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Biomedical subjects

J M Douglas

Publications and source records attributed to J M Douglas.

At least 55 records · Page 3Linked to original sources
PubMed1997

Attention deficits in stroke patients with aphasia.

Attentional capacity and sustained attention were investigated in 21 aphasic stroke patients and 21 non-brain-damaged patients. Attentional capacity was assessed using a series of reaction time (RT) tasks. The aphasic patients demonstrated impaired attentional capacity as shown by slower processing speed than the non-brain-damaged group (p < .01) and greater increases in RT with increased processing load (p < .05). Similar patterns were found for both verbal and spatial material. There was no significant relationship between severity of auditory comprehension deficits and attentional capacity. Sustained attention was assessed using a cognitive vigilance task requiring identification of a target letter presented infrequently over 32 minutes. Both the aphasic and the non-brain-damaged group demonstrated a decline in performance with time on task as shown by a steady increase in RTs (p < .0001), but the decline was equivalent across the groups. Thus, the aphasic group did not show a specific deficit in the ability to sustain attention.

Aphasia↗
PubMed1997

Prevalence of human immunodeficiency virus infection, mortality rate, and serogroup distribution among patients with pneumococcal bacteremia at Denver General Hospital, 1984-1994.

Pandemics of human immunodeficiency virus (HIV) type 1 infection and penicillin resistance highlight the urgency of preventing invasive pneumococcal disease with vaccination. We characterized pneumococcal serogroup distribution and the mortality rate among 460 patients with pneumococcal bacteremia from 1984 through 1994 at Denver General Hospital and the prevalence of HIV infection in patients for whom pneumococcal bacteremia was diagnosed from 1989 to 1994. Vaccine-related serogroups accounted for 426 isolates (92.6%), including 48 (92.3%) of 52 isolates from HIV-infected patients. Mortality among patients 15 years of age or older was higher during 1984-1988 (18[12.9%] of 140) than during 1989-1994 (10 [5.2%] of 191: rate ratio, 2.5; 95% confidence interval, 1.2-5.2). Of patients 15-59 years of age from 1989 to 1994, 44 (39.6%) of 111 men and three (7.3%) of 41 women were HIV-infected. Four (8.5%) of 47 HIV-infected patients and four (3.8%) of 105 other patients in this group died (age-weighted rate ratio, 1.8; 95% confidence interval, 0.5-6.2). We recommend routine screening of young adults with pneumococcal bacteremia for HIV infection and immunization of HIV-infected patients with pneumococcal vaccine (which includes most serogroups of infecting strains).

AIDS-Related Opportunistic Infections↗
PubMed1997

Feasibility and yield of screening urine for Chlamydia trachomatis by polymerase chain reaction among high-risk male youth in field-based and other nonclinic settings. A new strategy for sexually transmitted disease control.

BACKGROUND: Inner-city youth are at disproportionate risk for Chlamydia trachomatis infection. Identification of infected individuals is hampered by the often asymptomatic nature of infection and access and utilization barriers to clinic-based screening services. The feasibility and yield of screening urine for C. trachomatis by polymerase chain reaction was studied among high-risk male youth outside traditional clinic settings. METHODS: As part of a community-level sexually transmitted disease (STD) prevention program among high-risk youth in Denver, outreach workers enrolled subjects, administered questionnaires, and collected first-catch urine samples in nonclinical facility-based and field-based settings. Facility settings consisted of community/recreation centers, high-schools, and an STD/human immunodeficiency virus prevention storefront. Field settings included alleys, parking lots, parks, and residences. Individuals who tested C. trachomatis positive were contacted by program outreach workers and provided with standard treatment and partner notification services. RESULTS: Over a 20-month period, 486 urine specimens were collected, 32 (6.6%) of which were C. trachomatis positive. Rates were higher for subjects screened in the field than in facility settings (11.9% vs. 4.4%, P < 0.05). Subjects with chlamydial infection were more likely to have had vaginal intercourse in the previous 30 days (adjusted odds ratio: 2.9) and to have been recruited in field settings (adjusted odds ratio: 2.5). Of subjects with chlamydial infection, 31/32 (97%) were treated within a median of 8 days after urine collection. CONCLUSIONS: Urine chlamydial screening by polymerase chain reaction of sexually active male youth in nontraditional settings appears to be feasible and to provide yields similar to those reported in standard clinic settings. Evaluation of samples easily collected in nonclinic locations holds great promise as an additional strategy for the control of chlamydial infection and other STD among difficult-to-reach populations.

Adolescent↗
PubMed1997

Acceptability of genital herpes immunization. The role of health beliefs and health behaviors.

