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Biomedical subjects

L Fisher

Publications and source records attributed to L Fisher.

At least 19 recordsLinked to original sources
PubMed2000

Association of adolescent cigar use with other high-risk behaviors.

OBJECTIVES: To describe the association of cigar use with use of cigarettes, smokeless tobacco, and alcohol among adolescents; and to examine the association of self-esteem, physical activity, and use of tobacco promotional items with cigar use. METHODS: A cross-sectional study of 7104 girls and 5499 boys 10 to 15 years of age in 1997. Data were collected from self-report questionnaires. RESULTS: The prevalence of cigar use increased with age among both girls and boys. Among 11-year-olds, only 1% of girls and 3% of boys had used a cigar, whereas among 15-year-olds, 11% of girls and 25% of boys had used a cigar. Cigar users were much more likely than nonusers to have experimented with cigarettes (girls, odds ratio [OR]: 23.6; 95% confidence interval [CI]: 17.2-32.3; boys, OR: 21.3; 95% CI: 17.1-26.6), smokeless tobacco (girls, OR: 7.5; 95% CI: 4. 5-12.4; boys, OR: 13.0; 95% CI: 9.8-17.4), and alcohol (girls, OR: 6. 6; 95% CI: 4.8-9.1; boys, OR: 6.8; 95% CI: 5.3-8.8). There was a strong association between cigar use and binge drinking, especially among boys (girls, OR: 11.6; 95% CI: 7.9-16.9; boys, OR: 34.8; 95% CI: 19.4-62.3). Cigar users reported more hours of weekly physical activity than did nonusers. Additionally, cigar users were more likely to report high social self-esteem and to possess a tobacco promotional item. CONCLUSIONS: Adolescents who use cigars are more likely to use other tobacco products and alcohol, to report high social self-esteem, and to possess tobacco promotional items. Health care professionals and teachers should include cigar use in discussions with adolescents addressing substance use.

Adolescent↗
PubMed2000

The family and disease management in Hispanic and European-American patients with type 2 diabetes.

OBJECTIVE: To determine the relationship between the characteristics of families involved in disease management and the self-care practices of Hispanic and European-American (EA) patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 74 Hispanic patients and 113 EA patients with type 2 diabetes recruited from managed care settings were assessed on three domains of family life (family structure/organization, family world view, and family emotion management [four scales]) and five areas of disease management (biological, general health and function status, emotional tone, quality of life, and behavioral [seven scales]). Analyses assessed the independent associations of patient sex, family, and sex by family interactions with disease management. RESULTS: Both sex and the three domains of family life were related to disease management, but the results varied by ethnic group. For EA patients, sex, family world view, and family emotion management were related to disease management (scores for Family Coherence were negatively associated with HbA1c level and depression, and poor scores for Conflict Resolution were linked with high depression); for Hispanic patients, sex and family structure/organization were related to disease management (high scores for Organized Cohesiveness were associated with good diet and exercise, and high scores for Family Sex-Role Traditionalism were related to high quality of life). No significant interactions with sex occurred. CONCLUSIONS: Characteristics of the family setting in which disease management takes place are significantly linked to patient self-care behavior, and these linkages vary by patient ethnicity. A family's multiple independent dimensions provide multiple targets for intervention, and differences in family norms, structures, and emotion management should be considered to ensure that interventions are compatible with the setting of disease management.

Adult↗
PubMed2000

Can addressing family relationships improve outcomes in chronic disease? Report of the National Working Group on Family-Based Interventions in Chronic Disease.

The management of patients with chronic disease constitutes the largest single cost to the health care system in the United States. New approaches and methods are needed to reduce preventable complications and to enhance the health and well-being of patients with chronic disease and their families. Interventions that target the family setting in which disease management takes place have emerged as an alternative to traditional strategies that focus only on the individual patient or that consider the family only as a peripheral source of positive or negative social support. In this approach, the educational, relational, and personal needs of all family members are emphasized. Data reviewed by the National Working Group on Family-Based Interventions in Chronic Disease identified potential mechanisms by which the relational context of the family affects disease management and how characteristics of family relationships serve as risk or protective factors. In this paper we describe the major forms of family-based interventions, review the results of selected clinical trials, and present applications for clinical practice. The data suggest that approaches to the management of chronic disease should be expanded to include the broader relational context in which disease management takes place. Although it adds complexity to clinical intervention, this approach increases clinical flexibility, addresses the important players in disease management, and accounts for a significant number of risk and protective factors that affect outcome.

Adolescent↗
PubMed1999

NK2 receptors mediate tachykinin-induced contractions of rat uterus during the oestrous cycle.

