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Biomedical subjects

J F O'Neill

Publications and source records attributed to J F O'Neill.

At least 19 recordsLinked to original sources
PubMed2000

Improving HIV/AIDS services through palliative care: an HRSA perspective. Health Resources and Services Administration.

There has been a dramatic shift of the human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS) epidemic into poor, marginalized, and minority communities in the US. At the same time, the availability of new highly active antiretroviral treatments has made it possible for a large number of individuals to live for a much longer time with their disease. A net result is that the US is faced with an increasing number of people who are living with HIV/AIDS and are dependent on publicly supported health care services. In this paper, we review the palliative care efforts of the federal agency, the Health Resources and Services Administration (HRSA), responsible for providing Ryan White CARE Act HIV/AIDS care to medically underserved populations. In addition to supporting traditional hospice care, HRSA's HIV/AIDS Bureau has begun a series of initiatives that apply a broader concept of palliative care to its HIV programs in hospital- and community-based settings. Our interest is not to substitute palliation for access to new HIV therapies, such as highly active antiretroviral treatments, but to ensure that our health delivery systems attend to the alleviation of symptoms and suffering along with the provision of antiretroviral and other necessary treatments. HRSA's HIV/AIDS Bureau is organizing a broader provision of palliative care for its clients and actively contributing to improving care for the disenfranchised internationally.

Delivery of Health Care↗
PubMed2000

Who receives Ryan White CARE Act services? A demographic comparison of CARE act clients and the general AIDS population.

This study examines the extent to which health and social service providers funded by the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act serve women, minorities, and other vulnerable populations emphasized by the legislation. Demographic characteristics of AIDS-diagnosed clients served by CARE Act-funded providers in four metropolitan areas and two states are compared with Centers for Disease Control and Prevention estimates of AIDS prevalence. Clients of CARE Act-funded providers tend to reflect the demographics of local HIV/AIDS epidemics. Where differences exist, CARE Act clients are more likely to be women and minorities and less likely to be injecting drug users. CARE Act-funded providers are effectively reaching most medically underserved populations.

California↗
PubMed1998

Consistency in maintaining contact with HIV-related service providers: an analysis of the AIDS Cost and Services Utilization Study (ACSUS).

Patients (n = 1949) infected with HIV were recruited for the AIDS Cost & Service Utilization Survey (ACSUS) from ten U.S. cities and administered face to face interviews at three month intervals over an 18 month period from March 1, 1991 to August 31, 1992. The interview was designed to obtain information at each wave of data collection on the use of the following services: ambulatory care, hospitalization, emergency room use, support groups/counseling, drug and alcohol treatment, and dental care. Patients were found to be highly consistent in their patterns of utilization across time, regardless of the service in question. Of the patients who reported using an emergency room (ER) at Time 1, 52% also reported using an ER during the next three months later at Time 2. Of those who reported having been hospitalized during the Time 1 reporting period, almost 58% reported a hospitalization again at Time 2. Next, use of a service at Time 6 (n = 1404, 72.2%) was regressed onto whether the person received the service at Time 2 and the personal, financial, and medical variables. Except for dental services, utilization of a service one year in the past (Time 2) was the strongest predictor of Time 6 use. The findings indicated that the one factor consistently related to service use within this sample is a factor (as opposed to education, race, or even insurance) that is amenable to intervention: previous use of that service. The individuals studied established patterns of service utilization that are of reasonably long duration once they began use of a service. This continuity of care becomes more critical as the initiation of treatments begins with the diagnosis of HIV rather than AIDS. Findings suggest that HIV outreach efforts be targeted to increasing early use of medical and behavioral services in ambulatory care settings.

Acquired Immunodeficiency Syndrome↗
PubMed1998

The ocular manifestations of congenital infection: a study of the early effect and long-term outcome of maternally transmitted rubella and toxoplasmosis.

