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Biomedical subjects

J L Richardson

Publications and source records attributed to J L Richardson.

At least 19 recordsLinked to original sources
PubMed1992

Vaginal absorption of insulin in the rat: effect of penetration enhancers on insulin uptake and mucosal histology.

The absorption of insulin across the vaginal mucosa into the systemic circulation was studied in ovariectomized rats given subsequent estrogen treatment. Blood glucose levels were determined as an indirect measure of insulin absorption, and the effect of various enhancers on the hypoglycemic response was investigated. In the absence of any enhancer, no decrease in blood glucose levels was observed after vaginal administration of insulin. However, the coadministration of sodium taurodihydrofusidate, polyoxyethylene-9-lauryl ether, lysophosphatidylcholine, palmitoylcarnitine chloride, and lysophosphatidylglycerol significantly increased hypoglycemia, whereas citric acid had little effect. The histological changes in the vaginal epithelium after treatment with the enhancer systems were variable and often severe. While the efficacy of these compounds in promoting the vaginal absorption of insulin is encouraging, their mechanisms of action and long-term histological effects are yet to be defined.

Absorption↗
PubMed1992

Self-disclosure of HIV infection: preliminary results from a sample of Hispanic men.

We examined self-disclosure of HIV infection among 101 seropositive Hispanic men residing in Los Angeles. Results indicated that disclosure was highly selective and presumably influenced by the social, psychological, and material consequences of informing others about one's medical condition. Subjects tended to inform significant others such as parents, friends, and lovers than less significant others such as employers, landlords, and religious leaders. There was a relatively high rate of disclosure (75%) to doctors/dentists who were not treating subjects for HIV infection. Gay and bisexual subjects (89% of the sample) were more inclined to disclose their HIV serostatus to homosexual or bisexual others than to heterosexuals and to inform those who were aware of their sexual orientation. Disclosure increased with severity of disease independently of length of time since testing seropositive. Self-rated negative changes in appearance correlated with disclosure to less significant others. The role of cultural attitudes and values in self-disclosure of HIV infection is discussed.

Adolescent↗
PubMed1992

Stage and delay in breast cancer diagnosis by race, socioeconomic status, age and year.

Information on 23,567 Non-Hispanic White, 2,539 Black, and 2,380 Hispanic breast cancer cases diagnosed between 1977 and 1985 was used to evaluate the risk of late stage diagnosis and long duration of symptoms prior to diagnosis in relation to ethnicity, socioeconomic status, age and year of diagnosis. All data were collected by the University of Southern California Cancer Surveillance Program, the comprehensive population-based incidence registry of Los Angeles County. The results indicate that lower socioeconomic status, Black or Hispanic ethnicity, younger age, and earlier year of diagnosis are risk factors for late stage diagnosis and long duration of symptoms. The effect of ethnicity was not explained by lower SES levels among Black or Hispanic women. After controlling for duration of symptoms, race and SES remained significantly predictive of more advanced stage. More recent diagnosis across the 9 year time frame was not associated with improved stage for those of low SES. These results suggest that increased efforts are needed to reach low SES and Black and Hispanic women with campaigns to improve the stage at which breast cancer is detected.

Adult↗
PubMed1991

The important role of mass media in the diffusion of accurate information about AIDS.

This paper explores the vital role of mass media in diminishing the lack of consensus among those at risk for AIDS and those who treat them. It examines the perceptions of these groups with regard to the seriousness of the AIDS threat, what people at risk are really doing to protect themselves and others, and the accuracy and objectivity of media reports about AIDS. Results indicate that there is a disarming lack of consensus among those people who can do the most to influence the spread of AIDS. Results also indicate that those people at greatest risk for AIDS and for spreading the disease distrust the accuracy and objectivity of the media. The authors argue that consensus is required for a concerted fight on AIDS and that the mass media offer an effective avenue for encouraging it. They also explore methods for regaining media respect among high risk groups with regard to AIDS reporting.

AIDS-Related Complex↗
PubMed1991

Self-disclosure of HIV infection to sexual partners.

Self-disclosure of HIV infection to current sexual partners was examined in 138 seropositive men, mostly lower income Hispanics, from Los Angeles. Forty-five percent had been sexually active since learning their serostatus. Of these, 52% had kept their infection secret from one or more partners. The likelihood of disclosure decreased in direct proportion to the number of partners. Nondisclosure occurred in conjunction with unprotected receptive and insertive anal intercourse. Potential factors promoting nondisclosure are discussed.

HIV Seropositivity↗
PubMed1990

Psychosocial status at initiation of cancer treatment and survival.