BACKGROUND AND OBJECTIVES: Little is known about the acceptability of vaccines for prevention of sexually transmitted diseases (STDs). The purpose of this study was to examine potential predictors of genital herpes simplex virus type 2 (HSV-2) vaccine acceptability. GOALS: To evaluate the relationship of health beliefs and health behaviors to HSV-2 vaccine acceptability. STUDY DESIGN: Three hundred twenty-one subjects participating in two phase III clinical trials for an HSV-2 vaccine completed surveys addressing health beliefs, health behaviors, and acceptability of hypothetical HSV-2 vaccines. RESULTS: Bivariate analyses found that perceived benefits of vaccination, seatbelt use, a healthy diet, and having had cholesterol levels checked were associated with higher acceptability. Perceived limitations of HSV-2 immunization, alcohol use, and exercise were associated with lower acceptability. Multiple regression analysis identified perceived benefits of vaccination, decreased exercise, and lower alcohol use as significant independent predictors of greater HSV-2 vaccine acceptability. CONCLUSIONS: In groups of high-risk individuals who had completed participation in HSV-2 clinical trials, health beliefs and health behaviors influenced acceptability of hypothetical HSV-2 vaccination. The findings support the need to understand determinants of acceptance of vaccines for HSV-2 and other STDs.

Adult↗
PubMed1996

Doxycycline compared with azithromycin for treating women with genital Chlamydia trachomatis infections: an incremental cost-effectiveness analysis.

OBJECTIVE: To compare the economic consequences of doxycycline therapy with those of azithromycin therapy for women with uncomplicated cervical chlamydial infections. DESIGN: Decision analysis in which the health outcomes, costs, and cost-effectiveness of two provider-administered treatment strategies for women with uncomplicated cervical chlamydial infections were compared: 1) initial therapy with doxycycline, 100 mg orally twice daily for 7 days (estimated cost, $5.51) and 2) initial therapy with azithromycin, 1 g orally administered as a single dose (estimated cost, $18.75). RESULTS: Under baseline assumptions, the azithromycin strategy incurred fewer major and minor complications and was less expensive overall than the doxycycline strategy despite a higher initial cost for acquiring antibiotic agents. In univariate sensitivity analyses, the azithromycin strategy prevented more major complications but was more expensive than the doxycycline strategy when doxycycline effectiveness was greater than 0.93. In a multivariate sensitivity analysis combining 11 parameter estimates selected so that the cost-effectiveness of the doxycycline strategy would be maximized relative to that of the azithromycin strategy, the azithromycin strategy resulted in fewer complications but was more costly. The incremental cost-effectiveness was $521 per additional major complication prevented. However, if the difference in the cost of azithromycin and doxycycline decreased to $9.80, the azithromycin strategy was less expensive and more effective, even under these extreme conditions. CONCLUSIONS: On the basis of the best available data as derived from the literature and experts, the azithromycin strategy was more cost-effective than the doxycycline strategy for women with uncomplicated cervical chlamydial infections. Despite the dominance of the azithromycin strategy over the doxycycline strategy, the adoption of the azithromycin strategy may be limited by the practical financial constraints of our currently fragmented health care system, in which the costs and benefits of preventing chlamydia sequelae are often incurred by different components of the system.

Analysis of Variance↗
PubMed1996

A factorial survey study to assess the acceptability of HIV vaccine trial designs.

To aid in the design of human immunodeficiency virus (HIV) vaccine trials that maximize volunteer participation, factorial surveys were administered to 73 gay men who were participants in a larger study assessing HIV vaccine trial feasibility. Factorial surveys are "vignettes" that are randomly constructed through the combination of descriptive statements (dimensions) that reflect essential features. In this study, the dimensions define components of clinical trials to assess the efficacy of hypothetical HIV vaccines. Regression analysis shows that anticipated participation was decreased by a sustained vaccine-induced antibody response lasting 3 years, absence of gay men as research subjects in earlier phase trials for the products being tested, and rectal vaccine administration. Three years of scientific experience with the vaccine encouraged participation. We conclude that willingness to participate in vaccine trials varies systematically with some of their characteristics. Where there are design alternatives for identified negative components, these should be considered. If this is not possible, options for decreasing aversion to such features will need to be evaluated, including appropriate education regarding both the benefits and the risks associated with negatively evaluated features.

AIDS Vaccines↗
PubMed1996

Indicators of long-term family functioning following severe traumatic brain injury in adults.

