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Biomedical subjects

J D Leeper

Publications and source records attributed to J D Leeper.

At least 19 recordsLinked to original sources
PubMed2000

Carpal tunnel syndrome in women undergoing reduction mammaplasty.

Women with mammary hypertrophy who present for reduction mammaplasty have several well-described musculoskeletal complaints, but a high prevalence of carpal tunnel syndrome has not been reported. We identified 151 patients from a plastic surgery practice who underwent reduction mammaplasty from 1994 to 1996. To this group we added a convenience sample of 64 women volunteers with relatively smaller breasts (brassiere cup size B or smaller). We questioned the entire group about specific symptoms and examined them using standard provocative tests. Carpal tunnel syndrome was defined as the coexistence of symptoms and at least two physical examination findings. We examined its association with breast size, age, race, and body mass index. Stepwise logistic regression was used to determine which physical characteristics were predictive of the condition. Carpal tunnel syndrome was found in 30 patients (19.9 percent) (95 percent confidence interval, 13.8 to 27.1) and in none of the women in the convenience sample. Breast size and, to a lesser degree, body mass index were found to be highly significant predictors of carpal tunnel syndrome. After controlling for breast size, race was also significant. Breast size displayed an independent risk ratio of 6.67 when comparing the upper quartile of size to the lower quartiles. There is a markedly higher prevalence of carpal tunnel syndrome in women who present for reduction mammaplasty than in those with smaller breasts. Breast size was a significant predictor of carpal tunnel syndrome.

Adolescent↗
PubMed1996

Oral and tympanic temperatures as heat strain indicators for workers wearing chemical protective clothing.

Oral (Tor) and tympanic (Tty) temperatures were examined as alternatives for rectal temperature (Tre) as a heat strain indicator. Subjects were 20 male volunteers (age = 18-33 yr). A workload was determined in chemical protective clothing (CPC) by having the subject walk on a treadmill until a VO2 uptake of 1.33 (L/minute (approximately 650 W) was reached. At a second session subjects donned CPC and walked on the treadmill at the previously determined workload until Tre reached 39 degrees C, or heart rate reached 185 bpm, or volitional fatigue, i.e., one work cycle. Subjects then rested for 48 minutes. This cycle continued for 4 hours or until absolute fatigue at < 4 hours. Heart rate, Tor, Tty, Tre, and mean skin temperature were recorded every 10 minutes and at the end of work. A paired t-test was used to determine if a significant difference in the magnitude of temperature increase in Tor and Tty as compared with Tre existed. No significant difference (p > 0.05) was observed in delta Tor against delta Tre at 20, 30, 40, and 60 minutes of exercise, but delta Tor failed to display nonsignificant mean differences consistently throughout the test. However, delta Tty displayed no significant mean differences (p > 0.05) against delta Tre throughout the test. Tty significantly correlated with Tre at the 30- and 50-minute intervals (p < or = 0.05) and the end reading (p < or = 0.01). A repeated measures analysis of variance showed no significant difference between Tty and Tre over time. It was concluded that Tty has potential as a heat strain indicator for workers wearing CPC in the field, but Tor does not.

Adolescent↗
PubMed1993

Knowledge and attitudes toward breast-feeding: differences among dietitians, nurses, and physicians working with WIC clients.

We assessed the knowledge of and attitude toward breast-feeding of dietitians, nurses, and physicians who work with individuals in the Alabama Special Supplemental Food Program for Women, Infants, and Children. On a scale of 0 to 100, dietitians expressed stronger interest in lactation (78.6) and exhibited greater knowledge (79.6) of the questions asked than nurses (74.5 and 73.0, respectively). Attitude and knowledge scores of physicians (70.2 and 75.5, respectively) were not statistically different from those of dietitians or nurses. Respondents disagreed greatly about the relationship of breast-feeding to weight loss and the appropriateness of oral contraceptives during breast-feeding 6 weeks postpartum. Professionals were more knowledgeable about benefits to infants than about maternal concerns. Results of this study suggest that professional breast-feeding education programs should address maternal concerns such as weight loss, contraception, and mastitis as well as benefits to the infant.

