Biomedical subjects

Elizabeth Tolley

Publications and source records attributed to Elizabeth Tolley.

7 recordsLinked to original sources

PubMed2005

A framework for examining the sustained acceptability of microbicides.

The concept of acceptability involves a complex set of individual, couple and socio-cultural factors. Within a specific focus on microbicides, this article sets forth the relevant behavioral issues demanding attention as scientists and product developers strive to identify microbicides that will be used in a sustained, long-term fashion to prevent HIV/AIDS. The paper re-conceptualizes long-term acceptability within the ARRM framework, reviews the basic issues and research related to microbicide acceptability, discusses couple relationships (especially the nature of intimate relationships), and identifies related gender and power factors. The importance of the cultural context within various international settings pervades all of these issues. Finally, a set of challenges is discussed for those contemplating such research.

Acquired Immunodeficiency Syndrome↗

PubMed2005

The impact of menstrual side effects on contraceptive discontinuation: findings from a longitudinal study in Cairo, Egypt.

CONTEXT: Although many research studies have documented the relationship between menstrual side effects of contraceptives and discontinuation of use, few have sought to identify factors that predispose women to discontinue because of changes in bleeding patterns. Such information is important to enable family planning providers to better help women and couples choose appropriate methods and use them successfully. METHODS: Forty-eight women participating in six focus group discussions described their experiences using the IUD, the hormonal implant or the three-month injectable. Subsequently, 259 women using one of these methods for the first time were followed for up to 18 months to determine patterns of menstrual bleeding and perceptions of menstrual cycle change over time. Multivariable analytical methods were used to examine the associations between selected measures and method discontinuation. RESULTS: Contraceptive discontinuation differed by method: Nearly 70% of injectable users had stopped using their chosen method after one year, compared with 34% of IUD users and 10% of implant users. Before initiating a method, women reported an average of five bleeding days per cycle. During the first six months of use, IUD users reported an average of six days of bleeding per cycle; injectable and implant users reported 11-12. In multivariable models, each additional day of bleeding was significantly associated with a 2-4% increase in discontinuation, depending on method type. Among IUD users, women whose husbands knew that they had visited a clinic to initiate a method were less likely than others to discontinue method use (hazard ratio, -1.9). Age was significantly associated with decreased discontinuation among implant users. CONCLUSION: Counseling about bleeding and other side effects should be tailored to women's personal contexts and contraceptive experiences.

Adult↗

PubMed2005

Isoniazid hepatotoxicity associated with treatment of latent tuberculosis infection: a 7-year evaluation from a public health tuberculosis clinic.

OBJECTIVES: To determine the overall incidence of isoniazid (INH) hepatotoxicity in a public health tuberculosis clinic over a 7-year period, and to determine if systematic, limited aspartate aminotransferase (AST) monitoring would be of benefit in detecting INH hepatotoxicity. METHODS: Evaluation of INH hepatotoxicity in adults aged > or = 25 years from a database maintained from fall 1996 to 2003 in a public health department clinic. Hepatotoxicity was defined as AST levels more than five times the upper limit of normal (ULN). RESULTS: Among 3,377 patients started on INH therapy, 19 patients had AST levels more than five times the ULN, or a rate of 5.6 per 1,000 patients. Only 1 of 19 patients had prodromal symptoms associated with hepatotoxicity. After 1 month, 3 months, and 6 months of therapy, the numbers of hepatotoxic events per 1,000 patients were 2.75, 7.20, and 4.10. The age-specific numbers of hepatotoxic events per 1,000 patients were 4.40 for those from 25 to 34 years of age, inclusive; 8.54 for those between 35 to 49 years of age, inclusive; and 20.83 for those > or = 50 years old. Age > 49 years (p < 0.02) and baseline AST greater than ULN (p < 0.0003) were risk factors for hepatotoxicity. CONCLUSIONS: Consistent with earlier trials, INH hepatoxicity is age related. Our results suggest hepatotoxicity is also related to baseline AST greater than ULN. Moderate-to-severe hepatotoxicity frequently occurs without symptoms, suggesting the value of more widespread AST monitoring.

Adult↗

PubMed2003

Association of tumor necrosis factor gene polymorphisms and prolonged mechanical ventilation after coronary artery bypass surgery.

OBJECTIVE: Prolonged mechanical ventilation is a common complication after coronary artery bypass graft surgery. Tumor necrosis factor alpha is an important proinflammatory mediator in the post-coronary artery bypass graft inflammatory cascade. We attempted to study the effect of polymorphisms at the -308 site in the promoter region of the tumor necrosis factor gene (TNF-308) and the +250 site within the lymphotoxin-alpha gene (LT alpha+250) on the risk of prolonged mechanical ventilation after coronary artery bypass grafting. DESIGN: Prospective observational study. SETTING: Tertiary care center. PATIENTS: A total of 400 patients undergoing coronary artery bypass grafting were enrolled. MEASUREMENTS: The primary end point was time to extubate. Secondary end points were the percentages of patients extubated at 8, 24, and 48 hrs; the length of intensive care unit and hospital stay; the need for a rehabilitation facility; and 30-day mortality. Precollected blood was used for gene analysis. Genotyping was performed by polymerase chain reaction and restriction enzyme digestion. MAIN RESULTS: Patients with an AA genotype at the LT alpha+250 site and those without the LT alpha+250G/-308TNFG haplotype had a shorter duration of mechanical ventilation (11.5 vs. 27.8 hrs and 11.2 vs. 29.4 hrs; =.039 and.01, respectively). The risk of prolonged mechanical ventilation at 8, 24, and 48 hrs was higher for patients with a GA or GG genotype at the LT alpha+250 site and the LT alpha+250G/TNF-308G haplotype. This association between genotype and duration of mechanical ventilation was more dramatic in patients undergoing conventional coronary artery bypass grafting than in those undergoing off-pump coronary artery bypass grafting. With Bayesian analysis, clinical criteria and genotype can be used sequentially to predict the risk of prolonged mechanical ventilation. CONCLUSIONS: The LT alpha+250 and LT alpha+250G/TNF-308G haplotypes are associated with prolonged mechanical ventilation after coronary artery bypass graft. Preoperative genetic screening may guide intraoperative management to reduce postoperative complications.