PURPOSE: To study the spectrum of adverse ocular effects which result from maternally transmitted rubella and toxoplasma infection; further, to record the long-term visual and neurodevelopmental outcomes of these 2 major causes of fetal infection. STUDY DESIGN AND PATIENTS: A series of 55 patients with congenital infection have been studied prospectively on a long-term basis. The study group included a cohort of 34 cases with congenital rubella syndrome demonstrated by virus isolation, and 21 cases with a clinical diagnosis of congenital toxoplasmosis and serologic confirmation. All patients had specific disease-related ocular defects. Rubella patients were first identified during or following the last major rubella epidemic in 1963-1964, and some have been followed serially since that time. A separate study group of representative toxoplasmosis patients presented for examination and diagnosis at varying time periods between 1967 and 1991. OBSERVATIONS AND RESULTS: This study confirms that a broad spectrum of fetal injury may result from intrauterine infection and that both persistent and delayed-onset effects may continue or occur as late as 30 years after original infection. Many factors contribute to the varied outcome of prenatal infection, the 2 most important being the presence of maternal immunity during early gestation and the stage of gestation during which fetal exposure occurs in a nonimmune mother. RUBELLA: As a criteria of inclusion, all 34 rubella patients in this study exhibited one or more ocular defects at the time of birth or in the immediate neonatal period. Cataracts were present in 29 (85%) of the 34, of which 21 (63%) were bilateral. Microphthalmia, the next most frequent defect, was present in 28 (82%) of the 34 infants and was bilateral in 22 (65%). Glaucoma was recorded in 11 cases (29%) and presented either as a transient occurrence with early cloudy cornea in microphthalmic eyes (4 patients), as the infantile type with progressive buphthalmos (1 patient), or as a later-onset, aphakic glaucoma many months or years following cataract aspiration in 11 eyes of 6 patients. Rubella retinopathy was present in the majority of patients, although an accurate estimate of its incidence or laterality was not possible because of the frequency of cataracts and nystagmus and the difficulty in obtaining adequate fundus examination. TOXOPLASMOSIS: Twenty-one patients with congenital toxoplasmosis have been examined and followed for varying time periods, 7 for 20 years or more. The major reason for initial examination was parental awareness of an ocular deviation. Twelve children (57%) presented between the ages of 3 months and 4 years with an initial diagnosis of strabismus, 9 of whom had minor complaints or were diagnosed as part of routine examinations. All cases in this study have had evidence of retinochoroiditis, the primary ocular pathology of congenital toxoplasmosis. Two patients had chronic and recurrent inflammation with progressive vitreal traction bands, retinal detachments, and bilateral blindness. Macular lesions were always associated with central vision loss; however, over a period of years visual acuity gradually improved in several patients. Individuals with more severe ocular involvement were also afflicted with the most extensive central nervous system deficits, which occurred following exposure during the earliest weeks of gestation. CONCLUSIONS: Although congenital infection due to rubella virus has been almost completely eradicated in the United States, the long-term survivors from the prevaccination period continue to experience major complications from their early ocular and cerebral defects. They may be afflicted by the persistence of virus in their affected organs and the development of late manifestations of their congenital infection. Congenital toxoplasmosis continues to be the source of major defects for 3,000 to 4,100 infants in the United States each year; the spectrum of defects is wide and may vary from blindness and severe mental retardation to minor retinochoroidal lesions of little consequence. Effective solutions for either the prevention or treatment of congenital toxoplasmosis have not been developed in this country but are under intensive and continuing investigation.

Child↗
PubMed1997

Palliative medicine and HIV/AIDS.

This article provides an introduction to the field of palliative medicine as it applies to the care of HIV/AIDS. Issues of pain management, end-of-life care, ethics, and bereavement are discussed with the intention of providing the primary care physician additional resources in the provision of care to patients with HIV/AIDS.

Bereavement↗
PubMed1997

Primary care of the HIV-seropositive chemically dependent patient.