Alabama↗
PubMed1992

Breastfeeding among women in the Alabama WIC Program.

Women who participated in the Alabama WIC Program during 1986-88 and ceased breastfeeding during the months of May to August during those years breastfed an average 5.6 months. Slightly fewer than 15 percent of the women who breastfed continued for 12 months or longer; 45 percent continued for six months; 59 percent did so for 4 months; and 21 percent breastfed for one month or less. Breastfeeding duration was related positively and independently to increased maternal age and parity. Younger women were more likely than older women to stop breastfeeding due to perceived insufficient milk, in order to return to work or school, or to use oral contraceptives. Women who ceased breastfeeding at or after one year postpartum tended to be older.

Adolescent↗
PubMed1990

Effects of early parent touch on preterm infants' heart rates and arterial oxygen saturation levels.

A descriptive exploratory design was used in this study to evaluate the effects of early parent touch on the heart rates and arterial oxygen (O2) saturation levels of 36 preterm infants. The infants were between 27-33 weeks gestational age at birth, and were free of congenital defects. Infants were videotaped during parent visits on up to three separate occasions during the first month of life. Parents were encouraged to interact with their infants as they usually would, and data on the infants' heart rates and O2 saturation levels were recorded every 6 seconds on a portable computer that was interfaced with the infants' monitors. Mean O2 saturation levels were significantly lower during parent touch than during baseline periods on 45% of the visits, and significantly higher during parent touch periods on 19% of the visits. O2 saturation variability was greater during periods of parent touch, and there were more abnormal O2 saturation values during parent touch than during baseline periods. Mean heart rates during parent touch were significantly lower compared to baseline on 17% of the visits, and were higher during parent touch on 43% of the visits. There were no overall differences in mean heart rates between baseline, parent touch and post-visit classifications, although heart rate variability was greater during periods of parent touch. The results indicate that preterm infants' responses to early parent touch are variable, and suggest that blanket policies that limit parent touch during the early weeks of life may not be appropriate.(ABSTRACT TRUNCATED AT 250 WORDS)

Cues↗
PubMed1990

Poison centers in America: how well do they perform.

Marked differences in cell volume, service area, and center resources continue to exist between poison centers certified by the American Association of Poison Control Centers as Regional Poison Centers and those not meeting these criteria. However, the present clinical significance, if any, of these factors remains unproven. The only previous study, conducted in 1980, used only 1 test problem and did not attempt to separately analyze each of the differences between Regional Poison Centers and Non-regional Poison Centers. This study solicited the participation of all 208 US poison centers existing. Fifty-four poison centers (REGIONAL CENTERS 16/34 = 47%, NON-REGIONAL CENTERS 38/173 = 22%) agreed to participate. Three problems were presented to each center by simulated callers. Considerable variation was observed in efficiency and in extent of information provided. Overall, Regional Centers provided complete and correct answers for 83% of the presented cases, while Non-regional Centers did so in 57% of the cases. Although Regional Center status, staff experience, center call volume, medical direction all appear to be important, the most predictive factors were staff and center experience.

Humans↗
PubMed1988

American poison control centers: still not all the same?

Although poison control centers meeting the criteria for certification by the American Association of Poison Control Centers as regional centers are widely believed to differ from centers not meeting these criteria, this assumption has not recently been validated. We surveyed all poison control centers listed in the Emergency Medicine 1986 directory of poison control centers or in the 1986 American Association of Poison Control Centers membership directory regarding their operations. Of 208 poison control centers listed, 167 (80.2%) responded; 28 of 35 regional poison control centers (80.0%) responded, as did 139 of 173 nonregional poison control centers (80.3%). The median annual call volume was 3,899 for all centers. For regional poison control centers, the median was 44,429, and for nonregional poison control centers, 1,553 (P less than .001). There also were highly significant differences in population served, call volume per capita, center staffing, medical direction, staff orientation, and follow-up protocols.

Poison Control Centers↗
PubMed1988

Mental health training of primary care physicians: an outcome study.

