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Biomedical subjects

J J LaFerla

Publications and source records attributed to J J LaFerla.

At least 19 recordsLinked to original sources
PubMed1999

Impact of a new cervical pap smear screening guideline on member perceptions and comfort levels.

BACKGROUND: An evaluation was conducted to assess patient perceptions and comfort levels with a new triennial Pap smear screening guideline. METHODS: A random sample of women ages 20-69 (N = 673) was selected among members of three provider groups within a large health maintenance organization and mailed a survey. Questions pertained to Pap smear history and perceptions of the new guideline. RESULTS: The overall response rate was 63%. Over one-half of respondents had no recollection of being informed about the change in recommendation. Fourteen percent of subjects responded positively to the change, 16% were neutral, 20% were skeptical, and 50% made negative comments. Women significantly more likely to be negative or skeptical about the new guide line were those who reported more frequent prior Pap smears (P < 0.0001), those reporting a history of abnormal Pap smear (P < 0.01), and more educated women (P < 0.05). No statistical differences were found for those reporting a recent abnormal result, or based on provider group, age, or recollection of being informed. CONCLUSIONS: Regardless of patient knowledge and intellectual understanding of screening intervals, this new guideline raises patient concern about preventive care. More must be done to educate women regarding the change in recommended screening frequency and the reasons for it.

Adult↗
PubMed1990

Parental perceptions of genetic risk: correlation with choice of prenatal diagnostic procedures.

Determinants of patients' decisions to have prenatal diagnosis, and by which test (amniocentesis or chorionic villus sampling), is not well understood. We have administered questionnaires to couples referred for genetic counseling and procedures for advanced maternal age and determined patients' responses, decisions, and attributable determinants of their choice. Differences in perception of risks between partners, and choice of procedure, correlated with socioeconomic, educational status and age.

Adult↗
PubMed1989

Psychosexual aspects of virilization syndrome.

A case is reported of a 35-year-old black woman with marked hirsuitism. The focus is on the psychosexual aspects of her illness. Physicians must attend to the potentially devastating effects of virilization syndrome on their female patients.

Adult↗
PubMed1988

Determinants of altered anxiety after abnormal maternal serum alpha-fetoprotein screening.

With maternal serum alpha-fetoprotein testing, large numbers of previously "low-risk" patients are now considered high risk and are offered genetic testing. Anecdotally, these patients have been perceived as more highly anxious than other second-trimester patients referred for genetic testing because of advanced maternal age. Thus we have studied patient demographics, true genetic risks, the perceptions of risk, and state (situational) and trait (constitutional) anxiety for these patients and their partners. Significantly increased state anxiety was noted for mothers as compared with fathers both in the group of women referred for testing because of maternal serum alpha-fetoprotein levels and in those referred due to advanced maternal age. State anxiety was increased in the women referred for maternal serum alpha-fetoprotein levels as compared with women referred for advanced maternal age. True genetic risks were comparable between the groups. Some critics have argued that maternal serum alpha-fetoprotein screening engenders unnecessary anxiety. Our data show that patients undergoing genetic testing due to maternal serum alpha-fetoprotein levels have higher state anxiety than women undergoing testing because of advanced maternal age, but that indication is much less a factor than are partner differences. Therefore, increased anxiety after abnormal maternal serum alpha-fetoprotein testing results cannot be reasonably used as an argument against such testing.

Adult↗
PubMed1986

Human placental glutathione S-transferase-mediated metabolism of methyl parathion.

The ability of human placental glutathione S-transferase (GSHTr) to metabolize methyl parathion (MeP) was examined. MeP was found to be a substrate for both partially purified pre-term and highly purified term placental GSHTr. The characterization of the reaction by high performance liquid chromatography revealed the presence of desmethyl parathion (DesMeP) as the sole metabolite. Term placental GSHTr activity towards MeP ranged from 2.22 to 3.53 nmoles DesMeP formed X min-1 X mg-1 while an activity of 0.60 to 1.12 nmoles DesMeP formed X min-1 X mg-1 was observed with the pre-term placental enzyme. The absence of the O-dearylation reaction by pre-term and term placental GSHTr represents a major species- and/or tissue-specific difference.

Chromatography, High Pressure Liquid↗
PubMed1985

Myositis ossificans progressiva and pregnancy. A therapeutic dilemma.

Myositis ossificans progressiva is a rare but progressively debilitating autosomal dominant disease characterized by extraskeletal ossification involving muscle connective tissue. This report is the first on pregnancy and induced abortion in a patient with myositis ossificans progressiva. Intraoperative sector scanning ultrasound was of limited benefit in evacuation of the uterine cavity. Conservative management of an incomplete termination resulted in no adverse sequelae.