Ninety-two newly diagnosed patients with hematologic malignancies treated with chemotherapy, and 47 patients with rectal cancer treated with abdominal-perineal resection were prospectively studied to assess the relationship between mood and survival. Hematology patients were measured within one week of diagnosis and were remeasured at six months. Rectal cancer patients were measured within three months of surgery and remeasured six months later. Medical records were abstracted to obtain data on treatment given, disease characteristics and outcome of treatment. On univariate analyses using Cox regression, we examined the effect of depression, coping style and locus of control on survival. None of these variables were found to be significantly related to survival whether assessed at intake or six months later. Furthermore there were no statistically significant correlations between these factors and subsequent survival at two years or with long-term survival. Biological prognostic variables including extent of disease for rectal cancer patients and severity of specific type of hematologic cancer were significantly related to survival. Although psychosocial adjustment is important for the quality of life experienced by cancer patients it was not related to length of survival in this study. Further exploration of this issue should be conducted using patients with a single site and preferrably an early stage of disease.

Adaptation, Psychological↗
PubMed1990

The effect of compliance with treatment on survival among patients with hematologic malignancies.

Ninety-four newly diagnosed patients with hematologic malignancies were monitored for compliance with oral medication and scheduled clinic appointments over a 6-month treatment period. They were assigned at entry either to a control condition or an intervention condition designed to improve compliance. Compliance with medication was assessed objectively with serial serum drug and metabolite levels, as well as with self-report indices obtained on a monthly basis. Medical records were abstracted to obtain data on the number of appointments kept, treatment given, disease characteristics, and survival. On univariate analyses using the log-rank test, five variables were found to be significantly related to survival. These included compliance with allopurinol (probably acting as a surrogate for self-medication with other chemotherapeutic agents) (P = .007), control versus educational program cohort (P less than .001), disease severity (P = .009), Karnofsky at diagnosis (P = .011), sex (P = .084), and clinic appointments kept (P = .043). In hierarchical proportional hazards models, the following variables were associated with decreased risk of death: disease severity (P less than .025), keeping over 60% of appointments (P less than .05), allopurinol/oxipurinol compliance (P less than .01), and educational program cohort (P less than .05). After controlling for all other variables, three variables were associated with increased survival: high disease severity (relative risk [RR] = 2.48), high compliance with allopurinol (RR = .45), and educational program cohort (RR = .39). We conclude that compliance with oral medication has a significant effect on patient survival. In addition, the use of special educational and supportive programs designed to improve patient compliance are associated with significant prolongation of patient survival due to, as well as independent of their effects on compliance.

Adolescent↗
PubMed1990

Characteristics of eighth-grade students who initiate self-care in elementary and junior high school.

The purpose of this paper is to examine whether children who care for themselves for longer periods of time are at increased risk of poor grades, truancy, anger, family conflict, stress, risk-taking, and peer influences (in addition to the increased risk of substance use previously reported). Demographic characteristics of eighth-grade students who initiate self-care in junior high school are compared with those initiating self-care in elementary school. Further, increased risks for those initiating self-care in elementary school are examined. Over two thirds of the respondents (67.8%) cared for themselves after school without adult supervision at some time during the week; 23.5% for 1 to 4 hours per week, 15.7% for 5 to 10 hours per week, and 28.6% for 11 or more hours per week. Of those in self-care, 48.5% initiated self-care during elementary school and 51.5% during junior high school. Students who were in the highest category of self-care (greater than or equal to 11 hours per week) vs those in self-care zero hours per week were 1.5 to 2 times as likely to score high on risk-taking, anger, family conflict, and stress, to be more likely to see their friends as their major source of influence, and to attend more parties. The self-reports of academic grades did not differ. The grade of initiation of self-care (elementary vs junior high school) conferred additional risk for drinking alcohol (odds ratio = 1.4), risk-taking tendencies (odds ratio = 1.5), and attending parties (odds ratio = 1.6).

Adolescent↗
PubMed1989

Ozone trends in Atlanta, Georgia: have emission controls been effective?

Nine years of summertime ozone data from the Atlanta metropolitan area are analyzed and compared to local emissions of volatile organic carbon and nitrogen oxides. Trends from 1979 to 1987 were studied for the number of days per year ozone exceeded the NAAQS standard, the second-highest ozone level observed per year, and the first quartile summertime average ozone observed, as well as the mean difference between the ozone level observed downwind and upwind of the city. Because this last parameter is sensitive to chemical factors but relatively insensitive to the number of days each year with meteorological conditions conducive to ozone formation, its trend may be best suited for determining how effective emission controls have been in reducing O3 in the Atlanta area. In spite of the fact that sizeable reductions have been claimed for volatile organic carbon emissions over the past several years, the data give no indication that ozone levels have decreased and in fact imply that summertime ozone production may have increased. The results imply that either emissions have not decreased as much as has been claimed or that ozone is not sensitive to anthropogenic volatile organic carbon emissions. In either event, a reevaluation of our nation's strategy for O3 abatement in Atlanta and comparable cities is needed.

