Taking health education to the villages. Interview by Mandy Macdonald.
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Community Health Nursing↗
Biomedical subjects
J Edwards
Publications and source records attributed to J Edwards.
Ophthalmology and specialty education for medical students.
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Education, Medical↗
Age-related prognosis after acute myocardial infarction (the Multicenter Diltiazem Postinfarction Trial).
The basis for the excess mortality with age after acute myocardial infarction (AMI) is not clear, nor is it known whether the mode of death is altered with age. Age-related factors predictive of mortality and age-related mechanisms of the 333 deaths were examined in 2,466 patients who were enrolled in a placebo-controlled trial to determine the effect of diltiazem on mortality and reinfarction after AMI. There were 3 age groups with increasing mortality rates: ages 25 to 49 (n = 499), 50 to 64 (n = 1,228) and 65 to 75 years (n = 739). There was a significant age-related increase in the proportion of patients with baseline risk factors. These baseline characteristics did not differ by treatment (placebo vs diltiazem). However, multivariate survivorship analysis still identified age as an independent risk factor for cardiac death. The proportion of arrhythmic and myocardial failure deaths did not differ by treatment or age group.
Adult↗
The effects of inhibitors of arachidonate metabolism on spontaneous and evoked endplate potentials at normal and crotoxin-treated frog neuromuscular junctions.
Aspirin (1 mM), a selective cyclooxygenase inhibitor, decreased endplate potential (e.p.p.) amplitude but did not affect either the biphasic changes in m.e.p.p. frequency or triphasic changes in e.p.p. amplitude induced by crotoxin. Nordihydroguaiaretic acid (30 microM), a dual inhibitor of cyclooxygenase and lipoxygenase pathways, increased e.p.p. amplitude but did not affect the characteristic changes in m.e.p.p. frequency and e.p.p. amplitude in response to crotoxin. The incidence of giant m.e.p.p.s was reduced by aspirin and increased by NDGA. Arachidonate metabolism is not a major factor in the induction of neurotoxicity by crotoxin at the frog neuromuscular junction.
Animals↗
Antidepressant or antianxiety? A study of the efficacy of antidepressant medication.
The authors analyzed the relative contributions of improvement in depressive and anxiety symptoms, as measured by the Hamilton Rating Scale for Depression (HRSD) and the Hamilton Rating Scale for Anxiety (HRSA), respectively, after 1 week of treatment to the prediction of improvement in HRSD score after 6 weeks of antidepressant pharmacotherapy. Fifty-six subjects completed 6 weeks of treatment with either desipramine (n = 20), alprazolam (n = 18), or a desipramine-alprazolam combination (n = 18). The results showed that early improvement in the HRSD was a moderately strong predictor of the total 6-week improvement in HRSD score, and a better predictor than early improvement in the HRSA. Partial correlations showed that early HRSD improvement was significantly related to total HRSD improvement within the alprazolam group. This pattern of response differed from those observed for the other treatment groups. Desipramine-treated subjects showed gradual improvement over the course of the study, and the improvement in week 1 was not so strongly predictive of overall improvement. The relationship between early and total HRSD improvement for the combination treatment group was intermediate to the other two groups. These findings are discussed in the context of the relationship between depression and anxiety, and potential implications for the treatment of these overlapping and often mixed syndromes.
Adult↗
Cloning and heterologous expression of the penicillin biosynthetic gene cluster from penicillum chrysogenum.
A cosmid clone containing the putative penicillin biosynthetic gene cluster from Penicillium chrysogenum was used to transform the related filamentous fungi Neurospora crassa and Aspergillus niger, which do not produce beta-lactam antibiotics. Both of the transformed hosts contained intact P. chrysogenum DNA derived from the cosmid clone and produced authentic penicillin V. Assays of penicillin biosynthetic enzyme activity additionally demonstrated that they possessed delta-(L-alpha-amino-adipyl)-L-cysteinyl-D-valine synthetase (ACVS), isopenicillin N synthetase (IPNS) and acyl coenzyme A:6-aminopenicillanic acid acyltransferase (ACT) activity. The data suggests that genes encoding all the enzymes necessary for the biosynthesis of penicillin from amino acid precursors are closely linked in P. chrysogenum and constitute a gene cluster.
Acyltransferases↗
Rotation and translation of the jaw during speech.
A two-dimensional rigid-body model of jaw movement was used to describe jaw opening and closing gestures for vowels and for bilabial and alveolar consonants. Jaw movements were decomposed into three components: (a) rotation about the terminal hinge axis, (b) the horizontal translation of that axis, and (c) the vertical translation of that axis. Data were collected for 3 subjects in two separate recording sessions. Multiple regression analysis was used to examine the relationships among the three jaw movement components. For 2 subjects, but not for the third, an interdependence between jaw rotation and the first principal component of jaw translation, horizontal translation, was observed. For these 2 subjects, the first degree of freedom of jaw movement corresponded to a combination of rotation and the first principal component of jaw translation. For the third subject, the first degree of freedom of jaw movement corresponded to rotation alone. The results of this study, like those of Westbury (1988), indicate that an accurate description of jaw movement during speech requires the recording of two points of jaw movement.