Persons with chemical dependency problems account for a large and growing number of cases of HIV/AIDS in the United States. This group poses unique challenges as providers address their medical and psychosocial needs. Although much of the care of substance-using HIV patients is the same as that of non-substance-using patients, differences do exist. Treatment of the underlying chemical dependency is a cornerstone of caring for these patients.

Female↗
PubMed1992

Health care of the gay male patient.

A significant number of men presenting to any primary care physician are gay or have had sexual encounters with members of their own sex. It is important, therefore, that the physician be familiar with particular medical care issues commonly encountered in this population and that she or he also be aware of psychosocial issues that impact on the gay patient's well-being and on the physician's ability to provide competent primary care.

Homosexuality↗
PubMed1990

Human immunodeficiency virus and the primary care physician.

As the scope and size of the human immunodeficiency virus (HIV) epidemic grows, the primary care physician will need to assume a greater role. A knowledge of HIV risk factors and the ability to perform pretest and posttest counseling for HIV testing is essential. Counseling patients on HIV risk reduction should be part of the HIV risk interview. An understanding of the benefits and contraindications of testing, as well as a respect for the impact of testing, is important. All HIV-seropositive individuals should undergo a complete history and review of symptoms as soon as test results are known. Judicious use of laboratory testing, including monitoring of CD4 cell counts, is recommended. Pneumocystis carinii prophylaxis and zidovudine therapy should be offered to patients with appropriately low CD4 counts.

AIDS Serodiagnosis↗
PubMed1989

Inherited patterned lentiginosis in blacks.

We present 10 patients with autosomal dominant transmission of a pigmentary pattern characterized by facial, lip, extremity, buttock, and palmoplantar small, discrete hyperpigmented macules. None of the patients had lesions of the oral mucosa or internal organ system abnormalities. These patients' pigmentary pattern can resemble the ones seen in other lentiginosis syndromes. Those most closely mimicked--the Peutz-Jeghers syndrome, the centrofacial lentiginosis syndrome, and Carney's syndrome--all have associated internal abnormalities. We believe the pattern of pigmentation in these 10 black patients is distinct.

Adult↗
PubMed1988

Autosomal recessive pericentral pigmentary retinopathy.

A brother and sister, born to consanguineous parents, had pigmentary retinopathy in a pericentral distribution. The retinopathy was noted in infancy when the siblings were examined for strabismus. The optic disks, maculae, and retinal vessels were normal. There was mild reduction in amplitude of both scotopic and photopic electroretinographic responses. Both patients had moderate hyperopic astigmatism and esotropia. The fundus and visual acuity remained unchanged over periods of nine and 13 years in the brother and sister, respectively. Results of ocular examinations on the father, mother, and an older sister were normal. These findings support an autosomal recessive mode of inheritance in this family with pericentral pigmentary retinopathy.

Adolescent↗
PubMed1988

Infantile glaucoma in Down's syndrome (trisomy 21).

We examined five patients with Down's syndrome and bilateral infantile glaucoma. In the first few months of life four patients had large cloudy corneas, breaks in Descemet's membrane, increased intraocular pressure, photophobia, and tearing. In one patient the diagnosis was delayed until 3 1/2 years of age because of concomitant nasolacrimal duct obstruction. Two patients developed cataracts and retinal detachment and have undergone multiple surgical procedures. The clinical course in these two older patients suggests that coexistence of congenital glaucoma, severe myopia, and cataracts in patients with trisomy 21 strongly predisposes for the development of retinal detachment and poor visual outcome.

Adolescent↗
PubMed1988

Sinus histiocytosis presenting as an epibulbar mass. A clinicopathologic case report.

Sinus histiocytosis is a well-recognized condition that mainly affects children in the first decade of life. Although this usually benign disease often features massive cervical lymphadenopathy, numerous extranodal sites of involvement can be seen. We describe a new presenting manifestation for sinus histiocytosis. A 13-month-old infant developed a rapidly growing unilateral epibulbar tumor that involved the cornea. A complete physical examination revealed only mild inguinal lymphadenopathy. A diagnosis of sinus histiocytosis was made by histologic examination of the lesion after surgical excision.

