Biomedical subjects

Joseph A Burleson

Publications and source records attributed to Joseph A Burleson.

At least 19 recordsLinked to original sources

PubMed2006

Brief interventions for at-risk drinking: patient outcomes and cost-effectiveness in managed care organizations.

AIMS: Evaluate effectiveness and costs of brief interventions for patients screening positive for at-risk drinking in managed health care organizations (MCOs). METHODS: A pre-post, quasi-experimental, multi-site evaluation conducted at 15 clinic sites within five MCO settings. At-risk drinkers (N = 1329) received either: (i) brief intervention delivered by licensed practitioners; or (ii) brief intervention delivered by mid-level professional specialists (nurses); or (iii) usual care (comparison condition). Clinics were randomly assigned to three study conditions. Data were collected on the cost of screening and brief intervention. Follow-up interviews were conducted at 3 and 12 months. RESULTS: Participants in all three study conditions were drinking significantly less at 3-month follow-up, but the decline was significantly greater in the two intervention groups than in the control group. There were no significant differences between the two intervention conditions. Of the patients in the intervention conditions 60% reduced their alcohol consumption by > or =1 drink per week, compared with 53% of those in the control condition. No differences were found on a measure of the quality of life. Differential reductions in weekly alcohol consumption between intervention and control groups were significant at 12-month follow-up. Average incremental costs of the interventions were 4.16 US dollar per patient using licensed practitioners and 2.82 US dollar using mid-level specialists. CONCLUSION: Alcohol screening and brief intervention when implemented in managed care organizations produces modest, statistically significant reductions in at-risk drinking. Interventions delivered to a common protocol by mid-level specialists are as effective as those delivered by licensed practitioners at about two-thirds the cost.

Alcohol Drinking↗

PubMed2006

Pixel intensity and fractal analyses: detecting osteoporosis in perimenopausal and postmenopausal women by using digital panoramic images.

OBJECTIVE: Pixel intensity values (PI) and fractal dimensions (FD) were compared in selected mandibular regions on digital panoramic images of normal, osteopenic, and osteoporotic perimenopausal and postmenopausal women to evaluate their relative efficacies in detecting osteoporotic-associated bone density changes. STUDY DESIGN: Standardized mandibular angle, body, and canine/premolar (C/PM) regions on 54 charge-coupled device (CCD) digital panoramic images of normal and potentially osteoporotic postmenopausal women were analyzed for PI and FD. Lumbar spine and femoral neck dual-energy x-ray absorptiometry (DXA) on each patient served as the reference standard examination. Pearson correlation coefficients and analysis of variance (ANOVA) were performed. RESULTS: There was significant correlation among PI measurements (P < 0.01), and no significant correlation between FD. C/PM had significantly lower PI than control C/PM (P = 0.049). CONCLUSIONS: Osteoporotic changes in mandibular C/PM cancellous bone were detected in our study population on CCD digital panoramic images by using a robust image analysis paradigm. Future automated application of such image analysis could enable widespread, cost effective screening for osteoporosis in dental settings.

Absorptiometry, Photon↗

PubMed2006

Men's extramarital sex, marital relationships and sexual risk in urban poor communities in India.

The objectives of this paper are to (1) understand the nature of men's extramarital sexuality in three low income communities in Mumbai, India; (2) explore the associations between marital relationships and extramarital sex; and (3) assess the implications of the research results for intervention. Results are based on survey data collected from 2,408 randomly selected men from the three study communities and a matched subset of 260 randomly selected men and their wives who responded to a female version of the men's survey. These surveys produced a unique data set, which allows sociodemographic, attitudinal and behavioral variables from husband and wife and variables that are the product of husband and wife interaction to be utilized to predict men's extramarital sex through multiple sequential logistic regression analysis. Results indicate that men's extramarital sex is significantly associated with husband's and wife's age, wife's perception of domestic violence, husband's education and place of birth, husband's alcohol use, wife's willingness to engage in marital sex, and types of marital sexual acts. These results confirm the need to move from the individual to the couple as the unit of research and the need for intervention to reduce the risk of HIV/STI transmission within marriage both in India and internationally.