Adult↗
Implementing nutrition into the medical curriculum: a user's guide.
The medical profession is facing the challenges of the 1990s with a shift to outpatient care and preventive services. Medical schools will need to respond to these forces by reevaluating their curricula and setting new objectives. Nutrition is an essential element in the process of curriculum change. The nutrition educator will be expected to take a leading role in integrating nutrition into the medical school curriculum. This report presents steps and strategies to initiate the process.
Curriculum↗
Diagnosing personality disorders in recent-onset schizophrenia.
The present study aimed to determine the prevalence of personality disorders (PDs) and personality disorder traits in 40 recent-onset schizophrenic patients, to establish the degree of concordance between the Structured Interview for DSM-III Personality Disorders (SIDP) and the Million Multiaxial Clinical Inventory (MCMI-I), and to examine the interrater reliabilities for the diagnosis of SIDP disorders and traits. During their recovery phase, patients underwent the SIDP and completed the MCMI-I, a self-report inventory. Results showed that 57% of all patients had PDs according to the SIDP. The most common PDs were antisocial, borderline, and schizotypal, whereas the most common according to the MCMI-I were dependent, narcissistic, and avoidant. Both instruments indicated that multiple PD diagnoses were common. Paranoid and schizotypal traits were found to be ubiquitous across instruments. The level of agreements between the two instruments was poor on diagnostic assignment but better when trait scores were considered.
Adult↗
Personality disorder assessment for psychiatric inpatients.
The standardised criteria for DSM-III personality disorders encouraged the development of numerous multidimensional instruments to make the diagnosis of such disorders more objective and reliable compared with clinical judgement. Yet, there is no published research on the concordance between these instruments when used with psychiatric inpatients. Two such measures, the Millon Clinical Multiaxial Inventory (MCMI) and the Structured Interview for DSM-III Personality (SIDP), were chosen for this study. The MCMI identified a significantly greater number of personality disorders than the SIDP for each subject. Despite overall high interrater reliability with the SIDP, low agreement was found between the two instruments for most of the 11 DSM-III Axis II (personality disorders) categories. Different normative populations on which the instruments were developed, method variance, and theoretical differences between Millon and DSM-III, were all likely to contribute to the low concordance. Systematic research of possible confounding factors is suggested.
Adult↗
Lasers in gynecology.
Advances made in the field of gynecology through the use of laser technology have provided numerous benefits to women. Procedures requiring hospitalization can now be performed on an outpatient basis. New hope for couples experiencing infertility problems is now available through the development of new laser techniques. Ongoing research into cancer treatment, tissue welding, advances in delivery devices, and lasers will continue to revolutionize gynecologic laser applications.
Abdomen↗
Preoperative chemotherapy is beneficial for geriatric patients with locally advanced and metastatic breast cancer.
The relationship between aging and drug toxicity has been documented. We reviewed patients with Stage IIIB and Stage IV breast cancer with the primary tumor intact at presentation to compare the toxicity secondary to chemotherapy, the disease-free survival, and the survival in both young and elderly women. Fifty-three patients were studied. All received preoperative chemotherapy and mastectomy as part of treatment for breast cancer. Sixty years was used arbitrarily to divide the patients into two groups. Data were analyzed by unpaired T-test. Hematologic, nutritional, infectious, and cardiac toxicities were noted and compared between groups. Disease-free survival was studied in patients with Stage IIIB disease. Survival was examined in patients with Stage IIIB and Stage IV disease. We could not detect any statistically significant differences between young and elderly patients in any of these groups. The elderly patients in this study seemed to derive as much benefit from chemotherapy as did younger patients.
Adenocarcinoma↗
Pathogenesis of antigen-induced arthritis in mice deficient in neutrophil elastase and cathepsin G.
The contribution of neutrophil-derived elastase and cathepsin G to joint pathology has been examined in immune arthritis in the mouse. Neutrophils from beige mice are genetically deficient in lysosomal elastase and cathepsin G, but have normal levels of the acid hydrolases, beta-glucuronidase, and N-acetyl-beta-glucosaminidase. The development of antigen-induced arthritis in normal mice has been compared with that in beige mice. The pattern of synovitis (both leukocyte accumulation and plasma leakage) were indistinguishable in normal and beige mice. Cartilage proteoglycan depletion was quantified by measuring the decrease in safranin O staining intensity, and this, too, was unaltered in mice lacking elastase and cathepsin G. These results suggest that neutrophil elastase and cathepsin G do not contribute to these aspects of joint pathology in antigen-induced arthritis in the mouse.
Animals↗
Secondary acute myelocytic leukemia after adjuvant therapy for early-stage breast carcinoma. A new complication of cyclophosphamide, methotrexate, and 5-fluorouracil therapy.