Corneal Diseases↗
PubMed1988

Ocular findings in partial trisomy 3q. A case report and review of the literature.

The authors report the ocular findings in a patient with partial trisomy 3 [46, XY-15, der(15), t(3;15) (q26;128) mat] and review the literature on this chromosomal anomaly. The patient's main ocular finding was infantile glaucoma. The patient's mother was phenotypically normal and carried a balanced chromosome translocation. Awareness of the ocular abnormalities associated with partial trisomy syndromes is essential since more children with these syndromes survive today than in the past.

Chromosomes, Human, Pair 3↗
PubMed1988

Atypical cases of sinus histiocytosis (Rosai-Dorfman disease) with ophthalmological manifestations.

Sinus histiocytosis with massive lymphadenopathy is a non-neoplastic disease of unknown cause observed mainly in children with markedly enlarged cervical or other lymph nodes. We have reported two very atypical cases with extranodal manifestations that required ophthalmological consultation. Neither patient had significant lymphadenopathy. One patient, who had tumors of all four eyelids as well as lesions of the nose and larynx, was 68 years old when first examined, and 70 at the time of his last surgical procedure. The other patient, a 13-month-old child, had a unique corneoscleral lesion as his only clinical manifestation. The excised tissues obtained from the eyelids and larynx in case 1 and from the corneoscleral lesion in case 2 revealed characteristic histopathologic features of sinus histiocytosis (Rosai-Dorfman disease), including strongly positive immunoperoxidase staining for S-100 protein in the cytoplasm of most of the histiocytes.

Age Factors↗
PubMed1984

Incidence of chronic glaucoma, retinal detachment and secondary membrane surgery in pediatric aphakic patients.

The eyes of 392 consecutive childhood cataract aspiration procedures were analysed for frequency of the development of chronic glaucoma and retinal detachment and the performance of secondary membrane surgery. Three different modifications of the aspiration procedure were employed: the standard needle and syringe procedure leaving the posterior capsule intact (304 eyes), rotoextraction with small opening of the posterior capsule (34 eyes) and Ocutome aspiration with wide excision of the posterior capsule (54 eyes). The mean postoperative follow-up was 5.5 years. Chronic glaucoma was found in 6.1% of the eyes. Coexisting ocular anomalies and retained lens cortex increased the risk for this complication. Retinal detachment was found in 1.5% of the cases. Coexisting ocular anomalies and uncontrolled vitreous disturbance increased the possibility of retinal detachment. Secondary membrane procedures were performed in 62% of the eyes in which the aspiration procedure left the posterior capsule intact, in nearly 12% of those in which the posterior capsule was minimally opened and in none of those which had the posterior capsule widely excised. The secondary membrane surgery itself appeared to increase the risk for both glaucoma and retinal detachment. The aspiration procedure with the lowest incidence for all three complications was the Ocutome aspiration with wide excision of the posterior capsule.

Adolescent↗
PubMed1984

Acquired nystagmus in early childhood: a presenting sign of intracranial tumor.

This study is a multicenter, retrospective report of 10 infants in whom acquired nystagmus was the initial sign of chiasmal/ parachiasmal glioma. Nine patients presented before the age of 10 months. The nystagmus, primarily described as pendular and asymmetric, was difficult to differentiate from and therefore most often diagnosed as spasmus nutans . On average in the ten patients, the intracranial glioma was not recognized for 8.6 months after the onset of nystagmus. In the five diagnosed as spasmus nutans , the mean delay in recognizing the tumor was 14.5 months. Three associated clinical findings were present or developed in these patients to distinguish this entity from spasmus nutans : optic atrophy in all ten patients, poor feeding due to diencephalic syndrome in 5 of 10, and increased intracranial pressure with hydrocephalus in 3 of 10. The acquired nystagmus in these infants was evidence of a life-threatening chiasmal/ parachiasmal glioma.

Astrocytoma↗