PubMed Health⌕ Search

Biomedical subjects

D L Wolcott

Publications and source records attributed to D L Wolcott.

At least 19 recordsLinked to original sources
PubMed1991

Recombinant human erythropoietin and renal anemia: molecular biology, clinical efficacy, and nervous system effects.

Anemia (hematocrit less than 25%) predictably accompanies chronic renal failure and is present in over 90% of patients on chronic dialysis. Relative erythropoietin deficiency is the proximate cause. Recombinant human erythropoietin recently became available for research and clinical use. Erythropoietin production is regulated by a single copy gene located on chromosome 7; its expression has been shown in the kidney, liver, and macrophages. It is glycosylated protein of 166 amino acids with a molecular weight of 34,000 D. When given to patients with the anemia of renal failure, erythropoietin causes a dose-dependent rise in hematocrit to the normal range within 8 to 14 weeks. Complications of this response are minimal except for a significant incidence of hypertension. When the anemia is corrected, the patient's quality of life, cognitive function, and brain electrophysiology improve dramatically. Recombinant human erythropoietin represents a major breakthrough in the treatment of patients with chronic renal failure. Current reimbursement constraints limit its full application.

Anemia↗
PubMed1990

Longitudinal change in HIV transmission risk behaviors by gay male physicians.

Gay male physicians were surveyed in 1984 and 1985 about their knowledge and attitudes regarding HIV transmission and AIDS and changes they had made in social, health-related, and sexual activities since the onset of the AIDS epidemic. Most of the 37 subjects who participated in both surveys progressively lessened their participation in HIV transmission risk behaviors over time. Health belief, AIDS knowledge, health coping, social support, mood state, and age factors all contributed to changes in sexual behavior. The modeling of sexual-behavior changes showed general stability over time. This study provides further evidence that multiple psychosocial factors are associated with changes in sexual behavior, even in gay male physicians.

Adult↗
PubMed1989

Recombinant human erythropoietin treatment may improve quality of life and cognitive function in chronic hemodialysis patients.

Medical, psychological, and social adaptation (quality of life) as well as cognitive function were studied in 15 chronic stable hemodialysis patients before the onset of treatment with recombinant human erythropoietin (r-HuEPO), 1 month after stabilization of normal hematocrit levels, and 10 to 15 months after treatment onset. After r-HuEPO treatment, subjects had significantly higher hematocrits, markedly improved energy levels, and marginally improved global health. r-HuEPO treatment was also associated with progressively decreased levels of subject mood disturbance and dialysis-related stresses. Subjects had no increased participation in paid employment and only minimally increased participation in social and leisure activities at posttreatment data points. There was no significant improvement in cognitive function after treatment. r-HuEPO treatment appears to be associated with higher energy levels, significant psychological benefits, and minimal improvements in social adaptation. The effects on cognitive function merit further study.

Adaptation, Psychological↗
PubMed1989

The relationship between medical and psychological status in newly diagnosed gay men with AIDS.

We assessed current medical and psychological status in 50 homosexual/bisexual males who were within 3 months of the diagnosis of AIDS. Subjects had typically impaired cellular immunity, relatively well-maintained physical performance capacity, and reported surprisingly good current health status, in spite of significant numbers of medical symptoms. While as a group they reported moderate levels of psychological distress, intact self-esteem, and a high quality of life, a significant minority reported high psychological distress, low self-esteem, and low quality of life. Psychological distress was correlated with subjective, but not objective, measures of current health status.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Structured group intervention model for AIDS patients.

We have gathered and analyzed data on 50 gay men with AIDS before and after a ten-week structured group intervention aimed at reducing psychological distress and improving coping skills. Among the major findings have been information relating coping strategies to depression and anxiety, information about the support networks of people with AIDS, and the relationships between coping strategies, support networks and psychological mood states. We have also found that structured group interventions comprised of problem solving techniques, health education, relaxation training and emotional support are helpful in reducing anxiety and depression and in teaching people more positive ways of coping with their illness.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Quality of life in chronic dialysis patients. Factors unrelated to dialysis modality.