Adult↗

PubMed2006

Absence of iatrogenic or contagion effects in adolescent group therapy: findings from the Cannabis Youth Treatment (CYT) study.

Though widely used and presumed effective in practice, some scholars (Dishion et al., 1999) have raised the concern that group therapy for adolescents with substance use disorder and a range of deviancy has the potential for causing iatrogenic effects (e.g., increased substance use, behavior and legal problems) for those with low deviancy. Using data from 400 youth in the largest adolescent treatment experiment conducted to date (Dennis et al., 2004), this study shows that group composition in terms of conduct disorder symptoms is not associated with worse substance use, psychological, environmental or legal treatment outcomes. The results actually indicated that there was a slight advantage for youth with high conduct disorder to be included in the groups with less symptoms. The results appear consistent with recent meta-analyses of delinquency studies (Lipsey, 2006) which have found no evidence of iatrogenic effects. These results support the common clinical belief that group therapy for youths with substance use disorders is a safe and effective treatment modality.

Adolescent↗

PubMed2006

An interactive voice response (IVR) system for adolescents with alcohol use disorders: a pilot study.

In order to understand predictors of relapse among adolescents treated for alcohol use disorders (AUD), it is important to accurately assess the daily circumstances associated with use. This pilot study investigates the feasibility and acceptability of an interactive voice response (IVR) system in adolescents with AOSUD. Twenty-six adolescents 14 to 19 years old, with a mean age of 16.8, who were enrolled into an adolescent treatment program for AUD consented to make phone calls for 14 successive evenings to an IVR system and answer 14 questions pertaining to daily use of alcohol and other drugs. The subjects were compensated for their participation. A satisfaction questionnaire was administered at the end of the study. Participants completed 72% of scheduled recordings, with an average of 10.1 calls per subject. Most participants reported that they answered the questions honestly and accurately and were very much satisfied with the IVR system. The preliminary data presented here suggests that the use of IVR for the purpose of generating daily reports in youth is feasible and acceptable. The utilization of IVR systems should be explored to improve efficacy and attainment of generalizability to heterogeneous adolescent populations and lifestyles including for other psychiatric disorders.

Adolescent↗

PubMed2006

Suicidal ideation among adolescents with alcohol use disorders during treatment and aftercare.

The objectives of this study are to assess the magnitude and course of suicidal ideation during outpatient treatment and aftercare for adolescents with alcohol use disorders (AUD). One hundred seventy-seven adolescents meeting eligibility criteria, including no past 30-day suicidal behavior, participated in 9 weeks of outpatient cognitive-behavioral group therapy. Treatment completers were randomized into: (1) No-Active, (2) In-Person, or (3) Telephone aftercare conditions for a period of 12 weeks. No specific intervention for suicidal behavior was provided during the study. The Suicide Ideation Questionnaire (SIQ-JR, Reynolds, 1988) was administered at baseline, end of treatment, and end of aftercare. The results are as follows, a higher baseline suicidal ideation was associated with higher retention at the end of treatment and through aftercare. The In-Person Aftercare condition showed a significant decrease in suicidal ideation, relative to the No-Active Aftercare condition. There was a trend for similarly reduced severity of suicidal ideation in the Telephone Aftercare condition. In conclusion, the type of aftercare and resulting decrease in AUD may play a role in the reduction in suicidal ideation. The mechanism of change by which suicidal ideation is reduced in adolescents in treatment for AUD needs to be further explored.

Adolescent↗

PubMed2006

Effect of gender on communication of health information to older adults.

