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Biomedical subjects

D Baxter

Publications and source records attributed to D Baxter.

At least 37 records · Page 2Linked to original sources
PubMed1997

Mortality in elderly patients with organic brain disorder enrolled on the Salford Psychiatric Case Register.

The observed mortality of 397 elderly patients with organic brain disorder, recruited to the Salford Psychiatric Case Register between 1 January 1968 and 31 December 1975 and followed up by record linkage to 31 December 1985, was compared with expected mortality. The overall SMR was 1.91. SMRs were significantly raised for all age groups beyond 65 years, being highest in the younger age-bands and declining almost linearly with age. SMRs were elevated for both men and women, during all calendar periods, for incident and prevalent cases, and throughout the whole follow-up period, being highest in the first year. While social class variations may account for up to 9% of the excess deaths, marital status and ethnic differences had little effect.

Age Factors↗
PubMed1997

Sexual negotiation in the AIDS era: negotiated safety revisited.

OBJECTIVE: To test the safety of the 'negotiated safety' strategy-the strategy of dispensing with condoms within HIV-seronegative concordant regular sexual relationships under certain conditions. METHOD: Data from recently recruited cohort of homosexually active men (Sydney Men and Sexual Health cohort, n = 1037) are used to revisit negotiated safety. The men were surveyed using a structured questionnaire and questions addressing their sexual relationships and practice their own and their regular partner's serostatus, agreements entered into by the men concerning sexual practice within and outside their regular relationship, and contextual and demographic variables. RESULTS: The findings indicate that a significant number of men used negotiated safety as an HIV prevention strategy. In the 6 months prior to interview, of the 181 men in seroconcordant HIV-negative regular relationships, 62% had engaged in unprotected anal intercourse within their relationship, and 91% (165 men) had not engaged in unprotected anal intercourse outside their relationship. Of these 165 men, 82% had negotiated agreements about sex outside their relationship. The safety of negotiation was dependent not only on seroconcordance but also on the presence of an agreement; 82% of the men who had not engaged in unprotected anal intercourse outside their regular relationship had entered into an agreement with their partner, whereas only 56% of those who had engaged in unprotected anal intercourse had an agreement. The safety of negotiation was also related to the nature of the safety agreement reached between the men and on the acceptability of condoms. Agreements between HIV-negative seroconcordant regular partners prohibiting anal intercourse with casual partners or any form of sex with a casual partner were typically complied with, and men who had such negotiated agreements were at low risk of HIV infection. CONCLUSIONS: The adoption of the strategy of negotiated safety among men in HIV-seronegative regular relationships may help such men sustain the safety of their sexual practice.

Adolescent↗
PubMed1997

Respiratory sinus arrhythmia in children with severe cyanotic breath-holding spells.

In this study we sought to investigate parasympathetic activity among children with severe cyanotic breath-holding spells by examining respiratory sinus arrhythmia. The study sample was composed of two groups of patients, 16 subjects with cyanotic breath-holding spells (5 male, 11 female; mean age, 37.5 mo) and 17 controls (8 male, 9 female; mean age, 37.7 mo). Each subject's electrocardiogram was recorded in a quiet room and digitized by an 80386 personal computer during five 1-minute periods. R-R intervals within each 1-minute period were converted to heart rate in 120 successive 0.5 second intervals. The resultant heart rate time series was converted to its underlying frequency composition by a fast Fourier transform and averaged across minutes. Respiratory sinus arrhythmia was defined as the variability in the time series over a frequency range (0.096-0.48 Hz) corresponding to a range of respiratory rates from 6 to 30 breaths per minute. Analysis revealed after ANCOVA adjustment for age and gender with subject group and frequency bin as dependent measures, that subjects with cyanotic breath-holding spells had similar variability in their heart rates as did controls (group x frequency bin: F = 0.74, P = 0.71). This study supports the hypothesis that autonomic dysregulation in cyanotic breath-holding spells is not due to a primary disturbance in central parasympathetic control over cardiac rate and rhythm.

Analysis of Variance↗
PubMed1997

Gay youth and their precautionary sexual behaviors: the Sydney men and sexual health study.