The quality of life (medical, psychological, and social adaptation) of 66 chronic dialysis patients was studied cross-sectionally. The participants had similar levels of medical, psychological, and social adaptation to those found in previous studies of chronic dialysis patients. Medical, psychological, and social adaptation are independent dimensions that are only weakly intercorrelated. When categorized by specific individual or treatment characteristics, men and those over age 51 had poorer medical and psychological adaptation than did women and younger dialysis patients. Duration of dialysis was not related to quality of life. Vocationally active as compared to vocationally inactive subjects had generally superior medical, psychological, and social adaptation. Male sex, age over 51, and vocational inactivity are all associated with poorer dialysis patient adaptation. The development of profiles of groups of dialysis patients at increased risk for poor adaptation may help in targetting scarce psychosocial intervention resources. Studies of the psychosocial efficacy of differing treatment modalities need to consider non--treatment-related factors that may affect patient psychosocial outcomes.

Adjustment Disorders↗
PubMed1988

Quality of life in chronic dialysis patients: a critical comparison of continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis.

Thirty-three matched pairs of chronic continuous ambulatory peritoneal dialysis (CAPD) and center hemodialysis (CHD) patients from three dialysis programs were studied cross-sectionally to assess their current medical, psychological, and social status. The CAPD and CHD groups were similar on matching and medical status variables. The CAPD subject group had a higher quality of life, lower illness and modality related stress scores, and nonsignificantly lower mood disturbance scores. The groups did not differ in self-esteem or health locus of control. CAPD subjects reported higher frequency of participation in community activities, better relationships with dialysis physicians and patients, and were more likely to be currently vocationally active. Dialysis modality likely exerts an independent effect on the quality of life of chronic dialysis patients, and CAPD is likely superior to CHD in this regard. Longitudinal studies are needed to determine the relative role of patient-selection and modality-related factors in determining the psychological and social adaptation (quality of life) of chronic dialysis patients.

Activities of Daily Living↗
PubMed1988

Relationship of dialysis modality and other factors to cognitive function in chronic dialysis patients.

To determine if dialysis modality may be an independent factor in the level of cognitive function in chronic dialysis patients, cognitive function was studied in 17 pairs of continuous ambulatory peritoneal dialysis (CAPD) and center hemodialysis (CHD) subjects matched for sex, age, diabetic status, and interval since dialysis onset. Data on current metabolic, medical, psychological, and vocational function status were obtained. Neuropsychological (NP) measures included the Number Cancellation Protocol (NCP), Trailmaking test forms A and B (TMT A, TMT B), Symbol Digit Modalities (SDM), and the Rey Auditory Verbal Learning Test (RAVLT). The CAPD subject group had consistently more efficient cognitive function than the CHD subject group. Regardless of modality, the groups of subjects under age 51 and those who were vocationally active had significantly better NP performance. No cognitive function differences were found in groups categorized by sex or duration of dialysis. Creatinine levels were more highly correlated with NP scores than were BUN levels, with higher creatinine levels associated with better cognitive function. Serum calcium, CO2, total protein, albumin, and SGOT levels also were correlated with NP scores. CAPD may be more effective than HD in reversing uremic encephalopathy by mechanisms mostly unrelated to serum creatinine and BUN levels. Longitudinal studies will be needed to determine if dialysis modality is an independent factor in the degree of reversal of uremic encephalopathy.

Adult↗
PubMed1987

Changes in AIDS risk behaviors among homosexual male physicians and university students.

Two samples of homosexual men, 64 physicians and 58 university students, reported profound decreases in several sexual practices linked to transmission of acquired immune deficiency syndrome (AIDS). The physicians showed the greater reduction. When sociodemographic variables, health beliefs, feeling of control over outcome, mood, sexual interest before the AIDS epidemic, and medical care utilization were correlated with decrease and/or increase in AIDS risk behaviors, the clusters of variables most strongly correlated with change in risk behaviors differed between the physicians and students. Interventions designed to change behaviors in AIDS high-risk groups should be tailored for specific subgroups.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Illness concerns, attitudes towards homosexuality, and social support in gay men with AIDS.