This study investigated the degree of association between four sets of predictor variables (demographic, injury-related, patient functioning, and caregiver functioning variables) and the criterion variable of long-term family functioning following severe traumatic brain injury (TBI). Thirty families participated in the study and a minimum of 3.5 years had elapsed since the time of injury. The mean length of post-traumatic amnesia (PTA) for the brain-injured individuals was 92.4 days. Data collection took place in the family home and both the brain-injured family members and primary caregivers were involved. Standard regression analyses revealed that two sets of variables accounted for a significant amount of variance in long-term family functioning. The largest amount of variance, 55% (44% adjusted), was accounted for by the caregivers' self-report variables which measured caregivers' depression, social support, and coping as well as caregivers' preceptions of patient competency. Overall, measures of severity of injury (PTA), residual neurobehavioural function, and adequacy of social support for caregivers proved to be reliable and significant indicators of family functioning. These findings are discussed with respect to their implications for service delivery and long-term provision of support for caregivers of severely brain-injured individuals living with their families.

Activities of Daily Living↗
PubMed1996

Depression and use of mental health services among HIV-infected men.

Depression is a serious, common, and treatable condition among HIV-infected persons. We examined the prevalence and predictors of depression and use of mental health services among 475 HIV-infected men without AIDS. Participants were drawn from three sites in San Francisco and Denver that did not provide ongoing medical care or mental health services. Depression was measured using the Center for Epidemiology Studies Depression scale (CES-D). Overall, 176 men (37.1%) were classified as depressed based on having a CES-D score above the standard cut-off of > or = 16. In logistic regression analysis, persons with HIV-related symptoms (OR = 3.4; 95% CI = 2.0.-5.6), low social support (OR = 2.5; 95% CI = 1.6-3.9), who were unemployed (OR = 1.9; 95% CI = 1.1-3.3), and with CD4 count < 200 cells (OR = 1.9; 95% CI = 1.1-3.3), were significantly more likely to be depressed. Only 40.3% of depressed men had seen a mental health clinician in the previous year and only 6.3% were taking an antidepressant. Among depressed men, in logistic regression analysis, men who were unemployed (OR = 2.4; 95% CI = 1.2-4.7) and those with health insurance (OR = 2.2; 95% CI = 1.1-4.5) were more likely to have received these services. Increased evaluation and treatment of HIV-infected persons for depression is needed.

Analysis of Variance↗
PubMed1996

Feasibility of human immunodeficiency virus vaccine trials in homosexual men in the United States: risk behavior, seroincidence, and willingness to participate.

Human immunodeficiency virus (HIV)-seronegative high-risk homosexual men were enrolled in a vaccine feasibility study in three US cities. HIV seroincidence was 2.3/100 person-years (95% confidence interval [CI], 1.7-2.9) over 18 months in 1975 men. After receiving an explanation of HIV vaccine trial design, 37% stated they were "definitely" willing to participate in future trials; seroincidence was 3.7/100 person-years (95% CI, 2.5-4.9) in this subgroup. An additional 57% "might be" or were "probably" willing. Independent predictors of HIV seroconversion in multivariable pooled logistic regression analysis were having a known HIV-seropositive sex partner (odds ratio [OR], 4.5; 95% CI, 2.6-7.8), injection drug use (OR, 3.6; 95% CI, 1.2-10.7), unprotected receptive anal sex (OR, 2.4; 95% CI, 1.4-4.2), condom failure (OR, 2.4; 95% CI, 1.4-4.1), gonococcal/nongonococcal urethritis (OR, 2.3; 95% CI, 1.1-4.7), and age < 25 years (OR, 2.2; 95% CI, 1.2-4.2). Interest in vaccine trials and seroincidence in high-risk homosexual men are sufficiently high to initiate efficacy trials once a suitable candidate vaccine is identified. Risk factors for seroconversion highlight important area for development of ancillary intervention strategies.

AIDS Vaccines↗
PubMed1996

Prolonged and preferential production of polymeric immunoglobulin A in response to Streptococcus pneumoniae capsular polysaccharides.

