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Kevin Smith

Publications and source records attributed to Kevin Smith.

12 recordsLinked to original sources
PubMed2006

A qualitative exploration of the cancer experience among long-term survivors: comparisons by cancer type, ethnicity, gender, and age.

BACKGROUND: To elucidate meanings ascribed to the cancer experience by long-term survivors. METHODS: Semi-structured interviews were conducted with 58 cancer survivors (>15 years post-diagnosis). Respondents described how cancer affected their quality of life (QOL) generally and in 17 domains. Systematic content analyses were conducted to extract themes relating to meanings assigned to the cancer experience. Themes were analyzed by cancer type, gender, and age and confirmed using quantitative assessments of self-rated health and QOL. RESULTS: Four themes were identified: Personal Growth, That's Life. Relinquishing Control, and Resentment. Women more frequently acknowledged Personal Growth, and men more often indicated minimal impact on their lives (That's Life). Older survivors were disproportionately classified as That's Life and younger survivors as Personal Growth. No differences were observed by cancer type or ethnicity. Those who saw cancer as personal growth had the highest QOL, while those who resented cancer had the lowest QOL. CONCLUSIONS: Most long-term survivors retrospectively report that cancer either positively influenced their lives or had little long-term impact. Those who express Resentment report that pain, physical deformities, and social isolation significantly reduced their QOL. This qualitative study highlights how cancer survivors incorporate the cancer experience within their overall lives.

Adult↗
PubMed2005

Experiences of discrimination: validity and reliability of a self-report measure for population health research on racism and health.

Population health research on racial discrimination is hampered by a paucity of psychometrically validated instruments that can be feasibly used in large-scale studies. We therefore sought to investigate the validity and reliability of a short self-report instrument, the "Experiences of Discrimination" (EOD) measure, based on a prior instrument used in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Study participants were drawn from a cohort of working class adults, age 25-64, based in the Greater Boston area, Massachusetts (USA). The main study analytic sample included 159 black, 249 Latino, and 208 white participants; the validation study included 98 African American and 110 Latino participants who completed a re-test survey two to four weeks after the initial survey. The main and validation survey instruments included the EOD and several single-item discrimination questions; the validation survey also included the Williams Major and Everyday discrimination measures. Key findings indicated the EOD can be validly and reliably employed. Scale reliability was high, as demonstrated by confirmatory factor analysis, Cronbach's alpha (0.74 or greater), and test-re-test reliability coefficients (0.70). Structural equation modeling demonstrated the EOD had the highest correlation (r=0.79) with an underlying discrimination construct compared to other self-report discrimination measures employed. It was significantly associated with psychological distress and tended to be associated with cigarette smoking among blacks and Latinos, and it was not associated with social desirability in either group. By contrast, single-item measures were notably less reliable and had low correlations with the multi-item measures. These results underscore the need for using validated, multi-item measures of experiences of racial discrimination and suggest the EOD may be one such measure that can be validly employed with working class African Americans and Latino Americans.

Adult↗
PubMed2005

Sperm-mediated gene transfer: applications and implications.

Recent developments in studies of sperm-mediated gene transfer (SMGT) now provide solid ground for the notion that sperm cells can act as vectors for exogenous genetic sequences. A substantive body of evidence indicates that SMGT is potentially useable in animal transgenesis, but also suggests that the final fate of the exogenous sequences transferred by sperm is not always predictable. The analysis of SMGT-derived offspring has shown the existence of integrated foreign sequences in some cases, while in others stable modifications of the genome are difficult to detect. The appearance of SMGT-derived modified offspring on the one hand and, on the other hand, the rarity of actual modification of the genome, suggest inheritance as extrachromosomal structures. Several specific factors have been identified that mediate distinct steps in SMGT. Among those, a prominent role is played by an endogenous reverse transcriptase of retrotransposon origin. Mature spermatozoa are naturally protected against the intrusion of foreign nucleic acid molecules; however, particular environmental conditions, such as those occurring during human assisted reproduction, can abolish this protection. The possibility that sperm cells under these conditions carry genetic sequences affecting the integrity or identity of the host genome should be critically considered. These considerations further suggest the possibility that SMGT events may occasionally take place in nature, with profound implications for evolutionary processes.

Animals↗
PubMed2005

Access to services: multiple perspectives from adults with substance abuse disorders in Massachusetts.

This paper describes how 267 Massachusetts adult substance abuse consumers rated the substance abuse counseling they have received, their access to behavioral health care, and their overall experiences with their health plan or free care. This perspective is supplemented with information from administrative data on type of care received immediately after the baseline interview, including use of wraparound services while in treatment. We hypothesized that consumers in a carve-out behavioral health plan would view their care more favorably because they had a payment source for both substance abuse and mental health care. This hypothesis was confirmed. However, it is access to Medicaid insurance, not involvement of managed care, that is associated with greater access and higher consumer ratings of care.