High levels of illness-related psychologic distress, marked social stigmatization and loss of social support, and negative internalized feelings towards homosexuality have previously been reported in homosexual men with the diagnosis of acquired immune deficiency syndrome (AIDS). We assessed 50 homosexual or bisexual men who were within 3 months of their AIDS diagnosis with respect to medical status, illness concerns, attitudes towards homosexuality, and social support. Subjects reported levels of illness-related concerns comparable to previously studied cancer patients. Their attitudes towards homosexuality were similar to previously studied healthy homosexual males. Their social support needs were variable, as was their satisfaction with specific types of social support. Their social networks were moderately small. In this AIDS subject group, illness concerns, attitudes toward homosexuality, and social support satisfaction were significantly correlated with each other, and with previously reported levels of psychologic distress and subjective (but not objective) measures of health status.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Adaptation of adult bone marrow transplant recipient long-term survivors.

Although there is a small literature on psychosocial and psychiatric aspects of bone marrow transplants (BMT) in adult recipients during the BMT hospitalization phase, adaptation of long-term adult BMT recipient survivors has received little study. This study surveyed the adaptation of BMT recipient survivors over age 17 who were an average of 42 months posttransplant. Study variables included the recipients' current self-reported health status, mood state, social role function, self esteem, life satisfaction, and relationships with their BMT donors and other family members. A companion study of those who donated BMT to the recipients eligible for this study was also performed. The study participants were preponderantly young adults who currently were in an intimate relationship and vocationally active. About 1/4 of the subjects reported ongoing medical problems. Also, 15-25% reported significant emotional distress, low self-esteem, and less-than-optimal life satisfaction. The subjects' current quality of relationship with their donors was highly correlated with many measures of their psychosocial status. The findings indicate that about 75% of BMT recipient long-term survivors are doing well from a psychosocial as well as a medical standpoint, that the recipient-donor relationship may be sensitive to any changes in the recipient's status, and that 15-20% of BMT recipient survivors report a degree of psychological distress that might benefit from specific psychological/psychiatric intervention.

Adult↗
PubMed1986

Psychological adjustment of adult bone marrow transplant donors whose recipient survives.

The psychosocial and psychiatric impact of donating bone marrow (BM) has received little study. This mail questionnaire study of bone marrow donors whose recipient had survived more than one year post-BMT was undertaken to document the psychosocial consequences of donation on "successful" BM donors. Demographic, mood state, self-esteem, current life satisfaction, and donor-recipient relationship characteristics, donor-perceived approval from family members, and donor attitudes about BM donation were studied. A companion study of BM recipients was also performed to provide comparative data on the psychosocial status of donors and recipients. As a group BM donors manifested little emotional distress, high self-esteem, and a high degree of current life satisfaction. Donors reported little change in their relationships with their recipients since the BMT. However the current quality of their relationships with their recipients was highly correlated with several recipient health status and psychosocial variables, suggesting that recipient deterioration might significantly adversely impact donor psychosocial status. From 10% to 20% of donors indicated at least some negative consequences of donating.

Adult↗
PubMed1986

Treatment compliance in end-stage renal disease patients on dialysis.

This paper reviews the current knowledge concerning treatment compliance in patients with end-stage renal disease (ESRD). Adult hemodialysis patient noncompliance with the treatment regimen is very common. Objective and subjective measures of compliance, however, are often weakly correlated. In addition, the patients may be compliant with some aspects of the treatment regimen, but noncompliant with others. Unfortunately, no current model of predicting the degree of hemodialysis patient compliance is very accurate. In spite of this, behavioral approaches to increase regimen compliance do have at least short-term efficacy. There is a paucity of published data on compliance in adult peritoneal dialysis patients and an almost complete absence of systematic studies of compliance in children and adolescent dialysis patients. A multidimensional nosology of compliance behavior in ESRD patients is, therefore, proposed, as well as an approach to the diagnosis of noncompliance in ESRD patients and to possible interventions.

Adolescent↗