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Biomedical subjects

C M Callahan

Publications and source records attributed to C M Callahan.

68 records · Page 4Linked to original sources
PubMed1992

Urban high school youth and handguns. A school-based survey.

OBJECTIVE: To determine the prevalence of handgun ownership among urban high school youth and investigate associations with socioeconomic status, ethnicity, and deviant behaviors. DESIGN: Survey of half of the Seattle, Wash, public high schools, which enroll 50% of the school district's 11th-grade students (N = 970). MAIN OUTCOME MEASURES: Self-reports of handgun ownership, perceived access to handguns, racial/ethnic identity, social status (Hollingshead's Two Factor Index of Social Position), and social deviance (Seattle Self-Report Instrument) were determined. RESULTS: Thirty-four percent of the students reported easy access to handguns (47% of males, 22% of females) and 6.4% reported owning a handgun (11.4% of males, 1.5% of females). Reported firearm experiences indicated a high rate of handgun utilization: 33% of handgun owners had fired at someone, 9.7% of female students reported a firearm homicide or suicide in family members or close friends, and 6% of male students reported carrying a handgun to school sometime in the past. Handgun ownership was more common among students who reported deviant behaviors. Adjusting for age, gender, and racial/ethnic group and controlling for covariation among the problem behaviors, gang membership (odds ratio [OR], 8.8; 95% confidence interval [CI], 3.7 to 20.8), sentencing by a judge (OR, 4.6; 95% CI, 1.3 to 15.5), selling drugs (OR, 3.7; 95% CI, 1.8 to 7.8), suspension or expulsion from school (OR, 3.5; 95% CI, 1.7 to 7.0), and assault and battery (OR, 2.5; 95% CI, 1.1 to 5.9) were associated with handgun ownership. However, 22% of male handgun owners did not report any of the above behaviors. CONCLUSION: The availability of handguns to the urban high school students surveyed is pervasive, and it is not limited to high-risk groups.

Adolescent↗
PubMed1992

Measurement of gestational cocaine exposure: sensitivity of infants' hair, meconium, and urine.

We studied the sensitivity of testing the newborn infant's hair, meconium, and urine in detecting gestational cocaine exposure. The infants were born to 59 women who were interviewed to determine their use of cocaine during pregnancy and whose hair was analyzed for the presence of cocaine. Regression analysis was used to evaluate the relationship between cocaine in newborn hair and in maternal hair. Radioimmunoassay of infants' hair and gas chromatography-mass spectrometry of meconium were more sensitive than immunoassay of urine (p less than 0.02), which failed to identify 60% of cocaine-exposed infants. The quantity of benzoylecgonine in the newborn infant's hair correlated best with the proximal-segment maternal hair, representing the last 12 weeks of antepartum hair growth (R = less than R less than 0.83). Approximately half (52%) of the variation in infants' hair was explained by variation in the proximal maternal hair segment. Correlation (R = 0.77) and explained variation (59%) improved slightly when premature infants (n = 9) were excluded. We conclude that analysis of the newborn infant's hair by radioimmunoassay or of meconium by gas chromatography-mass spectrometry is more sensitive than analysis by immunoassay of urine, and can detect fetal cocaine exposure that occurred during the last two trimesters of pregnancy.

Adult↗
PubMed1992

The risk of nursing home placement and subsequent death among older adults.

This article examines the effects of the characteristics specified in the behavioral model of health services utilization and measured at baseline on the subsequent risk of nursing home placement and death within four years. Analyses of the 5,151 respondents in the Longitudinal Study on Aging indicate that the risk for nursing home placement is greater for older adults, Whites, those who lived alone, persons with telephones, those with fewer nonkin social supports, those who did not feel that they had much control over their future health, those with more household ADL or lower body limitations, and those who had been in the hospital during the year prior to baseline, or in a nursing home at any time before baseline. Among the 549 respondents placed in nursing homes, the risk of dying there was greater for older adults, men, those who had not lived in multigenerational households, persons who did not worry about their health, individuals with more upper body limitations, and respondents having a history of valvular heart disease or cancer. The odds of dying were 2.74 times greater among the 549 respondents placed in nursing homes than among the 4,602 respondents who remained in the community.

Aged↗
PubMed1991

Oral corticosteroid therapy for patients with stable chronic obstructive pulmonary disease. A meta-analysis.