OBJECTIVES: To examine the effect of gender on three key elements of communication with elderly individuals: effectiveness of the communication, perceived relevance to the individual, and effect of gender-stereotyped content. DESIGN: Survey. SETTING: University of Connecticut Health Center. PARTICIPANTS: Thirty-three subjects (17 female); aged 69 to 91 (mean+/-standard deviation 82+/-5.4). MEASUREMENTS: Older adults listened to 16 brief narratives randomized in order and by the sex of the speaker (Narrator Voice). Effectiveness was measured according to ability to identify key features (Risks), and subjects were asked to rate the relevance (Plausibility). Number of Risks detected and determinations of plausibility were analyzed according to Subject Gender and Narrator Voice. Narratives were written for either sex or included male or female bias (Neutral or Stereotyped). RESULTS: Female subjects identified a significantly higher number of Risks across all narratives (P=.01). Subjects perceived a significantly higher number of Risks with a female Narrator Voice (P=.03). A significant Voice-by-Stereotype interaction was present for female-stereotyped narratives (P=.009). In narratives rated as Plausible, subjects detected more Risks (P=.02). CONCLUSION: Subject Gender influenced communication effectiveness. A female speaker resulted in identification of more Risks for subjects of both sexes, particularly for Stereotyped narratives. There was no significant effect of matching Subject Gender and Narrator Voice. This study suggests that the sex of the speaker influences the effectiveness of communication with older adults. These findings should motivate future research into the means by which medical providers can improve communication with their patients.

Accidental Falls↗

PubMed2005

Early growth response gene 1 (EGR1) is deleted in estrogen receptor-negative human breast carcinoma.

BACKGROUND: Patients with estrogen receptor (ER)-positive and ER-negative breast carcinomas differ in terms of disease progression, treatment regimens, and prognosis. The mechanism underlying the biologic differences of the two groups is understood poorly. Array comparative genome hybridization (CGH) on breast carcinoma subtypes demonstrated a consistent association between loss in regions of chromosome 5q and ER-negative tumors. It was shown previously that early growth response gene 1 (EGR1) on 5q acts like a tumor-suppressor gene, with its expression repressed in breast carcinomas. METHODS: To test the hypothesis that EGR1 is deleted differentially in ER-negative versus ER-positive breast carcinomas, fluorescence in situ hybridization was employed in this study to determine the EGR1 deletion status in 50 breast carcinoma specimens. Deletion status was measured by the signal ratio of EGR1/chromosome 5. Linear regression was used to assess the results. RESULTS: The mean EGR1/chromosome 5 ratio for the ER-negative group was significantly lower compared with the same ratio for the ER-positive group (P < 0.001). Although grade alone was not significant for predicting the ratio, the interaction between ER status and grade was significant (P < 0.01): For ER-negative specimens, the higher the grade, the lower the EGR1/chromosome 5 ratio. CONCLUSIONS: The EGR1 gene appeared to be deleted in ER-negative human breast carcinomas. Egr-1 may contribute to the pathogenesis of ER-negative breast carcinomas versus ER-positive breast carcinomas.

Breast Neoplasms↗

PubMed2005

Self-efficacy as a predictor of treatment outcome in adolescent substance use disorders.

Youth substance abuse relapse prevention was examined as a function of patients' situational self-efficacy (SE), their confidence to abstain from substance use in high-risk situations. An increase in SE has been shown to be enhanced by cognitive behavioral therapy (CBT) in adults. Eighty-eight adolescent substance abusers were randomly assigned to either CBT or psycho-education (PET) group therapy. Substance use and SE were assessed at end of treatment, 3- and 9-months after the end of planned treatment. Increased SE predicted subsequent abstinence independently from drug urinalysis and treatment condition only during treatment, while previous substance use predicted subsequent self-efficacy. CBT was not differentially effective than PET in promoting SE. It is recommended that potential mediators and moderators of SE in the treatment of adolescent substance abuse should be further explored.

Adolescent↗

PubMed2005

The family perspective of ESRD deaths.

BACKGROUND: Nephrologists need to become more aware of how patients die. METHODS: Families of patients who died after receiving dialysis at 5 New England nephrology clinics were contacted and informed about the study. Postal questionnaires were completed 6 to 10 weeks after deaths to elicit the family members' perspectives. The tool inquired about quality of dying, site of death, advance care preferences, whether dialysis was discontinued, and terminal symptoms. RESULTS: There were 188 deaths, and 86 completed questionnaires (46%) were returned. The majority (64%) of family members believed that the patient had a peaceful death, followed by those who were unsure (24%), and those who thought the death was not peaceful (12%). Most deaths took place in institutional settings (56% in the hospital and 14% in nursing homes), and one quarter (27%) of the deaths occurred at home. Whereas some respondents perceived that patients preferred treatment to primarily extend life (28%), more believed that relieving pain (49%) was of greater importance, and the balance (24%) were unsure. Three quarters of the patient population were observed to be in pain during their last week of life. Pain was assessed as being extremely or moderately severe in more than 90% of patients. The second most distressing symptom was weakness or fatigue, followed by dyspnea, gastrointestinal problems, anxiety, and depression. There was significantly less likelihood of pain in the last week of life for patients who died at home compared with those who died in an institution. CONCLUSION: Nephrologists need to explore new ways to improve symptomatic treatment and minimize suffering of dying dialysis patients. These findings are the first step in benchmarking the prevalence and severity of terminal symptoms.

