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Biomedical subjects

G Marks

Publications and source records attributed to G Marks.

At least 37 records · Page 2Linked to original sources
PubMed1998

Is acculturation associated with sexual risk behaviours? An investigation of HIV-positive Latino men and women.

This cross-sectional study of 226 HIV-positive Latino men and women sampled and assessed at an outpatient HIV clinic in Los Angeles examined the associations among acculturation, use of a substance before sex, and unsafe sexual behaviour. As acculturation increased, men and women were increasingly likely to have engaged in unsafe sex in the most recent sexual encounter since testing seropositive. In men, the association was partially mediated by use of a substance (primarily alcohol) in the three hours before the sexual encounter; in women, the association was not mediated by drug use. The findings underscore the need for culturally sensitive, secondary prevention programmes for HIV-positive persons.

Acculturation↗
PubMed1998

Use of rectal cancer position as a prognostic indicator.

The hypothesis of this study was that the position of rectal cancer within the circumference of the rectum influences mortality. Tumor position was prospectively documented in 181 patients with rectal carcinoma by two examiners. The results were analyzed for correlation to survival using the Lifetest model and for multivariate correlation using the Cox regression model. An anterior tumor location was present in 43 patients and was found to have a significantly higher survival rate than other positions. Two-thirds of anterior tumors were of pathologically favorable Dukes' stages. Fifty-five patients had posterior tumors with decreased survival rates, two-thirds of which were of unfavorable stages. Circumferential position in 61 patients was most predictive of poorer outcome, with a relative risk of death being increased by 4.6 times (P = 0.014) and a 5-year survival rate of 68.8 per cent; 85 per cent of these tumors were of pathologically unfavorable stages. The 5-year survival rate for the whole group, which included 181 patients with all histopathological stages except those with distant metastases at presentation, was 78.5 per cent. This ranking of survival rates was found to be consistent in each category with the postoperatively determined Dukes' stage, which carried a prognostic significance of P = 0.0001. We conclude that tumor position is a significant indicator of prognosis available before surgery for rectal cancer.

Adenocarcinoma↗
PubMed1997

Functional decline in the elderly: evidence for direct and stress-buffering protective effects of social interactions and physical activity.

Advances in medical technology and improvements in health behavior have greatly increased the proportion of Americans who survive into old age. Consequently, identifying environmental and behavioral factors that enhance or protect the health and functional capacity of older adults is an important goal. This study investigated the extent to which social interactions and physical activity can protect older adults from the declines in functional ability that typically occur with age and the extent to which they buffer the negative effects of widowhood on physical functioning. Data were from the Longitudinal Study of Aging, a six-year follow-up of over 7,000 respondents in the 1984 National Health Interview Survey. Using individual growth curve models which examine the effects of predictor variables on change over time, this study investigated how physical activity, social interactions, and widowhood are related to the rate of change in functional health over a six-year period. Results suggested that physical activity and social interactions each exerted independent effects on functional decline. In addition, physical activity and social interactions buffered the effects of widowhood on functional decline, especially in men who died before the end of the study. Results suggest a need for health promotion programs to encourage both physical and social activities in the elderly.

Activities of Daily Living↗
PubMed1997

Distress and coping among women with HIV infection: preliminary findings from a multiethnic sample.

In a multiethnic sample of 53 women with HIV/AIDS, nearly 40% reported clinically significant levels of depression symptomatology and anxiety. Compared to a nonpatient norm, distress levels were higher among the Latina, African-American, and white women who made up the HIV sample. Prayer and rediscovery of self were their most frequent coping responses, suggesting that clinicians working with HIV/AIDS populations not overlook the importance of spiritual faith and practices in adapting to HIV infection.

Adaptation, Psychological↗
PubMed1997

Alcohol, tobacco and recreational drug use and the risk of non-Hodgkin's lymphoma.

A population based case-control study was conducted to determine whether risk of non-Hodgkin's lymphoma (NHL) in the absence of HIV infection is related to the previous use of tobacco, alcohol or recreational drugs. A total of 378 residents of Los Angeles County who were diagnosed with high- or intermediate-grade NHL were compared with individually age-, race- and sex-matched neighbourhood control subjects with regard to history of use of tobacco products, alcohol and ten specific recreational drugs. Risk of NHL among women decreased with increased consumption of alcoholic beverages (trend P = 0.03), with risk 50% lower among those consuming five or more drinks per week than among non-drinkers. Cocaine, amphetamines, Quaaludes and lysergic acid diethylamide (LSD) were each associated with a significantly increased risk of NHL in men with risk greater among those with more frequent use of these drugs. Confounding factors could not be excluded in these findings. The use of multiple types of drugs was also associated with a significantly increased risk of NHL in men (trend P = 0.005) with risk greatest among those using five or more types of drugs (odds ratio = 5.8, 95% confidence limits = 1.2-28.4); among these drugs, cocaine use appeared to account for the elevated risk of NHL among men based on multivariable analyses.