PURPOSE: To evaluate the effectiveness of oral corticosteroid therapy in patients with stable chronic obstructive pulmonary disease. DATA IDENTIFICATION: An English-language literature search using MEDLINE (1966 to 1989) and a bibliographic review of all retrieved articles identified 33 original studies of oral corticosteroid use in chronic obstructive pulmonary disease published since 1951. STUDY SELECTION: We submitted a photocopy of each study's "methods" section to three nonstudy physician-investigators who used nine explicit criteria to independently assess study quality. Ten studies met all criteria and five studies met some of the criteria. DATA EXTRACTION: To compare outcomes across all qualifying studies, we defined response to therapy as a 20% or greater increase in the baseline forced expiratory volume in 1 second (FEV1); we defined the treatment effect size for each study as the proportion of patients who responded to corticosteroid therapy minus the proportion of patients who responded to placebo. Potential confounding variables as related to eligibility criteria and treatment protocols were also assessed for each study. RESULTS OF DATA SYNTHESIS: Among ten studies that met all nine criteria, we found no significant differences in eligibility criteria, treatment protocol, or study design. No association was found between treatment effect size and publication date, study size, mean patient age, or FEV1. These studies had reported effect sizes ranging from 0% to 56%; we calculated a weighted mean effect size of 10% (95% CI, 2% to 18%). When studies meeting only some of the criteria were included in the calculation, the weighted mean effect size was 11% (95% CI, 4% to 18%). CONCLUSIONS: Patients with stable chronic obstructive pulmonary disease receiving oral corticosteroid therapy have a 20% or greater improvement in baseline FEV1 approximately 10% more often than similar patients receiving placebo.

Administration, Oral↗
PubMed1990

Preventing HIV infection in gay and bisexual men: experimental evaluation of attitude change from two risk reduction interventions.

In the course of learning their HIV serostatus, gay and bisexual men participated in small discussion groups aimed at increasing their practice of safer sex. Small discussion groups were randomly assigned to receive one of two interventions: a lecture/discussion by a gay health educator, or an intervention that included the lecture/discussion followed by a small group process aimed at increasing social skills for safer sex and at increasing peer support for safer sex. Men completed questionnaires relating to their knowledge about HIV and AIDS, attitudes toward sexual behavior change, and self-reported sexual behavior. At second follow-up, one year post-intervention, men who had received skills training and peer support endorsed significantly stronger attitudes in favor of safer sex than did men receiving lecture/discussion only. In particular, skills training and peer support caused greater reduction of the value placed on ejaculation inside the partner, stronger endorsement of plans to use condoms, and greater reduction of negative attitudes about condoms, than did lecture/discussion only. These results are helpful to design interventions for men who continue to engage in riskful behavior.

Adolescent↗
PubMed1989

AIDS prevention in homosexual and bisexual men: results of a randomized trial evaluating two risk reduction interventions.

This study evaluates two AIDS risk-reduction interventions targeted at homosexual and bisexual men. Participants were randomized into two peer-led interventions: both involved a lecture on 'safer sex', and one provided a skills-training component during which men could discuss and rehearse the negotiation of safer sexual encounters. Follow-up data collection assessed self-reported changes in sexual behavior at 6 and 12 months. Skills training increased condom use for insertive anal intercourse. In sessions providing skills training, condom use increased, on average, by 44% between pre-test and second follow-up compared with only 11% on average in sessions which did not provide such training.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Variables influencing condom use in a cohort of gay and bisexual men.

Nine hundred fifty-five of 1,384 (69 per cent) gay and bisexual men enrolled in a prospective study of the natural history of human immunodeficiency virus (HIV) infection who reported engaging in anal intercourse in the past six months were surveyed about condom use practices for both insertive (IAI) and receptive anal intercourse (RAI). The following results were obtained: 23 per cent of the men reported that they always used condoms for IAI and 21 per cent for RAI; 32 per cent sometimes used condoms for IAI; 28 per cent sometimes used condoms for RAI; 45 per cent never used condoms for IAI; and 50 per cent never used condoms for RAI. Multiple logistic regression analysis revealed that the following variables were associated with both insertive and receptive condom use: condom acceptability; a history of multiple and/or anonymous partners in the past six months, and the number of partners with whom one is "high" (drugs/alcohol) during sex. Knowledge of positive HIV serostatus was more strongly associated with receptive than with insertive use. Condom use is a relatively complex health-related behavior, and condom promotion programs should not limit themselves to stressing the dangers of unprotected intercourse.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Pancreatic exocrine aplasia, clinical features of leprechaunism, and abnormal gonadotropin regulation.