Abortion, Induced↗
PubMed1984

Sterilization failures with bipolar tubal cautery.

From a consecutive series of 105 patients undergoing bipolar tubal sterilization (BPS), ten pregnancies were reported, and a tubal patency rate of 16% was found at hysterosalpingography. There were no significant clinical variables separating the BPS failure patients from those with successful sterilization. Ninety percent of the BPS failures were intrauterine, and 90% occurred within three cycles of BPS. The results of this investigation suggest that (1) BPS tubal occlusion may be associated with an increased failure (pregnancy and tubal patency) rate; (2) the majority of BPS failures are intrauterine gestations; (3) delayed fibrosis, rather than immediate tubal destruction, may be the mechanism of BPS tubal occlusion; (4) for maximum effectiveness, patients undergoing BPS should use alternative contraception for two to three cycles; and (5) surgeons employing BPS require precise training in the application of this modality of female sterilization.

Cautery↗
PubMed1984

Inhibited sexual desire and orgasmic dysfunction in women.

Desire phase dysfunction and orgasmic dysfunction are frequently brought to the attention of the gynecologist. While a variety of psychosocial and organic factors may be involved, the clinician can be helpful in a number of ways. Specific techniques of sexual counsel for both ISD and orgasmic dysfunction have been presented. Recognition and treatment of sexual dysfunction can be a somewhat time-consuming but rewarding aspect of comprehensive women's health care.

Alcoholism↗
PubMed1983

Midtrimester abortion: techniques and complications.

Midtrimester abortion may be accomplished by a variety of techniques, alone or in combination. Comprehensive care of patients who require or request pregnancy termination in the second trimester must include careful assessment of medical and psychological conditions. Special attention needs to be paid to gestational age, and for many cases ultrasonography should be part of the evaluation. With the variety of techniques and combinations available, physicians can now individualize patient care to minimize morbidity and mortality while improving patient comfort and well being.

Abortion, Induced↗
PubMed1978

Psychoendocrine response to sexual arousal in human males.

The hypothesis is tested that luteinizing hormone (LH) and follicle stimulating hormone (FSH( may be released from the anterior pituitary in response to a psychological state of sexual arousal. LH levels in 10 male volunteers were found to be higher after viewing a sexually arousing film than after a control film. The magnitude of LH response was found to be positively correlated with the subjective evaluation of sexual arousal. FSH levels tended in the same direction bu the predominant and unexpected finding for this hormone was that levels were consistently lower during the first session, when anxiety was high, and higher during the second session, when anxiety was less, whether control or stimulus film had been shown. This study is analogous to those demonstrating the responsiveness of other anterior pituitary hormones to specific psychological states.

Erotica↗
PubMedDate not supplied

Pap smear screening in a health maintenance organization: 1986-1990.

BACKGROUND: To assess Pap smear utilization and compliance with screening recommendations, a study was conducted in a large midwestern HMO where cost is not a barrier to care. The purpose of the study was to examine rates of screening by age, identify the proportion of abnormal cytologic findings, and determine screening incidence for women with a diagnosis of cervical cancer. METHOD: Computerized records on screening frequency over a 5-year interval were examined for 23,649 consecutively enrolled women ages 18-70. In addition, medical records were examined for patients with a cervical cancer diagnosis (n = 32). RESULTS: Eighty-five percent of the women had at least one Pap smear within the 5-year duration. Nearly half (47%) obtained four to five tests, 30% obtained two or three tests, and 14% were screened only once during the 5 years. Percentages were similar across all age groups. Cytopathology reports indicated 95% of tests as normal, 4% as low-grade squamous intraepithelial lesions (SIL), <1% as high-grade squamous intraepithelial lesions, and 0.02% as suspected malignancy. Younger women were more likely to evidence SIL; older women were somewhat more likely to have carcinoma. For women with a cancer diagnosis, 63% had not been screened the previous year and 34% had no screening recorded for the prior 3 years. Twenty-two percent had no record of screening within the past 5 years compared with 8.5% of the total group. CONCLUSIONS: In HMOs with prepayment, one would hypothesize that patients would obtain more regular preventive screening of all types, yet women at highest risk seemed less likely to obtain Pap smear screening. This group is not fully understood and probably represents the best opportunity to reduce morbidity, mortality, and expense from preventable cervical neoplasias.

Adolescent↗