Adult Children↗

PubMed2005

Alcohol screening and brief intervention in primary care settings: implementation models and predictors.

OBJECTIVE: This study compared two different implementation strategies for Cutting Back, a primary care alcohol screening and brief intervention (SBI) program for hazardous and harmful drinkers. It also identified organizational factors contributing to the success or failure of SBI implementation. METHOD: Cutting Back was implemented in 10 primary care practices associated with managed care organizations (MCOs) in five states, through a system of planning, training, technical assistance and clinic feedback. Clinics were randomly assigned to one of two brief intervention systems: In the P Model, medical providers were responsible for delivering interventions, whereas in the S Model mid-level professionals (usually nurses) acted as the clinic specialists to provide that service. Data were collected to measure the performance of screening and delivery of interventions in each clinic. RESULTS: The S Model screened a higher percentage of patients than did the P Model during the best month of program operation (50% vs 44%) and over all months of operation (24% vs 19%). Of those patients who screened positive, more patients in the S condition received an intervention than in the P condition (73.1% vs 57.1%), but there was a considerable range of performance among the five sites within each condition. Results at the clinic level were mixed, with some MCOs performing alcohol SBI significantly better with the S model and others doing better with the P model. The ability of clinics to conduct SBI was significantly correlated with both provider characteristics and organizational factors (e.g., prior SBI experience, MCO stability, number of clinicians trained and the quality of the MCO coordinator's work). Lack of provider time, staff turnover and competing priorities correlated negatively with SBI performance. CONCLUSIONS: The extent to which a given delivery model is likely to work best within an MCO depends on complex provider and organizational characteristics.

Adolescent↗

PubMed2004

Prognostic significance of cyclooxygenase-2 in oropharyngeal squamous cell carcinoma.

PURPOSE: To determine the relative prognostic significance of cyclooxygenase (COX)-2 expression in patients with oropharyngeal squamous cell carcinoma (SCC). EXPERIMENTAL DESIGN: This retrospective cohort study included 82 patients with SCC referred to the Department of Therapeutic Radiology at Yale-New Haven Hospital (Connecticut) between 1980 and 1999 who were treated with primary external beam radiotherapy or gross total surgical resection and postoperative radiotherapy. A microarray of archival tumor tissue was constructed and stained with monoclonal antibodies directed against COX-2 and scored for intensity by a pathologist blinded to the clinical outcomes of the patients. COX-2 immunoreactivity and clinicopathological data were analyzed with respect to survival endpoints using bivariate and multivariate techniques. RESULTS: Frequency of COX-2 overexpression was 45%. In multivariate analysis, COX-2 positivity predicted poor 3-year survival (P = 0.02; odds ratio = 0.41; 95% confidence interval, 0.20-0.84). Increasing age was significantly associated with increased 3-year survival (P = 0.03; odds ratio = 1.04; 95% confidence interval, 1.004-1.09). Positive COX-2 status trended toward predicting decreased 3-year disease-free survival. CONCLUSIONS: COX-2 was the most important predictor of poor survival in this patient cohort. In patients with oropharyngeal SCC treated with external-beam radiation therapy, overexpression of COX-2 may affect clinical outcome, and COX-2 may therefore prove valuable both as a prognostic factor and as a therapeutic target.

Carcinoma, Squamous Cell↗

PubMed2004

Comparison of the effects of calcium loading with calcium citrate or calcium carbonate on bone turnover in postmenopausal women.