Adult↗
PubMed2005

Child custody and visitation decisions when the father has perpetrated violence against the mother.

This research evaluated the effectiveness of statutes mandating a presumption against custody to a perpetrator of domestic violence (DV) and judicial education about DV. Across six states, the authors examined 393 custody and/or visitation orders where the father perpetrated DV against the mother and surveyed 60 judges who entered those orders. With the presumption, more orders gave legal and physical custody to the mother and imposed a structured schedule and restrictive conditions on fathers' visits, except where there was also a "friendly parent" provision and a presumption for joint custody. The presumption is effective only as part of a consistent statutory scheme. Although 86% of judges had received DV education, they scored no better in knowledge or attitudes. More of their orders gave mothers sole physical custody, and knowledge was associated with maternal custody, yet fewer structured or restricted fathers' visitation. Quality of DV education is more important than statutory mandate.

Adult↗
PubMed2004

Estimation of non-response bias in the Medicare FFS HOS.

We examined non-response bias in physical component summary scores (PCS) and mental component summary scores (MCS) in the Medicare fee-for-service (FFS) Health Outcomes Survey (HOS) using two alternative methods, response propensity weighting and imputation for non-respondents. The two approaches gave nearly identical estimates of non-response bias. PCS scores were 0.74 points lower and MCS scores 0.51 points lower after adjustment for non-response through imputation and 0.63 and 0.46 lower after adjustment for propensity weighting. These levels are small for component scores suggesting that survey non-response to the FFS HOS does not adversely affect estimates of average health status for this population.

Aged↗
PubMed2003

Safety and efficacy of office-based surgery with monitored anesthesia care/sedation in 4778 consecutive plastic surgery procedures.

Office-based surgery has several potential benefits over hospital-based surgery, including cost containment, ease of scheduling, and convenience to both patients and surgeons. Scrutiny of office-based surgery by regulators and state-licensing agencies has increased and must be addressed by improved documentation of safety and efficacy. To evaluate the safety and efficacy of the authors' office-based plastic surgery, a review was undertaken of 3615 consecutive patients undergoing 4778 outpatient plastic surgery procedures under monitored anesthesia care/sedation in a single office. The charts of 3615 consecutive patients who had undergone office-based surgery with monitored anesthesia care/sedation between May of 1995 and May of 2000 were reviewed. In all cases, the anesthesia protocol used included sedation with midazolam, propofol, and a narcotic administered by a board-certified registered nurse anesthetist with local anesthesia provided by the surgeon. Charts were reviewed for patient profile, types of procedures, multiple procedures, duration of anesthesia, American Society of Anesthesiologists class, and complications related to anesthesia. Outcomes measured included death, airway compromise, dyspnea, hypotension, venous thrombosis, pulmonary emboli, protracted nausea and vomiting lasting more than 24 hours, and unplanned hospital admissions. Statistical analyses were performed using the Microsoft Excel program and the SAS package. Results were as follows: 92.3 percent of the patients were female and 7.7 percent were male, with a mean age of 42.7 years (range, 3 to 83 years). Patients underwent aesthetic (95.6 percent) and reconstructive (4.4 percent) plastic surgery procedures. Same-session multiple procedures occurred in 24.8 percent of patients. The vast majority of patients were healthy: 84.3 percent of patients were American Society of Anesthesiologists class I, 15.6 percent were class II, and 0.1 percent were class III. The operations required a mean of 111 minutes. There were no deaths, ventilator requirements, deep venous thromboses, or pulmonary emboli. Complications were as follows: 0.05 percent (n = 2) of patients had dyspnea that resolved, 0.2 percent (n = 6) of patients had protracted nausea and vomiting, and 0.05 percent (n = 2) of patients had unplanned hospital admissions (<24 hours). One patient had an emergent intubation. No prolonged adverse effects were noted. There was a 30-day follow-up minimum. Outpatient surgery is an important aspect of plastic surgery. It was shown that office-based surgery with intravenous sedation, performed by board-certified plastic surgeons and nurse anesthetists, is safe. Appropriate accreditation, safe anesthesia protocols, and proper patient selection constitute the basis for safe and efficacious office-based outpatient plastic surgery.

Adolescent↗
PubMed2003

Evaluation of a cleanser for petroleum-contaminated skin.