Many commentators have positioned Western gay youth as a high-risk group for HIV infection and obscured important cultural, social, and contextual differences between populations. This study compares risk of HIV transmission factors among 216 young (under 25 years) and 822 older (25 years or over) homosexually active men, recruited through Sydney gay community and other sources. Bivariate and multivariate analyses of survey data that were collected by personal interviews consistently supported our hypothesis of no difference in HIV-related risk factors between young and older men. Although young men in this cohort were more likely to be of unknown serostatus, they were at least as knowledgeable, as attached to gay community, and as precautionary in their sexual behaviors with regular and casual male partners as their older counterparts. Safety campaigns targeting these young gay men should focus, for example, on their lower rates of HIV antibody testing and not be based on a false premise of hedonistic, uninformed, and disenfranchised youth.

AIDS Serodiagnosis↗
PubMed1997

Finding and treating depression in Alzheimer's patients: a study of the effects on patients and caregivers.

Unrecognized and untreated depression occurs frequently in Alzheimer's disease (AD) patients, adding to the agony already experienced by patient and caregiver. The authors screened AD patients living with a family caregiver for depression. Twelve patients with confirmed depression were treated in an open-label study with antidepressant medication, with dosage adjustment by a psychiatrist at Weeks 2, 4, 8, and 16. Data collection occurred at baseline, Week 4, and Week 16. Depression decreased significantly (p < .01). Contrary to expectations, patient functional capacity declined (p = .045). Cognition remained unchanged (p > .05). Caregiver burden, caregiver depressive symptomatology, and quality of life of patient and caregiver remained unchanged (p > .05). The authors conclude that depression in AD can be detected if a collateral source, such as the caregiver, is available. The depression can and should be treated. More research is needed to determine the impact on patient functioning, caregiver burden, caregiver depressive symptomatology, and quality of life of patient and caregiver.

Aged↗
PubMed1995

The organization, delivery and audit of a specialist immunization clinic.

Immunization is a key primary prevention activity which has assisted in the reduction of childhood morbidity and premature mortality. Uptake rates for two-year-old children are now in excess of 90 per cent throughout the UK and for the vast majority of infants immunization is a routine procedure with a high benefit-to-risk ratio. Concerns about particular children, either because of their previous medical history or an adverse vaccine event, have been responded to in various ways. The experiences of a specialist immunization facility established in 1987, which since inception has seen just over 3,000 children are described. The clinic operates four sessions a week, with two held in the District General Hospital and two in community clinics; the resource requirements for the clinic are identified. A parent satisfaction survey for the first 1,700 attenders was undertaken in 1992 and the results are reported; their comments led to changes in the method of service delivery. A study of GPs' views was also undertaken at the same time; their satisfaction with the service is reflected in the continuing level of referrals, It is believed that all provider units should consider developing a similar facility for five reasons. First, it provides a source of expert advice for both professionals and parents; second, it facilitates the immunization of children with problem histories; third, it enables the investigation of serious post-vaccination adverse events; and fourth, the clinic provides a means of co-ordinating and delivering neonatal immunizations (including BCG, HBV, Varicella zoster and the vaccination of pre-term infants). And finally the clinic offers training for health care staff involved in primary immunization programmes and travel vaccination services.

Child↗
PubMed1994

Cutaneous findings in HIV-1-positive patients: a 42-month prospective study. Military Medical Consortium for the Advancement of Retroviral Research (MMCARR).