Calcium supplementation is known to increase bone mineral density and decrease fractures, but the relative efficacy of different forms of calcium supplementation is not established. We compared the effects of calcium carbonate and calcium citrate on markers of bone resorption in older postmenopausal women in an open-labeled crossover study. Forty women were randomized to receive 1000 mg/day of either calcium citrate or calcium carbonate for 12 weeks, followed by a 2-week washout without calcium supplements and 12 weeks treatment with the alternate calcium supplement. All women received vitamin D (900 IU/day). Thirty-four women (25 Caucasian, nine Hispanic) completed the study. No significant differences in the decrease in parathyroid hormone (PTH) or bone specific alkaline phosphatase or the increase in urinary calcium/creatinine were detected between the two treatments. However, calcium citrate supplementation decreased the collagen cross-link resorption markers, urinary N-telopeptide (-30%), C-telopeptide (-31%), free deoxypyridinoline (19%) and serum N-telopeptide (-8%), compared to no significant change following calcium carbonate supplementation (+2%, +3%, +2% and +2%, respectively; P<0.05). Calcium citrate decreased markers of bone resorption significantly more than calcium carbonate in postmenopausal women, although no differences in their effects in calcium excretion or PTH were detected.

Aged↗

PubMed2004

Correlation between ancillary community services with adolescent substance use disorders treatment outcome.

OBJECTIVE: This study explores whether participation in ancillary out-of-program services predicts outcomes of adolescents treated for substance use disorders. METHOD: Eighty-eight consenting adolescents, 13-18 years of age recruited at an outpatient program filled the Teen Treatment Services Review (T-TSR) during eight weekly sessions, and at 3-and 9-Month post-treatment. Outcome variables included urinalysis and three subscales of the Teen-Addiction Severity Index (T-ASI) during Treatment (DT) and at follow-ups. The predictor variable was the number of reported Out-of-Program service contact Days (OD). RESULTS: While DT OD did not correlate with DT urinalysis, high DT OD days showed a trend toward predicting negative 3-month (3-M) urinalysis. By contrast, high 3-M OD days-predicted positive 3-M urinalyses as well as high use on all three T-ASI subscales. Out-of-Program services between 3-and 9-M post-treatment were not correlated with 9-M objective or subjective outcomes. CONCLUSION: The more therapeutic services received during treatment, the better the short-term outcome. The more therapeutic services received post-treatment, however, the poorer the shortterm outcome. Use of outside services presented a response rather than a cause of substance use.

Adolescent↗

PubMed2003

Effects of vitamin D supplementation on strength, physical function, and health perception in older, community-dwelling men.

OBJECTIVES: To study the effects of vitamin D supplementation in healthier populations of men. DESIGN: : Randomized, controlled trial. SETTING: General clinical research center. PARTICIPANTS: Sixty-five healthy, community-dwelling men (mean age+/-standard deviation=76+/-4, range 65-87). INTERVENTION: Cholecalciferol (1,000 IU/d) or placebo supplementation for 6 months; all received 500 mg supplemental calcium. MEASUREMENTS: Upper and lower extremity muscle strength and power, physical performance and activity, health perception, calcium and vitamin D intake, and biochemical assessment, including 25-hydroxyvitamin D (25OHD), parathyroid hormone (PTH), and ionized calcium levels. RESULTS: The levels of 25OHD increased and PTH decreased in the cholecalciferol group, whereas there were no significant changes in the control group (P<.001). Baseline 25OHD levels correlated with baseline single-leg stance time and physical activity score. Baseline PTH levels correlated with baseline 8-foot walk time and physical activity score. No significant difference in strength, power, physical performance, or health perception was found between groups. CONCLUSION: The 25OHD or PTH levels correlated with physical activity and physical performance in older, community-dwelling men with normal 25OHD status. Vitamin D supplementation increased 25OHD levels and decreased PTH levels but did not increase muscle strength or improve physical performance or health perception in this group of healthy, older men. Further investigations of the effects of vitamin D supplementation should focus on individuals with low levels of vitamin D.

25-Hydroxyvitamin D 2↗

PubMed2002

Interleukin-10 levels in seminal plasma: implications for chronic prostatitis-chronic pelvic pain syndrome.