Bayes Theorem↗

PubMed2002

Risk factors for late-onset nosocomial pneumonia caused by Stenotrophomonas maltophilia in critically ill trauma patients.

Patients with nosocomial pneumonia caused by Stenotrophomonas maltophilia often receive inadequate empiric antibiotic therapy, potentially increasing mortality. Knowledge of the risk factors associated with S. maltophilia pneumonia may better guide the selection of empiric antibiotic therapy. Potential risk factors for S. maltophilia pneumonia were retrospectively analyzed for critically ill trauma patients with late-onset gram-negative pneumonia. The effects of S. maltophilia infection and inadequate empiric antibiotic therapy on patient outcomes were also assessed. By multivariate analysis, S. maltophilia pneumonia was found to be associated with cefepime exposure and tracheostomy in patients with a single pneumonia episode and with higher Injury Severity Score and pulmonary contusion in patients with multiple pneumonia episodes. S. maltophilia pneumonia was associated with increased patient morbidity; only inadequate empiric antibiotic therapy was associated with a higher mortality rate. In critically ill trauma patients with late-onset ventilator-associated pneumonia and these risk factors, empiric antibiotic therapy should include agents active against S. maltophilia.

Adult↗

PubMed2002

Prevalence of cardiovascular risk factors before kidney transplantation.

CONTEXT: Assessing the prevalence of cardiovascular risk factors is an essential step in developing risk profiles and individualizing interventions to reduce the cardiovascular morbidity and mortality of kidney transplant recipients. OBJECTIVE: To examine the prevalence of pretransplant modifiable, potentially modifiable, and nonmodifiable cardiovascular risk factors in patients who received kidney transplants between January 1, 1994, and December 31, 1996. DESIGN: An exploratory, retrospective nested case-control design was employed to assess pretransplant cardiovascular risk factors in kidney transplant recipients with documented posttransplant cardiovascular events (n = 12) and kidney transplant recipients with no documented posttransplant cardiovascular events (n = 66). Data were analyzed using frequencies, unpaired t tests, and chi 2 analyses. RESULTS: Significantly higher means of body mass index values greater than 25 kg/m2 (32.3 +/- 5.8 kg/m2 vs 28.8 +/- 3.4 kg/m2) and serum total cholesterol levels greater than 200 mg/dL (254.5 +/- 5.7 mg/dL vs 242.3 +/- 39.3 mg/dL) were noted in patients with documented cardiovascular events compared to those with no documented cardiovascular events, respectively. Diabetes was more prevalent in patients with documented cardiovascular events (33%); these patients were also predominantly African American men who had a higher prevalence of family and personal histories of cardiovascular disease (17% and 33%).

Adult↗

PubMedDate not supplied

Maintenance asthma treatment with fluticasone/salmeterol combination via Diskus: effect on outcomes in inner-city children enrolled in TennCare.

Although current national guidelines suggest combination inhaled corticosteroid/long-acting inhaled beta2-agonist as the preferred treatment in moderate and severe persistent asthma for children, trials aimed at reducing emergency department (ED) visits and hospitalizations in minority inner-city children have not been conducted with the combination product of fluticasone/salmeterol via Diskus (Advair). This study assessed the effect of fluticasone/salmeterol combination via Diskus therapy on hospitalizations and ED visits in children with asthma. We conducted a prospective 1-year study with an intervention group compared with a usual care control group. This study took place at an inner-city university-affiliated children's medical center allergy clinic. Inner-city patients with asthma aged 4-17 years with a history of frequent ED visits and hospitalizations for the 2 previous years were enrolled beginning in July 2001. A control group of inner-city asthmatic patients was identified via hospital medical records. Patients were prescribed fluticasone/salmeterol combination via Diskus (n = 39) for 1 year and were compared with a usual care control group (n = 39). Although the investigators did not intervene in the control patients, review of their records revealed that all control patients had inhaled corticosteroids prescribed during the intervention period. Outcome measures included ED visits and hospitalizations for 1 year after enrollment versus the mean for acute care visits for 2 years before enrollment in the study. The intervention group had a 20% reduction in ED visits, which was significant compared with the control group (p = 0.017); both groups had significant reductions in hospitalizations. The risk of experiencing an asthma exacerbation (ED visit or hospitalization) was reduced by 33% in the intervention group compared with the control group (risk ratio, 0.67; 95% confidence interval, 0.49-0.90; p = 0.005). Our results suggest that fluticasone/salmeterol combination via Diskus is associated with a reduction in risk of acute exacerbations of asthma in inner-city children, including ED visits and hospitalizations.

Administration, Inhalation↗