It is well documented that primary care physicians encounter many patients in their practices who suffer psychiatric morbidity, especially affective, anxiety and substance abuse disorders. These physicians have been unable to effectively address the needs of these patients, over half of whom receive care exclusively in the primary care sector. Five years after implementing a curriculum to train family practice physicians to assume a comprehensive psychiatric role with patients in their practices, the authors undertook an outcome evaluation. The focus was on psychiatric disorder recognition, diagnosis, documentation, and management, including referral. It was hoped that biopsychosocial and community mental health orientations emphasized during training would be incorporated into the subsequent primary care practices of physicians in the study. In the research design, physician-generated diagnoses were compared with DIS/DSM-III diagnoses; physician interviews and chart audits enabled processes of care delivery to be evaluated. Unexpectedly, physicians were not found to assume an appropriately active or comprehensive mental health role in their practices following the training intervention. Of ninety-four DIS-generated diagnoses in the study population of fifty-one patients, 79 percent were unrecognized. Patients were assumed to function well emotionally, and psychiatric dimensions of patient complaints were not examined in the majority of cases. The physicians did diagnose and treat a number of patients with mental symptoms who were not identified by the DIS. These patients had high, but sub-diagnostic, DIS symptom counts. Most received a diagnosis of adjustment disorder in response to medical illness. Though this finding underscores shortcomings of present psychiatric nosology when applied in the general medical setting, the foremost consideration was the large number of DIS-identified patients with serious psychopathology, needing active assessment and intervention, who were unrecognized, undiagnosed or untreated. Implications of these findings for the psychiatric training of primary care physicians are examined.

Curriculum↗
PubMed1987

Effects of differential alcohol dehydrogenase activity on the developmental toxicity of ethanol in Drosophila melanogaster.

The role of alcohol dehydrogenase (ADH) activity in ethanol toxicity was investigated in Drosophila melanogaster. Flies from three congenic Adh strains (high, medium, and low ADH activity) were allowed to deposit eggs on medium containing 0, 4, or 8% ethanol. The resulting larvae were allowed to complete their development in the medium, and emerging flies were examined for defects. Flies with high ADH activity had malformation incidences of 0.8, 2.4, and 5.2% at 0, 4, and 8% ethanol, respectively. The comparable incidences for the low ADH strain were 1.0, 4.1, and 8.4%, while those for the medium ADH strain were intermediate in value. These results indicate that ethanol teratogenesis may be inversely related to ADH activity. When larvae were treated with ethanol for different lengths of time during development, the incidence of defects in flies from the high ADH strain was 3.9% when exposure started at the first instar and 3.09% when exposure started at the third instar. Results of the same exposures for the intermediate ADH strain were 5.2 and 3.4%, respectively, while those for the low ADH strain were 6.9 and 5.5%, respectively. Thus, length of ethanol exposure was directly related to the increased incidence of malformations in all tested Drosophila strains. For all tested strains, defect incidences appeared to be dose-related as well, regardless of length of exposure. ADH in Drosophila has a dual function and thus can catalyze oxidation of both ethanol and its toxic metabolite, acetaldehyde. This suggests that ethanol is the proximate teratogen in Drosophila.

Aging↗
PubMed1987

Inside the hidden mental health network. Examining mental health care delivery of primary care physicians.

Mental disorder diagnoses among 51 patients, made by a group of 20 family physicians, were compared with diagnoses generated by the Diagnostic Interview Schedule (DIS). Processes of diagnosis, decision making, and treatment planning were then examined through structured physician interviews and chart audits. In this study, 75 of 94 DIS diagnoses (79%) were undetected. During interview and chart audit, the physicians were found to have consistently underestimated, misinterpreted, or neglected psychiatric aspects of care among a majority of patients in the study. These physicians had all satisfactorily completed a psychiatry curriculum designed for family physicians. Analysis of these results suggests that a mental health role is often not integrated into primary care practice, regardless of physician performance during psychiatric training experiences. Assumption of this role appears to be state dependent on involvement with a psychiatric treatment setting. Primary care practice patterns do not seem to result in application of appropriate skills and therapeutic attitudes to detect, diagnose, and correctly manage the majority of mental disorders that occur. The need is reaffirmed for active collaboration between mental health professional and primary care providers in training and in incorporation of psychiatric skills into primary care practice.