PURPOSE: Chronic prostatitis-chronic pelvic pain syndrome is a disease of unknown pathogenesis. We investigated whether the chronic inflammation and pain experienced by patients may be caused by an imbalance of proinflammatory versus anti-inflammatory cytokines within the prostate, namely interleukin (IL)-8, interferon-gamma and IL-2 versus IL-10. We measured these inflammatory cytokines in seminal plasma as a reflection of the prostate environment. MATERIALS AND METHODS: We measured levels of IL-8, interferon-gamma, IL-2 and IL-10 in the seminal plasma of 31 patients with chronic prostatitis-chronic pelvic pain syndrome and 14 controls using enzyme-linked immunosorbent assay. Results were correlated with health related quality of life, as measured by the Multidimensional Pain Inventory, McGill pain questionnaire and International Prostate Symptom Score. RESULTS: The cytokines analyzed were detectable in the seminal plasma of patients with chronic prostatitis-chronic pelvic pain syndrome and controls. Interferon-gamma, IL-2 and IL-10 levels were statistically greater in patients. Furthermore, IL-10 levels correlated directly with measures of life interference (r = 0.52, p <0.01) and pain severity (r = 0.53, p <0 0.01), and inversely with spousal support (r = -0.39, p <0.04). CONCLUSIONS: Our study suggests that IL-10 may have a role in the pain symptoms experienced by patients with chronic prostatitis-chronic pelvic pain syndrome.

Adult↗

PubMed2002

Nerve growth factor and chronic prostatitis/chronic pelvic pain syndrome.

OBJECTIVES: To investigate whether the pain experienced by patients with chronic prostatitis/chronic pelvic pain syndrome (CPPS) may be related to the expression of nerve growth factor (NGF), induced by inflammation and tissue injury experienced as a result of chronic inflammation. CPPS is a disease of unknown pathogenesis. METHODS: We measured the levels of NGF and the pro-inflammatory cytokine interleukin (IL)-6 and compared these with the levels of IL-8, interferon-gamma, IL-2, and IL-10 in the seminal plasma of 31 patients with CPPS and 14 controls using enzyme-linked immunosorbent assay technology. Results were correlated with health-related quality of life as measured by the multidimensional pain inventory, the McGill pain questionnaire, and the International Prostate Symptom Score. RESULTS: The cytokines analyzed were detectable in the seminal plasma from the patients with CPPS and controls. NGF correlated directly with pain severity (P <0.01) and IL-10 levels (P <0.04), and IL-6 correlated inversely with pain severity (P <0.03). CONCLUSIONS: These results suggest that NGF and cytokines that regulate inflammation (IL-6 and IL-10) may play a role in the pain symptoms experienced by patients with CPPS.

Biomarkers↗

PubMed2002

Cutaneous blood flow and thermoregulation in Prader-Willi syndrome patients.

We examined adrenergic controlled cutaneous blood flow and temperature regulation in Prader-Willi syndrome. A body mass index was calculated for each participant. Thermal and laser Doppler finger probes were applied for continuous simultaneous surface temperature and capillary blood flow recording. Analysis with respect to group, age, body mass index, and genetic cause were performed. There were 32 patients (mean = 17.5 years of age) and five control subjects (mean = 15.6 years of age). There were no significant differences in mean ages or sex between groups. There was no significant difference in averaged blood flow measures with respect to group (P = 0.81), age (P = 0.16), body mass index (P = 0.54), or genetic identification (P = 0.81). There was no significant difference in average temperature measures as a function of group (P = 0.95), body mass index (P = 0.82), or genetic identification (P = 0.95). There was a significant difference in average temperature (P = 0.008) and trend in temperature change over time (P = 0.07) with respect to age for both patients and control subjects. Younger participants had higher average temperatures (30.6 degrees C vs 28.4 degrees C) in both study groups. We conclude that the central regulation and adrenergic control of cutaneous temperature and blood flow regulation in Prader-Willi syndrome at rest is not different from control subjects. These observations strengthen prior observations that a primary disturbance in parasympathetic autonomic regulation exists in Prader-Willi syndrome.

Adolescent↗