We examined tachykinin-induced contractions of uteri from rats during the oestrous cycle. The potencies of substance P, neurokinin A, neurokinin B and the tachykinin NK2 receptor-selective agonist, [Lys5, MeLeu9, Nle10] neurokinin A-(4-10), and of the non-peptide tachykinin NK1, NK2 and NK3 receptor antagonists (S)1-[2-[3-(3,4-dichlorophenyl)-1-(3-isopropoxyphenylacetyl)pip eridin-3-yl]ethyl]-4phenyl-1-azonia-bicyclo[2.2.2]octane (SR 140333), (S)-N-methyl-N [4-(4-acetylamino-4-phenylpiperidino)-2-(3,4-dichlorophenyl)butyl]benzam ide (SR 48968) and (S)-(N)-(1-(3-(1-benzoyl-3-(3,4-dichlorophenyl)piperidin-3-yl)prop yl)-4-phenylpiperidin-4-yl)-N-methylacetamide (SR 142801), were examined. The relative agonist potencies, i.e., [Lys5, MeLeu9, Nle10] neurokinin A-(4-10) > or = neurokinin A > neurokinin B > or = substance P were similar in preparations from rats in dioestrus/metoestrus and those in proestrus/oestrus. Apparent pK(B) values for SR 48968 versus neurokinin A and [Lys5, MeLeu9, Nle10] neurokinin A-(4-10), were 9.9 and 9.2, respectively, indicating activation of an NK2 receptor. SR 140333 (10 nM) produced only a small rightward shift of the log concentration-response curve to substance P. SR 48968 (3 nM), but not SR 142801 (100-300 nM) reduced the effect of neurokinin B. These data indicate that in the rat tachykinin-induced contractions of the uteri during the oestrous cycle are mediated primarily by tachykinin NK2 receptors, and that fluctuations in ovarian hormonal levels during the oestrous cycle have little influence on the uterine response to tachykinins.

Animals↗
PubMed1999

Tachykinin receptors mediating contractions of oestrogen-primed rat uterus: classification using non-peptide antagonists.

1. The aim of the present study was to characterize the tachykinin receptors mediating contractions of the uterus from the oestrogen-primed rat. Apparent pKB values versus mammalian tachykinins and some subtype-selective agonists were determined for the non-peptide NK1, NK2 and NK3 receptor antagonists SR 140333, SR 48968 and SR 142801, respectively. 2. Apparent pKB values for SR 48968 tested at concentrations of 3, 10 and 30 nmol/L versus neurokinin (NKA, [Lys5MeLeu9Nle10] NKA(4-10) and [Nle10] NKA(4-10) were 8.79, 9.44 and 9.33, respectively, indicating activation of an NK2 receptor and, in the case of NKA, the possible activation of an additional receptor subtype. SR 48968 (30 nmol/L) did not affect responses to NKB (1 mumol/L), senktide (30 nmol/L), substance P (SP; 100 nmol/L) or [Sar9Met(O2)11] SP (100 nmol/L), indicating its selectivity at this concentration. 3. SR 140333 (1-100 nmol/L) reduced the effects of the NK1-preferring agonists SP and [Sar9Met(O2)11] SP, indicating the presence of NK1 receptors. The pKB estimate versus [Sar9Met(O2)11] was 9.01. SR 140333 (100 nmol/L) did not affect responses to NK2 and NK3 receptor-preferring agonists. 4. SR 142801 (100 nmol/L to 1 mumol/L) produced small rightward shifts in the log concentration-response curves to NKB, yielding an apparent pKB value of 7.0. At 1 mumol/L, SR 142801 reduced responses to the NK2 agonists, suggesting some non-selectivity at this concentration. 5. Taken together, these data provide strong evidence that tachykinin-induced contractions of the uterus of the oestrogen-primed rat are mediated by NK2 receptors, with some contribution from NK1 receptors.

Animals↗
PubMed1999

Symptoms of depression are important to psychological adaptation and metabolic control in children with diabetes mellitus.

AIMS: Sixty-two children (37 girls, 25 boys) between 9 and 18 years of age were enrolled to investigate: (1) the relationship between adaptation to diabetes mellitus (DM) and psychological functioning; (2) if adaptation or psychological functioning was related to metabolic control; and (3) if the patients' ability to cope with diabetes as assessed by physicians, was correlated to adaptation or psychological functioning. METHODS: Psychological functioning was measured by three general psychological instruments for depressive symptoms, self-esteem and fear. Diabetes adaptation was evaluated by questionnaires and coping with diabetes by an assessment of the physicians. Metabolic control was expressed by the individual HbA1c measured during the last year. RESULTS: Adaptation to diabetes correlated to psychological functioning (depression, P<0.001; self-esteem, P<0.01; and fear, P<0.01). Multiple regression analyses showed that metabolic control was predicted by adaptation (P=0.0013) with monitoring of diabetes as the only significant aspect of the adaptation (P < or = 0.0001). In turn, adaptation was predicted by symptoms of depression and metabolic control (P<0.0001). In support of this observation, a depressed (n = 9) and a non depressed (n= 53) group showed significant differences in metabolic control (P < or = 0.01), adaptation (P < or = 0.001) and self-esteem (P < or = 0.001). The only significant variable for the physicians assessment was metabolic control, which explained 35 % of the variance (P < 0.001). CONCLUSIONS: The major conclusion is that symptoms of depression affect both adaptation and metabolic control. It should be of concern to identify patients with depressive symptoms, offer treatment for their emotional difficulties and increase the support for taking care of their diabetes.