Adolescent↗
PubMed1997

Disclosing HIV status and sexual orientation to employers.

Seropositive gay and bisexual men who reveal their sexual orientation or HIV/AIDS status to their employer risk discriminatory reprisals. However, non-disclosure may limit potential social, emotional, and tangible support. Among our sample of 389 seropositive gay and bisexual men employed in the US, 52% were 'out' to their employer and 35% had disclosed their serostatus to him or her. Among gay men, employer awareness of their sexual orientation was related to their being European American (vs Latino or African American), being HIV-seropositive for more than 4 years, and having a gay or bisexual employer. Disclosure of HIV infection in the total sample was related to being European American, HIV-seropositive for more than 4 years, symptomatic (vs asymptomatic), 'out' at work, and having a gay or bisexual employer. Men who had informed their employers of their HIV status reported consequences that were substantially more positive than those anticipated by men who had not disclosed. Policy and research implications for improving the work environment for gay and bisexual men living with HIV are considered.

Attitude to Health↗
PubMed1997

[Results of the local excision of rectal cancer after high-dose radiotherapy associated or not to chemotherapy].

Local excision of rectal cancer in low-risk patients is appealing but it provides limited control of the disease. Postoperative radiation therapy may improve results. The Authors report on their experience with preoperative high dose radiation therapy for rectal cancer patients; more recently, chemoradiation was used. Local excision is advised only for those patients with minimal or no residual disease. The results obtained in 34 cases are encouraging; moreover, a better control of the disease seems to be offered combining chemo- and radiotherapy.

Adult↗
PubMed1996

Prognostic significance of tumor fixation of rectal carcinoma. Implications for adjunctive radiation therapy.

BACKGROUND: This study was conducted to assess the prognostic significance of adjunctive radiation in the surgical management of rectal carcinoma patients with tumor fixation. METHODS: Two hundred and ninety-seven patients with a histologic diagnosis of adenocarcinoma of the rectum were treated with high dose preoperative radiation ( > or = 45 Gray [Gy]) followed by surgical resection of the tumor (Group A). One hundred and seventy-four patients underwent initial curative surgery (Group B) followed by selective postoperative radiation (45-50 Gy) for those with pathologic T3, T4, or N+ (B2, C) cancers (N = 143). The two patient groups were compared by presenting clinical stage of the disease to assess the prognostic significance of tumor fixation on results of adjunctive therapy. Follow-up ranged from 24 months to 180 months. RESULTS: The 5-year actuarial survival of Groups A and B was similar, 69% and 61% respectively. Survival was significantly better for Group A patients with fixed cancer (57% vs. 33%, P = 0.003). Survival was also better for patients in Group A with tumors located in the distal rectum (70% vs. 56%, P = 0.02). The local recurrence rate for patients with tumors located in the distal rectum was 17% for Group A and 19% for Group B (P = 0.74). The local recurrence rate for fixed cancers was 23% and 50% for Group A and Group B respectively (P = 0.0009). The incidence of small bowel complications (Grade 3 or 4) was lower for patients undergoing preoperative radiation compared with patients treated with postoperative radiation, (4% vs. 13%, P < 0.05). CONCLUSIONS: When special considerations of sphincter-preserving surgery are not an issue, mobile rectal carcinoma may be effectively treated with surgery and selective postoperative radiation. However, fixed tumors, especially those located in the distal rectum, are better treated with high dose preoperative radiation.

Adenocarcinoma↗
PubMed1995

Induction of antigen-specific T and B cell immunity in colon carcinoma patients by anti-idiotypic antibody.

Polyclonal goat anti-idiotypic Abs directed against anti-human gastrointestinal carcinoma mAb GA733 were administered to 13 colon cancer patients who had their primary tumor and lymph node metastases removed before immunotherapy. Patients received four s.c. doses (0.5 to 8 mg each) of alum-precipitated anti-idiotypic Ab. Seven of the 13 patients produced anti-anti-Ids that bound specifically to the GA733 epitope on tumor cells and shared idiotopes with mAb GA733. In four of the seven responding patients, anti-Id therapy specifically modulated T cell responses. In two patients who did not demonstrate GA733 Ag/anti-Id-reactive T cells before therapy, anti-Id administration induced CD4+, MHC class II-dependent T cells that specifically proliferated in culture in response to stimulation with either anti-Id or GA733 Ag. In two other patients who did demonstrate Ag/anti-Id-reactive T cells before therapy, anti-Id administration transiently induced lymphocytes that suppressed the proliferative responses of cultured pretherapy lymphocytes to stimulation with anti-Id or GA733 Ag. Nine of the 13 treated patients showed no evidence of disease after 39 to 86 mo of observation. Five of these patients developed Ag-specific Ab3 and one had, in addition, a T cell response.

