and consideration of two-step testing on admission.

Adult↗
PubMed1986

Smallpox and biological warfare: the case for abandoning vaccination of military personnel.

Smallpox was officially declared eradicated from the world in 1980. Earlier, in 1972, over 50 nations signed the Biological Weapons Convention renouncing this entire category of weapons. Despite this international agreement, both the United States and the Soviet Union continue to vaccinate their military troops against smallpox, thus implying that each fears the other might still use it in biological warfare. Vaccination is not a harmless procedure, and vaccinia infections continue to be reported in troops and their contacts. Negotiating an end to the vaccination of troops would be a final step in ending the fear of smallpox.

Biological Warfare↗
PubMedDate not supplied

Content validity of a Scale to measure silencing and affectivity among women living with HIV/AIDS.

This study measured quantitatively and explored qualitatively silencing behaviors and affectivity (mood) in women living with HIV/AIDS and confirmed the validity of the Silencing the Self Scale and the Positive and Negative Affect Scale. Silencing behaviors are interpersonal communication styles that suppress personal needs and feelings to preserve relationships with others. Silencing behaviors serve as protective strategies that allow one to divorce oneself from an overbearing culture. Affectivity is a way of measuring one's personal mood state by a positive to negative continuum. The results indicate that the women silenced themselves profoundly, especially when it came to putting the needs of their children or dependents before their own. The women also had high levels of negative affectivity. The research findings from this study extend nursing knowledge by addressing the unique social processes of women living with HIV/AIDS within health care service structures and significant social groups. Further exploration of "silencing" as a phenomenon of this group through measurement and experience will help define specific interventions that are meaningful to and for women living with HIV/AIDS.

Adult↗
PubMedDate not supplied

Abuse histories among newly incarcerated women in a New York City jail.

This article reports the findings from a study of women detained in the women's jail at Rikers Island Correctional Facility in New York City. Interviews were used to gather data on five variables: women's childhood physical and sexual abuse, victimization as adults, drug use, homelessness, and suicide. These findings were analyzed along with biological data on STDs. The conclusions suggest that an association exists between childhood physical and sexual abuse and drug use, suicide attempts, and homelessness in adulthood. The findings indicate that these experiences are common for the population under study, and that a positive association between the variables exists in a sample of incarcerated women. Implications and questions for further research are discussed.

Adaptation, Psychological↗