Adaptation, Psychological↗
PubMed1999

The effects of family conflict resolution and decision making on the provision of help for an elder with Alzheimer's disease.

This study explored how characteristics of multigeneration families of patients with Alzheimer's disease (AD) affected the family's ability to provide help to their ill elder. An intensive patient and family assessment battery was employed with 211 families with an elder with AD, and measures of the amount and kind of help offered by the family group were recorded. Above and beyond control variables, families that used a focused decision-making style and positive conflict resolution methods provided more help than families that did not use these styles and methods. These data suggest the importance of the family system of care in disease management.

Adult↗
PubMed1999

A longitudinal study of predictors of nursing home placement for patients with dementia: the contribution of family characteristics.

The caregivers of elderly patients with dementia (N = 164) were followed for 2 years to determine if characteristics of the multigeneration family predicted nursing home placement (NHP) over and above the effects of patient demographics, severity of patient disease, and characteristics of caregivers. Clinical assessment occurred at baseline, and caregivers were assessed by questionnaire and interview at baseline and every 6 months. No patient demographic, severity, or caregiver characteristic significantly predicted NHP. Families scoring high on emotional closeness, high on negative family feelings, and low on family efficiency institutionalized their ill elders at a significantly higher rate than other families, especially at low levels of patient severity. The findings argue that a careful examination of the multigeneration family should increase the prediction of NHP and the relevance of services offered to these families.

Aged↗
PubMed1999

Allergen-induced synthesis of F(2)-isoprostanes in atopic asthmatics. Evidence for oxidant stress.

It is thought that reactive oxygen species (ROS) participate in the inflammation which characterizes asthma, but the evidence supporting this contention is incomplete. F(2)-isoprostanes (F(2)-IsoPs) are arachidonate products formed on membrane phospholipids by the action of ROS and thereby represent a quantitative measure of oxidant stress in vivo. Using a mass spectrometric assay we measured urinary release of F(2)-IsoPs in 11 patients with mild atopic asthma after inhaled allergen challenge. The excretion of F(2)-IsoPs increased at 2 h after allergen (1.5 +/- 0.2 versus 2.6 +/- 0.3 ng/mg creatinine) and remained significantly elevated in all urine collections for the 8-h period of the study (analysis of variance [ANOVA]). The measured compounds were of noncyclooxygenase origin because neither aspirin nor indomethacin given before challenge suppressed them. Urinary F(2)-IsoPs remained unchanged after inhaled methacholine challenge. In nine atopic asthmatics, F(2)-IsoPs were quantified in bronchoalveolar lavage fluid (BALF) at baseline values and in a separate segment 24 h after allergen instillation. F(2)-IsoPs were elevated late in the BALF (0.9 +/- 0.2 versus 11.4 +/- 3.0 pg /ml, baseline versus allergen, respectively, p = 0.007). The increase was inhibited by pretreatment of the subjects with inhaled corticosteroids. These findings provide a new evidence for a role for ROS and lipid peroxidation in allergen-induced airway inflammation.

Administration, Inhalation↗
PubMed1999

SAS-CIS preference study in postlingually deafened adults implanted with the CLARION cochlear implant.

This study examined the speech perception performance of 71 postlingually deafened adults implanted with the CLARION Multi-Strategy Cochlear Implant. After 3 months of implant use, one third of the patients (n = 23) preferred to use the Simultaneous Analog Stimulation (SAS) strategy, and two thirds of them (n = 48) chose to use the Continuous Interleaved Sampler (CIS) strategy. The mean CID sentence scores were similar for the SAS and CIS user groups at the 3-month postoperative interval. In contrast, the mean CNC word score of the SAS users was significantly higher than the mean score of the CIS users after 3 months of implant experience. Patients who preferred to use SAS demonstrated significantly shorter duration of deafness at time of implantation than did the CIS users, whereas the CIS users demonstrated significantly higher preoperative sentence recognition scores than the SAS users. The results suggested that access to a preferred processing strategy improved the overall group performance of postlingually deafened adults in the present study compared to the results of previous studies in which only the CIS strategy was available to most patients with the Clarion.

Choice Behavior↗
PubMed1999

The effect of long-term deafness on speech recognition in postlingually deafened adult CLARION cochlear implant users.

Research suggests that duration of deafness prior to cochlear implantation affects postoperative speech recognition in adults. Duration of deafness usually is defined as the number of years between the onset of profound deafness and implantation. The purpose of this study was to examine the effects of duration of deafness--expressed as percentage of life with deafness--independent of age at implantation on postoperative speech recognition in adult postlingually deafened CLARION Multi-Strategy Cochlear Implant users. Speech recognition tests (CID sentences and NU6 words) were administered to 202 consecutively implanted adults preoperatively and at 3 and 6 months after initial device fitting. Patients implanted at a younger age and those with smaller percentages of their lives with deafness achieved the highest levels of short-term postoperative speech recognition. Patients who had been deaf for > or =60% of their lives demonstrated a slower rate of speech recognition improvement than those with shorter durations of deafness, but still continued to improve with increased implant experience.

Adult↗