Adult↗
PubMed1995

Women's self-disclosure of HIV infection: rates, reasons, and reactions.

A survey of 65 ethnically diverse women at 2 outpatient HIV clinics revealed relatively low rates of disclosure of HIV-positive serostatus to extended family members, somewhat higher rates for immediate family members, and highest rates for lovers and friends. Spanish-speaking Latinas were less likely to disclose their serostatus or to discuss HIV-related worries with others than English-speaking Latinas, African Americans, and Anglo Americans. Reasons for disclosure and nondisclosure varied by target. In general, targets reacted positively to disclosure. Implications for clinicians treating women with HIV infection are discussed.

Adolescent↗
PubMed1995

Culturally sanctioned secrets? Latino men's nondisclosure of HIV infection to family, friends, and lovers.

Spanish-speaking Latino men (n = 107) were more likely than English-speaking Latinos (n = 85) and Whites (n = 206) to withhold their HIV-positive serostatus and their gay or bisexual orientation from significant others, especially family members. Similar effects were observed when Latinos were divided by birthplace and when analyses controlled for sociodemographic and medical factors. Reasons for revealing or concealing an HIV diagnosis varied across targets. Although both Latinos and Whites were more likely to withhold their diagnosis from their parents to prevent worrying them than to avoid personal rejection, this tendency was somewhat stronger among Latinos. Our findings suggest that some traditional values may deter Latinos from seeking HIV-related social support in times of need.

Acculturation↗
PubMed1995

Self-disclosure of HIV infection among men who vary in time since seropositive diagnosis and symptomatic status.

OBJECTIVE: To assess self-disclosure of HIV-positive serostatus to family, friends, and intimate lovers among asymptomatic and symptomatic men who varied in length of time since HIV-seropositive diagnosis. Additionally, the study assessed the anticipated and actual interpersonal consequences of disclosure. METHODS: A multiethnic sample of 684 men with HIV/AIDS completed self-administered questionnaires at two HIV-outpatient clinics in Los Angeles. The cross-sectional analysis stratified the men by time since testing HIV-seropositive and symptomatic status. Disclosure to six significant others (intimate lover, close friend, mother, father, sister, brother) was examined in univariate and multivariate analyses. RESULTS: Men recently diagnosed HIV-seropositive (within 2-4 months) were more likely to have informed intimate lovers and friends than family members; disclosure to father was extremely low. Disclosure was generally lower among asymptomatic than symptomatic men; 21% of asymptomatic men who had tested HIV-seropositive in the previous year had not informed any of the six significant others considered in the study. Disclosure rates were higher among men diagnosed less recently. The interpersonal reactions of those informed were more favorable than the reactions non-disclosers anticipated; however, both actual and anticipated reactions were generally supportive. CONCLUSION: Many asymptomatic men inform few or no significant others of their HIV infection in the first few months after HIV diagnosis. Given the generally supportive reactions reported, HIV-seropositive men should be encouraged, when appropriate, to inform family, friends, and intimate lovers of their serostatus.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Peer consultation: a look at process.

After attending graduate nursing school, and being exposed to the concepts of peer supervision and consultation, six women formed a peer consultation group. A peer consultation group, simply stated, is a professional support group. In this article, evolution of the group process is described from personal experience and personal perspectives. The aim is to inspire other CNSs and nursing personnel involved in advanced practice to consider involvement in such a group to enhance their own professional growth and well-being. Although the format, group size, individual composition, and beneficial aspects of the group have varied throughout the 5-year tenure, group members unanimously agree that such a forum has been invaluable for their professional growth and development.

Consultants↗
PubMed1995

Women living with HIV: sexual behaviors and counseling experiences.

Seventy-two ethnically diverse women attending two outpatient HIV clinics in Los Angeles self-administered questionnaires. Nineteen women (26%) reported sexual activity in the two months prior to the survey; most were sexually monogamous and emotionally involved with live-in male partners. According to self-reports, 13 women (18% of the total sample and 68% of those who were sexually active) had engaged in at least one form of risky sexual activity. The majority (81%) of sexual partners were aware of the respondent's HIV infection, but most (67%) were seronegative. Post-test counseling was reportedly noncomprehensive (e.g., 47% of the respondents did not recall receiving information about using condoms correctly). Few women accessed HIV support services. Results underscore the need for more effective counseling and support interventions for this population.