A female infant displaying morphological and clinical abnormalities is described. She had severe developmental delay, intrauterine growth retardation, and failure to thrive. Her features included an elfin facies, body and facial hirsutism, buttonlike nipples and prominent clitoris and labia. Endocrinological evaluation revealed markedly elevated serum gonadotropin levels. An LHRH stimulation test showed no LH response to LHRH but a rapid and pronounced FSH response. The patient died at 13 months following a respiratory infection. Postmortem examination revealed normal pituitary histology but an unusual pancreatic histology characterized by total absence of acinar cells. This patient had features suggestive of several clinical syndromes including leprechaunism, Shwachman syndrome, and Johanson-Blizzard syndrome, none of which, was completely satisfied. It is concluded that the infant may represent an atypical case of leprechaunism or a previously undescribed syndrome.

Facial Expression↗
PubMed1987

Some effects of cigarette smoking, arsenic, and SO2 on mortality among US copper smelter workers.

Previous studies of the relationship between arsenic levels and respiratory cancer among copper smelter workers have not directly accounted for possible effects of SO2 exposure and cigarette smoking. This is a report on the 1949-1980 mortality experience of 6,078 white male workers who worked at least 3 years between 1 January 1946 and 31 December 1976 at one or more of eight US copper smelters. The completeness of the cohort was verified statistically, and worker exposures to arsenic, SO2, dust, nickel, cadmium, and lead were estimated from retrospective industrial hygiene surveys reported elsewhere. By using internal controls, a dose-response relationship for lung cancer was observed with exposure to arsenic and SO2. When cigarette smoking data were included with arsenic and SO2 exposure data in a nested case-control analysis, only smoking and arsenic were statistically significant factors. The arsenic-lung cancer relationship was confined to a single smelter associated with high content feed. In the remaining smelters mortality for all causes of death and for all cancer was not high based on comparisons with national, state, and local rates.

Air Pollutants, Occupational↗
PubMedDate not supplied

Fellowship training in academic general internal medicine: a curriculum survey.

OBJECTIVE: To determine whether current fellowships in general internal medicine (FGIM) meet the perceived needs and objectives of physicians entering careers in academic internal medicine. DESIGN: A modified Delphi method yielded the 18 curricular elements included in the mailed survey. Participants outlined both actual and ideal fellowship experiences by rating the degree of emphasis of each curricular element on a Likert scale. Respondents then prioritized elements by rank-ordering them on perceived importance. Current job descriptions and opinions on related issues in FGIM were collected. PARTICIPANTS: Potential fellows, current fellows, and recent graduates were surveyed. Individuals were identified through the Society of General Internal Medicine associates' mailing list and solicitation of program directors. Nonfellow associates served as the proxy group for potential fellows. MEASUREMENTS AND MAIN RESULTS: 579 surveys were mailed; 348 (60%) responses were received, of which 288 (50%) were suitable for analysis. Of all respondents, 38% were current fellows and 40% were recent graduates. When asked to prioritize educational needs during fellowship training, respondents ranked research methodology, ambulatory medicine, critical review of the literature, epidemiology, biostatistics, teaching skills, medical consultation, grant writing, preventive medicine, and design of educational curriculum as the top ten. Only minor deviations in rank order were found between graduates and nongraduates. Mean Likert scale scores for degree of emphasis of each curricular element in graduates' actual fellowships were compared with mean scores for graduates' ideal fellowship descriptions. High-priority elements that were perceived as adequately emphasized included research methodology, critical analysis of the literature, epidemiology, and biostatistics. High-priority elements that were perceived as inadequately emphasized included ambulatory medicine, teaching skills, medical consultation, grant writing, preventive medicine, and design of educational curricula. CONCLUSIONS: FGIM largely meet the expectations of their fellows for preparation for research responsibilities. However, several curricular elements concerned with preparation for future clinical and teaching responsibilities are perceived by graduates as underemphasized. These areas deserve increased emphasis during fellowship training to better prepare fellows for their future roles in academic general internal medicine.