Streptococcus pneumoniae is an invasive mucosal pathogen for which host defense is dependent on capsular polysaccharide-specific antibody. Capsule-specific immunoglobulin G (IgG), IgM, and IgA are produced following pneumococcal vaccination and infection. Serum IgA has two molecular forms, polymeric and monomeric. These forms may modulate the avidity of antigen binding and evolve over time as the immune response matures. Therefore, we sequentially characterized the molecular forms of serum IgA to three serotypes of pneumococcal capsular polysaccharides (types 8, 12F, and 14) after pneumococcal vaccination and after natural infection with type 14 S. pneumoniae. Although typically the form of IgA in antigen-specific systemic responses to protein antigens is predominantly polymeric in sera of patients shortly after exposure and shifts to the monomeric form in sera obtained several weeks later, the form of IgA in response to each pneumococcal capsular polysaccharide remained predominantly polymeric 1 month after natural infection and up to I year following vaccination. In contrast, IgA to pneumococcal cell wall polysaccharide was both polymeric and monomeric. Moreover, the form of IgA in response to polyribosyl-ribitol-phosphate (PRP), the capsular polysaccharide of Haemophilus influenzae type b, was predominantly monomeric in the sera of 8 of 10 subjects tested 1 to 3 months after vaccination with either PRP alone or the diphtheria toxoid conjugate of PRP. We conclude that systemic responses to pneumococcal capsular polysaccharides are distinct in the production of predominantly polymeric IgA over time. The persistence of polymeric IgA may facilitate binding and clearance of pneumococci from the systemic circulation or reflect limited maturation of the immune response to pneumococcal capsular polysaccharides.

Adult↗
PubMed1995

Diagnostic video-assisted thoracoscopic procedures.

OBJECTIVE: The authors evaluated the effectiveness and the limitations of video-assisted diagnostic thoracoscopy. SUMMARY BACKGROUND DATA: The initial successes achieved with the use of video-assisted diagnostic thoracoscopic techniques has lead to an enthusiastic propagation of its use by thoracic surgeons as well as by some pulmonologists. However, detailed analyses of the diagnostic yield and potential limitations of this technique in relation to the roentgenographic and pathologic presentations of the patients are necessary to ensure its safe and effective application. METHODS: From July 1991 to December 1993, 102 diagnostic video-assisted thoracoscopic procedures were performed. All patients received other preoperative diagnostic workups without a definitive diagnosis. The initial roentgenographic presentations of these patients included 42 pulmonary nodules, 23 interstitial processes, 11 parenchymal infiltrates, 6 pleural effusions, 10 mediastinal tumors, and 10 mediastinal lymphadenopathies. If the procedure was completed without minithoracotomy or extension of any port site, then it was defined as an exclusive thoracoscopic biopsy (ETB); if the procedure was completed with the assistance of minithoracotomy (4-6 cm), then it was defined as a supplementary thoracoscopic biopsy (STB). RESULTS: Ninety-two of the pathology reports (90.2%) were interpreted as conclusive. Of these, 35 tumors were malignant and 67 benign. Ten pathology reports were inconclusive and on initial roentgenography had presented as pulmonary infiltrates (4 cases), pulmonary nodule (2), pleural effusion (2), interstitial process (1), and mediastinal lymphadenopathy (1). Seventy-six procedures (74.5%) were completed thoracoscopically and were classified as ETB. The remaining 26 procedures (25.5%) were completed with minithoracotomy and were classified as STB. The underlying diseases in the STB group were carcinoma (8 cases), Hodgkin's lymphoma (3), sarcoidosis (3), tuberculosis (2), interstitial pneumonitis (2), organizing pneumonia (2), mesothelioma (1), and miscellaneous disease (5). The reasons given for minithoracotomy were diffuse intrapleural adhesion (10 cases), technical inexperience (8), inability to localize the lesion (5), problems with anesthesia (1), poor patient tolerance (1), and unknown (1). Four patients (3.9%) experienced complications and three (2.9%) died while in the hospital. CONCLUSIONS: Diagnostic thoracoscopy provides high diagnostic yield with very low risk. However, 25.5% of the procedures require minithoracotomy to obtain adequate tissue for definitive diagnosis. This finding supports the assertion that diagnostic thoracoscopy should be performed only by experienced thoracic surgeons who can extend the procedure when indicated.

Adolescent↗
PubMed1994

Emotional, behavioral, and HIV risks associated with sexual abuse among adult homosexual and bisexual men.

From May 1989 through April 1990, 1,001 adult homosexual and bisexual men attending urban sexually transmitted disease clinics were interviewed regarding abusive sexual contacts during childhood and adolescence. Sexual abuse was found to be significantly associated with mental health counseling and hospitalization, psychoactive substance use, depression, suicidal thought or actions, social support, sexual identity development, HIV risk behavior including unprotected and intercourse and injecting drug use, and risk of sexually transmitted diseases including HIV infection. Data suggest that sexual abuse may have a wide-ranging influence on the quality of life and health risk behavior of homosexual men. Increased awareness as to the potential outcomes of male sexual abuse is critically important to the design and implementation of medical and psychological services for sexually abused men.