BACKGROUND: Cutaneous disease is common in patients infected with HIV-1. OBJECTIVE: The aim of our study was to identify cutaneous markers associated with HIV-1 infection and disease progression as measured by Walter Reed (WR) stage. METHODS: For 42 months we have observed 912 HIV-1-positive patients in all WR stages. All patients had an extensive past and present medical history taken as well as a complete physical examination, periodic visits, and appropriate diagnostic procedures. RESULTS: Increasing dryness of the skin and seborrheic dermatitis are early findings in a large percentage of patients in WR stage 1; the occurrence and severity of both conditions increase with disease progression. Tinea infections, condylomata acuminata, and verrucae are seen early, but with disease progression, although there is no clear increase in occurrence, these infections become more diffuse and resistant to treatment. Flares in acne vulgaris and folliculitis show a peak occurrence in early and mid-stage disease with a decreased occurrence in late-stage disease. Herpes simplex infections, oral candidiasis, molluscum contagiosum, Staphylococcus aureus infections, and oral hairy leukoplakia show a marked increase in occurrence with advanced disease. Conditions that have a statistically significant association with disease progression as measured by a change in a stage include drug eruptions, seborrheic dermatitis, oral candidiasis, oral hairy leukoplakia, molluscum contagiosum, herpes zoster, and hyperpigmentation (nail, oral, skin). CONCLUSION: The most frequent and persistent cutaneous disorders were asteatosis (with or without asteatotic eczema) and seborrheic dermatitis. Conditions that were associated with a change in WR stage include drug eruptions, seborrheic dermatitis, oral candidiasis, oral hairy leukoplakia, molluscum contagiosum, herpes zoster, and hyperpigmentation. In addition to Kaposi's sarcoma, patients with HIV-1 disease have an increased potential for the development of both cutaneous epithelial and probably melanocytic malignancies. Epithelial tumors were seen in patients in all stages of disease.

AIDS-Related Opportunistic Infections↗
PubMed1993

Clinical features of inflammatory dermatoses in human immunodeficiency virus type 1 disease and their correlation with Walter Reed stage. Military Medical Consortium for Applied Retroviral Research.

BACKGROUND: As part of a military study of the natural history of human immunodeficiency virus type 1 (HIV-1) disease, all patients entered in the study were examined for cutaneous changes associated with HIV-1 infection. OBJECTIVE: Our purpose was to characterize and record the types of inflammatory dermatoses in a large number of HIV-1-infected patients to determine whether there was a correlation with the stage of disease. METHODS: The clinical findings in each case were compared with the results of cultures and biopsy specimens and correlated with Walter Reed stage. RESULTS: Most of the inflammatory dermatoses were maculopapular eruptions often with prominent follicular involvement, and in some there was a lichenoid component. With increasing Walter Reed stage, many eruptions become papulosquamous, some with psoriasiform scale and some with a hypertrophic lichenoid appearance. CONCLUSION: Although most of the inflammatory eruptions were nonspecific clinically, most cases showed features resembling those in graft-versus-host disease.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Histopathologic and immunohistochemical findings associated with inflammatory dermatoses in human immunodeficiency virus type 1 disease and their correlation with Walter Reed stage. Military Medical Consortium for Applied Retroviral Research.

BACKGROUND: Cutaneous lesions are common in patients with human immunodeficiency virus type 1 (HIV-1) infection. In many cases they are nonspecific inflammatory dermatoses. OBJECTIVE: Our goal was to determine whether features of these inflammatory dermatoses were characteristic of HIV-1 infection and whether the changes correlated with the stage of disease. METHODS: Biopsy specimens of inflammatory dermatoses from 176 HIV-1-infected patients in all Walter Reed stages were reviewed and the changes were compared with each WR stage. RESULTS: The changes found were nonspecific but were suggestive of features described in graft-versus-host disease and became more prominent in late-stage disease. CONCLUSION: A correlation was found between the changes and the stage of disease, and the findings add support to prior reports that at least some of the changes in HIV-1 infection may be autoimmune in origin.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Melanocytic activation in HIV-1 disease: HMB-45 staining in common acquired nevi. Military Medical Consortium for the Advancement of Retroviral Research.

BACKGROUND: An increase in pigmented lesions has been reported in HIV-1-infected patients. In a study of HIV-1-positive patients, we have seen patients who noticed new or changing pigmented lesions. OBJECTIVE: The goal of this study was to determine to what degree these pigmented lesions showed evidence of significant melanocytic proliferation as opposed to increased pigment production without significant melanocytic proliferation. METHODS: Biopsy specimens were studied with routine light microscopy and immunohistochemical stains including S-100 protein, HMB-45, and proliferating cell nuclear antigen. RESULTS: The lesions included two malignant melanomas and 42 benign melanocytic lesions. Significant staining of dermal melanocytes with HMB-45 was present in two of three melanomas and in 19 of 42 nevi. With stains for proliferating cell nuclear antigen there was a positive reaction in the dermal component of both melanomas and a negative reaction in the dermal cells of the nevi. CONCLUSION: In some HIV-1-infected patients there is stimulation of melanosome production without significant melanocyte proliferation.