Adult↗
PubMedDate not supplied

Depression of elderly outpatients: primary care physicians' attitudes and practice patterns.

OBJECTIVE: To determine primary care physicians' attitudes and practice patterns concerning the diagnosis and treatment of depression in elderly outpatients. DESIGN: Survey of primary care physicians' attitudes using a 22-item questionnaire. Current practice patterns were identified from a computerized medical record system. SETTING: Academic primary care group practice at an urban ambulatory care clinic. PATIENTS/PARTICIPANTS: Thirty-five faculty general internists and 118 resident internal medicine physicians who had cared for 2,759 patients 65 years of age and older in the previous year. MEASUREMENTS AND MAIN RESULTS: Attitudes: Eighty percent of all physicians considered the diagnosis and treatment of depressed elderly patients to be their responsibility. Fifty-five percent of the internists felt confident in accurately diagnosing depression, and 35% felt confident in prescribing antidepressants for this population. Residents reported more difficulties in dealing with depressed elderly patients than did faculty. Practice patterns: Of patients greater than or equal to 65 years old, 8% were prescribed antidepressants, 5.4% had current diagnoses of depression, and 2% were seen for evaluation by psychiatry professionals. Age was negatively correlated with depression diagnosis, antidepressant drug use, and psychiatry evaluation. CONCLUSIONS: Internists in this primary care group practice accept responsibility for the treatment of depressed elderly patients but perceive their clinical skills as inadequate and are frustrated with their practice environment. Interventions aimed at improving the diagnosis and treatment of depressed elderly patients may be more effective if they are able to improve knowledge, attitudes, and the practice environment.

Aged↗
PubMedDate not supplied

The analysis of cocaine and benzoylecgonine in meconium.

We describe an assay for measuring cocaine and benzoylecgonine in meconium of infants born to mothers suspected of using cocaine during their pregnancy. The assay involves the use of fluorescence polarization immunoassay (FPIA) to screen for benzoylecgonine in a methanolic extract of the meconium. The FPIA is sensitive to 0.6 microgram benzoylecgonine per gram meconium. Confirmation of the presence (or absence) of benzoylecgonine and cocaine in meconium samples was performed by solid phase extraction of a second methanolic extract of the meconium, derivatizing using BSTFA, followed by a gas chromatographic/mass spectrometric (GC/MS) analysis, which can detect both cocaine and benzoylecgonine. The GC/MS confirmation was sensitive to less than 0.25 microgram cocaine or 0.5 microgram benzoylecgonine per gram meconium. FPIA, which is commonly used in many toxicology laboratories, is advantageous because it precludes the need to use radioimmunoassays for the initial screen. The confirmation step provides greater certainty for the presence of cocaine and/or benzoylecgonine in meconium.

Cocaine↗
PubMedDate not supplied

Money for guns: evaluation of the Seattle Gun Buy-Back Program.

Community involvement in local firearms policy is advocated to be an important component of efforts to curtail violence. This report describes the first evaluation of one such effort, a gun buy-back program conducted in Seattle, WA, during the fall of 1992. The evaluation included (a) surveys of 500 participants and a description of the firearms exchanged; (b) monitoring police reports, trauma center admissions, and medical examiners' data to assess short-term effects on the frequency of firearm-related events; and (c) an assessment of community beliefs by random-digit dialing telephone interviews of 1,000 residents. Of the 1,172 firearms relinquished, 95 percent were handguns, 83 percent were operational, and 67 percent were owned for more than 5 years. Twenty-five percent were exchanged by women. The mean age of participants in the exchange program was 51 years. Females and persons in older age groups were more likely than males (83 percent versus 70 percent, P < 0.01) and minors (88 percent versus 55 percent, P < 0.05) to select safe disposal as motivation to participate. Comparing firearm-related events per month before and after the program, crimes and deaths increased, and injuries decreased, but the changes were not statistically significant. Telephone interviews revealed broad support for publicly funded gun buy-back programs even among households (61 percent) with firearms. Gun buy-back programs are a broadly supported means to decrease voluntarily the prevalence of handguns within a community, but their effect on decreasing violent crime and reducing firearm mortality is unknown.

Adolescent↗