Adolescent↗
PubMed1994

Characterization of prothrombin activation during cardiac surgery by hemostatic molecular markers.

BACKGROUND: Prothrombin activation represents the key regulatory step in the hemostatic process. Once formed, thrombin contributes to the generation of fibrin as well as the activation of platelets and fibrinolysis. Failure to suppress thrombin formation during cardiac surgery could result in disorders of hemostasis and thrombosis in the perioperative period. The aim of this study was to determine the time course for prothrombin activation during the perioperative period associated with cardiac surgery. METHODS: We measured prothrombin activation during the perioperative period in 19 adult patients undergoing primary cardiac surgery using enzyme-linked immunosorbent assays for the detection of thrombin formation (prothrombin fragment 1.2 and thrombin-antithrombin III complex) and thrombin activity (fibrinopeptide A and fibrin monomer). Blood samples were obtained preoperatively; at 30-min intervals during cardiopulmonary bypass (CPB); and 1, 3, and 20 h after completion of CPB. RESULTS: Despite anticoagulation with heparin, plasma concentrations of prothrombin fragment 1.2, thrombin-antithrombin III complex, and fibrin monomer increased throughout CPB. Peak concentrations for all hemostatic markers occurred in the samples obtained 3 h after completion of CPB. By the morning after surgery, plasma prothrombin fragment 1.2 returned to preoperative concentrations; however, fibrinopeptide A and fibrin monomer concentrations remained significantly increased (P < 0.05) compared to preoperative values. CONCLUSIONS: These data clearly demonstrate the occurrence of prothrombin activation and thrombin activity during CPB despite heparin concentrations adequate to maintain the activated clotting time greater than 400 s. Hemostatic markers for the activation of prothrombin demonstrated peak concentrations 3 h after completion of CPB with a return to baseline concentrations by the morning after surgery. Markers for thrombin activity, however, suggest the presence of active thrombin through the morning after surgery. Further investigations will be necessary to determine the role of hemostatic activation in thrombotic complications after cardiac surgery.

Aged↗
PubMed1994

Utility of quantitative enzyme immunoassay reactivity for predicting human immunodeficiency virus seropositivity in low- and high-prevalence populations.

To assess the utility of quantitative enzyme immunoassay (EIA) reactivity for predicting human immunodeficiency virus seropositivity, we evaluated 22,823 serum samples from homo- and bisexual men, heterosexual intravenous drug users, and other heterosexuals with initial screening by EIA, retesting of reactive samples in duplicate, and confirmatory Western blot (immunoblot) testing. Quantitative EIA reactivity was determined by a mean of the optical density ratio of the three assays performed for each reactive specimen. A total of 1,773 samples (7.8%) were repeatedly reactive, and 1,747 (7.7%) were confirmed Western blot positive. All 26 EIA-reactive-Western blot-negative samples had low-level EIA reactivity (ratio < 2.2), while most (86%) of the Western blot-positive samples had high-level reactivity (ratio, > 3.0). The positive predictive value for samples with moderate-to-high-level EIA reactivity (ratio, > 2.2) was 100% for all risk groups. These results support the value of quantitative EIA reactivity in predicting human immunodeficiency virus seropositivity and suggest that confirmatory testing of specimens with high-level reactivity is not necessary in all situations.

Algorithms↗
PubMed1994

Preparations for AIDS vaccine trials. Developing brief valid screening instruments for HIV-related sexual risk behavior among gay and bisexual men.

Enrolling and tracking cohorts for HIV vaccine efficacy trials requires that participants disclose behaviors that place them at risk for exposure to HIV. Brief screening procedures have been suggested for this purpose. In a previous study gay and bisexual men in three U.S. cities reported unprotected anal intercourse on a brief screening instrument. Screen reports were compared to subsequent in-depth, face-to-face interview data; 29% of the men who reported unprotected anal intercourse during the interview failed to disclose this behavior during screening. For recruitment into an HIV vaccine feasibility study at the same study sites, screening procedures were modified to encourage accurate reporting: to lessen stigma, low risk as well as high risk sexual behaviors were assessed, and screens were administered by trained study staff who presented it as a tool for understanding the gay community. Failures to disclose risk decreased to 18%, a rate that, while lower than in the previous study, remains high. Men less likely to disclose unprotected sex during the screen engaged in fewer high risk sexual behaviors, had more stringent norms regarding sexual safety, and were less identified with the gay community than were men who disclosed unprotected sex. Failure to disclose risk may have significant implications for participant selection and behavior tracking during vaccine trials. More systematic assessments that are sensitive to target communities may facilitate disclosure.

AIDS Vaccines↗