Air Pollutants, Occupational↗
PubMed1989

Social environment and adjustment after laryngectomy.

The relationship between social environmental variables and psychological, physical, and speech dysfunction after laryngectomy surgery was examined. The relationships between these categories of dysfunction and the following three social environmental factors were examined: (1) acceptance and emotional support from family and friends; (2) disease-specific support from peers who have had the same surgical intervention and from professionals; and (3) socioeconomic status (SES). Data were collected from 60 total laryngectomy patients an average of 24.3 months after surgery. The type of support provided was different for each source of support, family-friend or peer-professional. Interpersonal support from family and friends was strongly associated with psychosocial and physical dysfunction but had a weaker association with speech adjustment. Diseases-specific support from speech therapists and other laryngectomees was a weaker predictor of dysfunction but a stronger predictor of communication adaptation. SES was not predictive of dysfunction or communication adaptation. Thus different sources of social support can make specific contributions to minimizing physical and psychosocial dysfunction and acquiring skills to overcome the limitations imposed by the surgery.

Adaptation, Psychological↗
PubMed1989

Substance use among eighth-grade students who take care of themselves after school.

This investigation focused on substance use among children who regularly care for themselves after school (latchkey children). The data, collected from 4932 eighth-grade students, indicated that self-care is an important risk factor for alcohol, tobacco, and marijuana use. Data collected from 2185 parents validated these findings. Eighth-grade students, who took care of themselves for 11 or more hours a week, were at twice the risk of substance use as those who did not take care of themselves at all. This relationship held at all levels of sociodemographic status, extracurricular activities, sources of social influence, and stress. Of the 186 stratified tests of the relationship, 90% were significant; even those not found to be significant were in the direction expected. Path analyses suggest that risk-taking, having friends who smoke, and being offered cigarettes may partially explain the relationship between self-care and substance use. Those eighth-grade students who select friends who smoke and place themselves in situations in which they are offered cigarettes may be manifesting a desire to display their sense of maturity and independence. The fact that the increase in substance use occurred among almost all strata tested and the fact that mediation was not complete suggest that more than one mechanism may account for the associated increase in substance use. It is also possible that more time in self-care results in more unnoticed solitary trials of substances, as well as trials motivated by peer offers or peer pressure to use substances.

Adolescent↗
PubMed1988

The influence of symptoms of disease and side effects of treatment on compliance with cancer therapy.

To provide a systematic analysis of how adverse symptoms of disease and side effects of cancer therapy relate to patient noncompliance with treatment, we interviewed 107 patients with hematologic malignancies at the initiation of therapy and 6 months later to collect information on the type, frequency, and difficulty of unpleasant physical effects experienced. Level of compliance was monitored (biochemically and with self-report) on a monthly basis for oral self administration of allopurinol and prednisone. Appointment-keeping to receive infused chemotherapy was also monitored. Nausea was the most frequent side effect experienced. Nausea, fever, and pain were the most difficult physical effects to tolerate when they occurred. Complex treatment regimens and severe diseases related to reports of more physical effects. Younger patients had a more difficult time dealing with these effects than did older patients. Neither the occurrence, frequency, or difficulty dealing with any of the effects related to noncompliance with either of the two self-administered medications. Difficulty with particular effects did relate to noncompliance with clinic appointments to receive infused chemotherapy.

Adult↗
PubMed1987

Frequency and adequacy of breast cancer screening among elderly Hispanic women.

Studies have demonstrated that Hispanic (relative to Anglo) women are at greater risk for late-stage breast cancer diagnosis. Screening irregularity may be a factor contributing to late-stage diagnosis, yet virtually nothing is known about the breast cancer-screening behavior of Hispanic women. We interviewed 600 elderly Hispanic women residing in Los Angeles to collect information on frequency of physician breast examinations and mammography and on regularity and competence of breast self-examination. Predictors of screening were also examined. Fifty percent of our sample indicated that they had had a breast exam within the past year; 12.5% had had a mammogram within the past year (74% never had had a mammogram); and 47% reported that they had performed breast self-examination within the past month. Few of the women were able to demonstrate adequate breast self-examination technique on a foam breast model, and only 1% found all five lumps present. Thus, although the observed frequency of screening and self-examination is comparable to national norms, it is unlikely that our subjects' attempts at self-examination would lead to early breast cancer detection. Age, educational level, emotional reactions to screening, and media cues predicted screening behavior. Physician instruction in breast self-examination increased the frequency and adequacy of self-examination. Perceived susceptibility to cancer, perceived benefits of early detection, and level of acculturation were not strong predictors. The extent to which our results generalize to other subpopulations of Hispanic women is discussed.