Adult↗
PubMed1994

High-dose preoperative radiation and full thickness local excision: a new option for selected T3 distal rectal cancers.

PURPOSE: To assess the efficacy of high-dose preoperative radiation and full thickness local excision as an option for the management of selected distal rectal cancers. METHODS AND MATERIALS: Forty-eight patients with invasive distal rectal cancer have been treated with high-dose preoperative radiation (45-55 GY at 180 cGy/fx) followed 6 to 8 weeks later by full thickness local excision. Three groups of patients are included in this study. Group 1 (N = 15) Medically Compromised: patients with rectal cancers Stages T3 or > 3 cm in size and significant cardiorespiratory disease that precluded radical surgery. Group 2 (N = 18) Elective: patients suitable for local treatment by standard criteria (Stages < T2 and < 3 cm in size), and group 3 (N = 15) Staged: patients with Stages T3 or > 3 cm in size that postradiation were downstaged and met the criteria as in group 2. One patient in group 3 was found to be pathologically T3 following full thickness local excision and was converted to an abdominoperineal resection. Follow-up ranges from 6-96 months with a median of 40 months. RESULTS: The overall 5-year actuarial survival for the whole group is 83.5% and local recurrence is 10%. The 5-year survival is 74%, 92%, and 88% for Groups 1, 2, and 3 and 90%, 89%, and 50% for postradiation pathologic stages T0/T1, T2, and T3, respectively. Local recurrence rate by treatment groups are 20%, 11%, and 0% for groups 1, 2, and 3 and 11%, 0%, and 67% for postradiation Stages T0/T1, T2, and T3, respectively. Surgical complications, primarily wound healing, were observed in five patients (10%). Four patients required a subsequent colostomy (three for recurrence and one for a rectovaginal fistula). Sphincter function as measured by Parks criteria was good/excellent in 88% of patients. CONCLUSION: High-dose preoperative radiation and full thickness local excision appear to be a promising new option for the management of selected patients with invasive distal rectal cancers. Selected patients with Stage T3 cancers that as a result of preoperative radiation are downstaged and met the criteria for primary local therapy (T2 or less) appear to have an excellent survival with retained normal sphincter function following full thickness local excision.

Adenocarcinoma↗
PubMed1994

Downstaging of advanced rectal cancer following combined preoperative chemotherapy and high dose radiation.

PURPOSE: To assess the potential downstaging of advanced rectal cancer with combined preoperative chemoradiation. METHODS AND MATERIALS: Thirty-one patients with fixed rectal cancers (stage > or = cT3) were treated with concomitant preoperative chemotherapy and high-dose radiation in an effort to improve resectability. Three (10%) patients had partially fixed low rectal cancers, 24 (77%) patients had fixed tumors, and 4 (13%) had advanced fixation with pelvic sidewall invasion. Radiation was delivered to the whole pelvis using shaped anterior and posterior and lateral fields to 45 Gy followed by a boost to the tumor. Median total radiation dose was 55.8 Gy. Chemotherapy consisted of low dose continuous infusion of 5-FU (200-300 mg/m2/day) for the duration of radiation treatment. All 31 patients underwent surgical resection of tumor 6-8 weeks following treatment. Median follow up is 24 months (range 9-60). RESULTS: Twenty-three (74%) of the tumors were clinically downstaged following preoperative treatment. Of 24 fixed cancers, 11 (46%) became mobile, 6 (25%) became partially fixed, and 7 remained fixed. Of the four tumors with advanced fixation, two (50%) became mobile and two (50%) no longer had tumor extension to the pelvic sidewall. Two of the three initially partially fixed cancers became mobile and one remained partially fixed. Following surgery, the pathologic postradiation T-stages were as follows: T0: 10%, T1: 0%, T2: 32%, T3: 42%, and T4:16%. Seven patients (23%) were also node-positive (T0-2: 2, T3: 4, T4: 1), and two patients (6%) had liver metastases at surgery. Preoperative chemoradiation was well tolerated. There was no significant hematological toxicity. Acute grade 3 gastrointestinal toxicity was seen in six patients requiring a short hospitalization for dehydration and/or abdominal discomfort. No patient developed grade 4 toxicity. Five patients (16%) developed local recurrence of disease (T0-2: 0/13, T3: 1/13, and T4: 4/5). The actuarial 3-year survival is 68%. CONCLUSIONS: Concomitant preoperative chemoradiation using low dose continuous infusional 5-FU for advanced rectal cancer is relatively safe with acceptable morbidity. This approach is associated with considerable clinical and pathologic downstaging of cancer. Tumor resectability is improved with potential for improved local control of disease and survival.

Adult↗