Adult↗
PubMed1991

Social class, gay men and AIDS prevention.

The relationship between sexuality, gay communities and class is potentially a very large problem for AIDS prevention. Class is a historical process which interacts with sexuality in ways still little understood. The complexities of modern class structures need full acknowledgement; labour market groupings are internally divided, and cultural privilege and exclusion are important. A community survey in New South Wales of men who have sex with men shows the class selectiveness usual in such research. An exploration of correlates of labour market position, income and education finds few relationships with attachment to milieu except for involvement with gay organisations, and minor differences in broad measures of sexuality but some class differences in HIV risk-taking and some differences in exposure to information and in attitude. An exploration of several cases from a life-history study of working-class gay men shows the impact of class circumstance on the formation of sexual relationships and points to the accessibility of unlabelled homosexual activity in working-class milieux. Research on working-class education points to the importance of curriculum change in overcoming class exclusion, and is moving towards empowerment models of great relevance in AIDS education.

Acquired Immunodeficiency Syndrome↗
PubMed1990

A female sex offender with multiple paraphilias: a psychologic, physiologic (laboratory sexual arousal) and endocrine case study.

A 20 year old female pedophile exhibiting multiple paraphilias and who had been both a victim of incest and an active participant, undertook extensive clinical, psychometric, endocrine and laboratory sexual arousal studies. Her psychiatric, psychometric and physiologic arousal profiles showed similarities to those of a sizable proportion of male child molesters, especially incestors. It is suggested that laboratory arousal tests (using the vaginal photoplethysmograph) may have a role in the assessment of some female sex offenders.

Adult↗
PubMed1989

Myocardial glutathione depletion impairs recovery after short periods of ischemia.

Isolated, isovolumic rat hearts, perfused by Krebs-Henseleit buffer at constant coronary flow rate, were used to explore the hypothesis that endogenous cardiac glutathione provides protection against myocardial dysfunction associated with short periods of ischemia. Experimental animals were depleted of cardiac glutathione to 35% of control levels by intraperitoneal injections of diethylmaleate (DEM). Left ventricular pressure, coronary perfusion pressure, and glutathione levels were measured in control and experimental hearts after 60 minutes of oxygenated perfusion and after 20 minutes of global, no-flow ischemia and 30 minutes of reperfusion. With each protocol, both control and glutathione-depleted hearts received either standard buffer or one supplemented with 2 mM glutathione. Recovery of systolic function after ischemia-reperfusion was impaired in DEM-treated hearts compared with controls. In addition, the rise in perfusion pressure and chamber stiffness was also greater in DEM-treated hearts compared with controls. Recovery in glutathione-depleted hearts was improved when the reperfusate was supplemented with glutathione. In addition, the supplemented reperfusate prevented the decrease in compliance and the increase in coronary perfusion pressure in the glutathione-depleted hearts. Ischemia-reperfusion alone were not associated with a significant alteration in myocardial glutathione levels. Prewashout myocardial levels of glutathione were elevated after reperfusion with glutathione-supplemented buffer but fell to baseline levels after a short washout period. These studies demonstrate that endogenous glutathione is important in protection of myocardium from injury after ischemia-reperfusion, presumably by modifying levels of active oxygen intermediates. The smaller changes in left ventricular pressure and coronary resistance after administration of GSH probably reflects an extracellular mechanism because benefit is seen soon after reperfusion.

Animals↗
PubMed1989

Introduction to blood trauma.

The response of blood to abnormal conditions is a very complicated mechanism which is not fully understood. There have been many improvements and discoveries in materials and procedures to minimize the adverse reactions. Also, the body has very efficient compensatory responses to aide in recovery from such challenges. However, it is important to be aware of these possible complications and give appropriate support during the blood's recovery period.

Blood Physiological Phenomena↗