Aged↗
PubMed1987

Path model of multidimensional compliance with cancer therapy.

Patients newly diagnosed with hematologic malignancies were followed for a 6-month treatment period to assess compliance with three regimen requirements for cancer therapy: anti-neoplastic medication self-administered intermittently, supportive medication self-administered daily, and monthly clinic appointments. The effect on compliance of three intervention "packages" (some combination of education, shaping of pill-taking behavior, and home restructuring) and the extent that patient satisfaction, knowledge, and uncertainty about illness-related events mediated the effects of the interventions were also examined. Blood levels of the drugs and self-report measures indicated that compliance with daily pill taking was higher for each intervention group compared to a control group. Similar results were obtained for compliance with clinic appointments. No improvement in intermittent self-medication was found. Although each intervention package increased patient knowledge and satisfaction, path analyses demonstrated that knowledge did not affect any aspect of compliance, whereas satisfaction was associated with increased appointment keeping only. Daily pill taking was influenced directly by the behavioral components of the interventions. Uncertainty did not influence compliance but was associated with depression, which was negatively correlated with intermittent self-medication.

Administration, Oral↗
PubMed1987

Physician attitudes and experience regarding the care of patients with acquired immunodeficiency syndrome (AIDS) and related disorders (ARC).

The number of patients with acquired immunodeficiency syndrome (AIDS) continues to increase. These patients require medical care from physicians who are well trained and who are willing to provide that care. In 1985, we undertook a survey of 314 heterosexual and homosexual physicians in Los Angeles County to determine their willingness and perceived ability to care for patients with AIDS. This survey indicates that most physicians believe that special clinics staffed by physicians who have a particular expertise in caring for AIDS patients should be established. Many of the physicians surveyed indicated that concerns about the risk of contagion with AIDS is a deterrent to treating AIDS patients. Current evidence indicates this concern is unfounded. Both heterosexual and homosexual physicians indicated a lack of medical knowledge and experience regarding the opportunistic infections and cancers that are associated with AIDS, although many physicians in both groups expressed a desire to receive more training in this regard. Our survey indicates that there is a definite need for more clinically based training opportunities for physicians who would like to provide care for AIDS patients. If such training were to become available, it is likely that sufficient numbers of physicians would be willing to care for AIDS patients.

AIDS-Related Complex↗
PubMed1987

Compliance with oral drug therapy in patients with hematologic malignancy.

Compliance with oral self-administered allopurinol (daily medication) and prednisone (intermittent medication) as well as compliance with monthly scheduled clinic appointments, were examined in 108 patients with newly diagnosed hematologic malignancy. Baseline levels of compliance (control group) were compared to results obtained after implementation of three intervention packages, whose aim was to increase compliance. The packages included combinations of education, home psychologic support and restructuring, and training in pill taking. A 24-hour profile of the two drugs and their metabolites was first determined. Serum samples were then obtained monthly over 6 months and analyzed for presence of the drugs. Control patients were fully compliant with allopurinol only 16.8% of the time. This rate increased significantly (44% to 48% of the time) for those who received any one of the intervention programs. With respect to prednisone, control patients were compliant 26.8% of the time, with no real improvement after interventions. Finally, self reports overestimated compliance by a factor of two when compared to drug analysis. The results indicated that full compliance with oral medications was remarkably low among our patients who have treatable and in some cases curable hematologic malignancy. However, compliance can be significantly improved by the use of various intervention packages.

Administration, Oral↗
PubMed1987

Health behavior of elderly Hispanic women: does cultural assimilation make a difference?

The role of cultural assimilation in Hispanic health behavior has received little empirical examination. Prior studies have operationalized assimilation primarily in terms of language preference and have obtained weak or no effects. We interviewed 603 elderly Hispanic women residing in Los Angeles to evaluate the usefulness of cultural factors as predictors of preventive health behavior (e.g., physical examination, screening for breast cancer) more rigorously. Factor analysis of responses yielded four dimensions of cultural assimilation: "language preference", "country of birth", "contact with homeland", and "attitudes about children's friends." After controlling for education and age, no dimension of assimilation associated strongly or consistently with health behavior. Of the four dimensions, use of English language associated most closely with increased screening, although most of the effects for language were small in magnitude. These findings, coupled with those of other studies, strongly suggest that cultural factors may have little impact on the health behavior of Hispanics. Access to and availability of services, affective reactions toward screening, and sociodemographic factors are stronger determinants of Hispanic health practices.

Aged↗