The occurrence of treatment-related hematologic malignancies after adjuvant therapy with alkylating agents for gastrointestinal cancers, ovarian carcinoma, and breast cancer and after treatment for Hodgkin's disease, non-Hodgkin's lymphoma, germ-cell tumors, and multiple myeloma has been well documented. Adjuvant chemotherapy is frequently used for the treatment of early stage breast cancer, and to date there has been no increase in the incidence of secondary myelodysplastic syndromes or acute leukemia after cyclophosphamide-based regimens when compared with surgical controls. This report describes two patients who developed acute myelocytic leukemia only after exposure to cyclophosphamide, methotrexate, and 5-fluorouracil adjuvant therapy. These two cases of acute leukemia, which developed 3 years after diagnosis of breast cancer and initiation of chemotherapy, were characterized by trilineage dysplasia and pancytopenia, and had abnormalities of chromosomes 5 and 7: characteristics consistent with treatment-related leukemia. Many women are diagnosed with early stage breast cancer each year who are potential candidates for adjuvant therapy. Although certain subgroups of patients have been shown to benefit from adjuvant therapy, continued efforts must be directed at identifying responders so that others will not be exposed to the additional risks of chemotherapy.
Aged↗
Human immunodeficiency virus infection in prostitutes.
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Acquired Immunodeficiency Syndrome↗
Influence of body habitus and race on bone mineral density of the midradius, hip, and spine in aging women.
Osteoporosis and fractures of the hip are less common in black women and in obese white women than in nonobese white women. To determine the effects of race, age, and body weight on bone mineral density (BMD), BMD of the lumbar spine, trochanter, and femoral neck were determined by dual-photon absorptiometry in 131 nonobese white women and 34 nonobese black women, all of whom were within 30% of their ideal body weight, and in 24 obese white women and 27 obese black women, all of whom weighed more than 30% of their ideal body weight and were in the same age range as the nonobese women. All of them were 51 years of age or older, and most of them were postmenopausal. BMD of the midradius was measured by single-photon absorptiometry. Whereas body weight was significantly higher in the black as compared to the white women, the ages of the two groups were not different from each other. BMD declined with age and increased with body weight in both the black and white women at each of the four sites measured. After adjusting for age and weight by covariate analyses, black women had greater BMDs than white women at the midradius, lumbar spine, and femoral neck (p less than 0.001), but not at the trochanter (p = 0.18). The increases in BMD observed in the obese and black women in the present study are consistent with the previous findings that osteoporosis and fractures of the hip are less common in black and in obese white women than in nonobese white women.
Aged↗
Amplification of the isopenicillin N synthetase gene in a strain of Penicillium chrysogenum producing high levels of penicillin.
The isopenicillin N synthetase (IPNS) gene has been isolated from wild-type Penicillium chrysogenum and used as a probe to detect the equivalent gene on Southern blots of genomic DNA from a mutant producing high levels of penicillin. The IPNS gene in this strain is contained within a region of DNA of wild-type restriction pattern that extends for at least 39 kb and is present at between 8 and 16 copies. The steady state level of IPNS mRNA in the mutant producing high levels of penicillin is between 32- and 64-fold of that of the wild type, suggesting that the rate of transcription of some or all of the copies has been increased. In addition we have also shown that both the IPNS mRNA and enzyme is present throughout the growth phase in both strains under the culture conditions used. IPNS enzyme activity is greatly increased in the strain with the high penicillin titre.
Cloning, Molecular↗
The effects of muscle-building exercise on bone mineral density of the radius, spine, and hip in young men.
We previously demonstrated that muscle-building exercise is associated with increases in serum Gla-protein, serum 1,25(OH)2D, and urinary cyclic AMP. These studies were interpreted to mean that this form of exercise increases bone formation and modifies the vitamin D-endocrine system to provide more calcium for bone. The present investigation was carried out in normal young adult white men to determine the effects of exercise on bone mineral density at weight-bearing and nonweight-bearing sites. Twelve men who had regularly engaged in muscle-building exercises (use of weights, exercise machines, or both) for at least 1 year and 50 age-matched controls (aged 19-40 years) were studied. The body weights of the two groups were not different from each other (78 +/- 2 vs. 74 +/- 1 kg, NS). Bone mineral density (BMD) of the lumbar spine, trochanter, and femoral neck was measured by dual-photon absorptiometry, and BMD of the midradius was measured by single photon absorptiometry. It was found that muscle-building exercise was associated with increased BMD at the lumbar spine (1.35 +/- 0.03 vs. 1.22 +/- 0.02 g/cm2, P less than 0.01), trochanter (0.99 +/- 0.04 vs. 0.86 +/- 0.02 g/cm2, P less than 0.01), and femoral neck (1.18 +/- 0.03 vs. 1.02 +/- 0.02 g/cm2, P less than 0.001) but not at the midradius (0.77 +/- 0.02 vs. 0.77 +/- 0.01 g/cm2, NS). These studies provide additional evidence that muscle-building exercise is associated with increases in BMD at weight-bearing sites but not at nonweight-bearing sites.
Adult↗