Adult↗
PubMed1987

Storytelling: a measure of anxiety in hospitalized children.

This study investigates the use of storytelling as a method of measuring children's anxiety during hospitalization. Sixty-seven hospitalized children were asked to create stories about pictures they were shown. The stories were categorized as negative or positive in tone and, hence, the children were categorized as anxious or not anxious. Children who told negative stories displayed significantly more negative behaviors and showed significantly higher anxiety levels and poorer adjustment to hospitalization as measured by observational methods. The most anxious children were male, black, and rural. Implications for practitioners who work with children in medical settings are discussed.

Adolescent↗
PubMed1987

Children's adjustment to the hospital: a rural/urban comparison.

This paper presents the findings of an investigation to determine whether or not there is a difference in the degree of psychological upset of rural and urban children during hospitalization. The subjects in the study were 70 children between the ages of 4 and 17 years who participated in the Child Life Program during hospitalization at Children's Hospital in Birmingham, Alabama. The anxiety levels of the children were evaluated by using three instruments: a 13-item, self-report test of fears; a 64-item observation checklist of negative behaviors; and a 4-item anxiety rating scale. The results revealed that on specific measures rural children exhibited a statistically significantly greater degree of psychological upset during hospitalization than urban children. Implications of these results in determining procedures to reduce anxiety of children during hospitalization are briefly considered.

Adaptation, Psychological↗
PubMed1986

Children's health care: brief report. Nature experiences for hospitalized children.

Numerous projects conducted in various settings have supported the thesis that nature activities aid in the development of self-concept, self-confidence, and level of achievement. The nature activities described in this article were designed to cultivate the hospitalized children a sense of wonder about their world and to involve them in sensory experiences that would aid them in adjusting to their hospital experiences. As a unit, these experiments provide a comprehensive approach to therapy for the hospitalized child and add a positive dimension to the child life program.

Alabama↗
PubMed1985

Supplemental Food Program: effects on health and pregnancy outcome.

To determine the effect of participation in the Special Supplemental Food Program for Women, Infants, and Children on use of health care, health-related practices, health knowledge, and pregnancy outcome, a total of 519 pregnant women were interviewed during public health department clinics in six Alabama counties. Of the sample, 341 women were participants in the WIC program and were therefore at nutritional risk; 178 were control subjects (nonparticipants) who were not at nutritional risk. There were no significant differences in pregnancy outcome between the two groups. In fact, mean birth weight was identical (7.13 lb), and mean weight gain for WIC participants was 25.8 lb, compared to 24.9 for controls. Other findings were less positive, however. Utilization patterns and health-related practices differed little between groups. There was no significant difference in the percentage of women planning to nurse. Significantly more WIC participants had discussed nursing, but significantly fewer felt they knew how to nurse. WIC is effective in overcoming nutritional risk and improving pregnancy outcome, but its educational component needs to be strengthened.

Adolescent↗
PubMed1985

Mental disorders among physical disability determination patients.

Persons claiming physical disability who were evaluated at a primary care health center in a small southern city were administered the Diagnostic Interview Schedule. Fifty-six per cent of the 43 patients were found to have one or more psychiatric disorders. The relationship between physical disability and psychiatric disorders needs to be recognized in the disability evaluation system.

Adult↗
PubMed1984

An analysis of the effects of suicide prevention facilities on suicide rates in the United States.

Since the 1960s, there has been a massive effort to reduce suicide mortality in the United States through prevention centers which invite suicidal persons to phone for supportive services. In spite of virtually total lack of evidence concerning the efficacy of these services, they proliferated until, by 1973, nearly every metropolitan area in the United States had at least one. Suicide rates increased slightly throughout this time. We studied 1968 through 1973, the years of greatest growth of suicide prevention facilities, comparing suicide rates in counties that added these centers with counties that did not do so. An association of centers with the reduction of suicides in young white females emerged. This finding was replicated on a different set of counties for a different time span. The results are discussed in light of the fact that this group constitutes the major clients of these centers.

Adolescent↗