BACKGROUND: Extremity injuries contaminated with petroleum products pose clinical dilemmas. This project was designed to evaluate the efficacy of a dioctyl sulfosuccinate (DS) solution for cleansing petroleum-contaminated skin. METHODS: One hundred Sprague-Dawley rats were subjected to a contamination protocol followed by a cleansing procedure. Four petroleum contaminants and five cleansing solutions were selected. The protocol consisted of shaving, initial punch biopsy, contamination, precleansing punch biopsy, standardized scrub protocol, and postcleansing punch biopsy. Biopsy samples were analyzed for petroleum residue using fluorometry. RESULTS: The 10% DS solution had the highest reduction of crude oil, grease, and tar: 99.6 +/- 0.4% (mean +/- SD) contaminant reduction for crude oil, 99.8 +/- 0.2% for grease, and 99.8 +/- 0.2% for tar. The other cleansers showed less efficacy (p < 0.05). CONCLUSION: Concentrated DS appears to be significantly more effective at cleaning petroleum products from skin than the commonly chosen surgical and commercial cleansers.

Analysis of Variance↗
PubMed2002

A preliminary evaluation of the differences in the glycosylation of alpha-1-acid glycoprotein between individual liver diseases.

During the acute phase response (APR) to tissue injury or infection, the liver is responsible for the level of mediators such as cytokines required at the site of inflammation and providing the essential components for wound healing and tissue repair. Additionally there are substantial alterations in the expression of plasma proteins of hepatic origin such as alpha-1-acid glycoprotein (AGP). The APR also results in alterations to the branching, sialylation and fucosylation of the oligosaccharide chains of AGP. This study investigated whether liver damage could be correlated with changes in AGP glycosylation in groups of patients with various liver diseases (alcoholic liver disease, hepatitis B, hepatitis C, cirrhosis). Hyperfucosylation occurred in all cases of liver disease, although the hepatitis B and C samples showed a more significant increase in comparison with the others. Additionally N-acetylgalactosamine (GalNAc) was detected in the majority of the hepatitis C samples, which was unexpected since this monosaccharide is not a usual component of the N-linked oligosaccharide chains. It was also determined by concanavalin (con) A chromatography that there is a shift towards the increased branching of the oligosaccharide chains in inflammatory liver diseases compared to normal serum.

Adult↗
PubMed2002

The prevalence of major depression or dysthymia among aged Medicare Fee-for-Service beneficiaries.

RESEARCH OBJECTIVE: Estimates of the prevalence of major depression vary widely. Current estimates range from 2 to 14 % depending upon the definition and procedure for diagnosis. Further, most estimates are for special populations, either living in selected geographic areas or receiving specific types of medical care. A national survey of Medicare Fee-for-Service (FFS) beneficiaries provides an opportunity to assess the current level of major depression or dysthymia among a diverse population of older Americans. STUDY DESIGN: The Health Outcomes Survey (HOS) was administered to a national random sample of 1,000 Medicare FFS beneficiaries. We used the Mental Component Summary (MCS) measure of the SF-36 to estimate the prevalence of major depression or dysthymia. Logistic regression was used to examine associated factors. RESULTS: The response rate was 61.7%. Using an MCS score of 42 or lower, prevalence of major depression or dysthymia was estimated to be 25% for respondents age 65 years and older. Logistic regression analysis revealed that the likelihood of major depression or dysthymia was associated with years of education (Odds Ratio (OR) = 0.87), difficulties performing activities of daily living (OR = 1.72), and Medicaid enrollment (OR = 2.67). CONCLUSIONS: The results revealed that one-quarter of the respondents reported mental health problems consistent with major depression or dysthymia. This is higher than previously reported. Like previous studies, years of education, physical impairment, and poverty are strong predictors of major depression or dysthymia. The high rate of major depression or dysthymia implies there may be considerable unmet need among elderly Medicare FFS beneficiaries for diagnosing and treating mental illness.

Aged↗
PubMedDate not supplied

The effect of total shoulder arthroplasty on self-assessed health status is comparable to that of total hip arthroplasty and coronary artery bypass grafting.

The purpose of this study was to assess the impact of total shoulder arthroplasty on the self-assessed health status of a large series of patients with glenohumeral osteoarthritis. In 91 patients we were able to compare the 8 quantitative domains of Short Form-36 (SF-36) before surgery and at 30 to 60 months after surgery. These preoperative and postoperative scores were compared with data from an age- and gender-matched control population. These results were also compared with those reported for patients who underwent other common, effective surgical procedures. Preoperative SF-36 values were significantly lower than population controls for 6 of 8 SF-36 domains (physical function, social function, physical role function, emotional role function, vitality, and comfort). Patients improved significantly in 4 of 8 SF-36 domains at 30 to 60 months after total shoulder arthroplasty: physical role function (P <.01), comfort (P <.01), social function (P <.01), and mental health (P <.05). Although the improvements were significant and similar to the postoperative scores reported for total hip arthroplasty and coronary bypass procedures, the scores did not reach those of the general population.

Aged↗