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Biomedical subjects

L Gilbert

Publications and source records attributed to L Gilbert.

At least 19 recordsLinked to original sources
PubMed1998

Dispensing doctors and prescribing pharmacists: a South African perspective.

Adopting an historical and international perspective, this article explores and analyses the relationship and controversy between pharmacists and dispensing doctors in South Africa. In order to gain a better insight into this troublesome relationship, a combination of qualitative and quantitative methods has been employed. The findings reveal a deep ongoing sense of competition, which is manifest in the form of public debate and continuous attempts to protect professional task domains. Most of the pharmacists interviewed in this study mentioned the "dispensing doctor" as the main problem facing the community pharmacist in South Africa. Meanwhile, the medical profession, as a united front, is fiercely protecting its "inherent" right to dispense medicines. Using the South African scenario, issues such as occupational task boundaries, "business" versus "professional" systems as well as the role of the state are discussed in relation to professional dominance, jurisdiction and autonomy.

Attitude of Health Personnel↗
PubMed1997

Infections with Corynebacterium diphtheriae--changing epidemiology and clinical manifestations. Report of the third international meeting of the European Laboratory Working Group on Diphtheria (ELWGD), Institute Pasteur, Paris 7-8 June 1996.

A widespread epidemic of diphtheria began in 1990 in the former Soviet Union, in the context of falling immunisation rates and social disruption. Control was impeded by limited diagnostic resources in affected countries (mainly Russia) and there was a risk of spread to neighbouring countries. The European Laboratory Working Group on Diphtheria (ELWGD) was formed to assist in control of the epidemic. The ELWGD is convened by the Public Health Laboratory Service in the United Kingdom and includes 15 laboratories in Europe, one in North America (Centers for Disease Control and Prevention) and the Institute of Clinical Pathology and Medical Research, Sydney. At the group's last annual meeting in Paris, reports were presented on the progress of the epidemic, control strategies and improvements in laboratory diagnosis. The group discussed the increased carriage of, and infection with, nontoxigenic Corynebacterium diphtheriae in countries with high immunisation rates, including the United Kingdom and Australia. They also considered the possible relationship between this increase and the continued diphtheria outbreak in eastern Europe. Preliminary results of molecular typing of toxigenic and nontoxigenic isolates from many parts of the world were presented. It was agreed that further epidemiological investigation is required, using a standardised ribotyping system.

Corynebacterium diphtheriae↗
PubMed1997

The influence of parasympatholytics on the resolution of acute attacks of asthma.

PURPOSE: To evaluate the role of parasympatholytics in the resolution of acute attacks of asthma. METHODS: This study employed a prospective sequential design in which the influence of 0.5 and 1.0 mg of ipratropium bromide on peak expiratory flow rates (PEFR), hospital admissions, and length of stay (LOS) in the emergency department (ED) was evaluated. The parasympatholytic was added to a well-investigated standard therapeutic regimen that was anchored by the use of repetitive doses of albuterol, and employed pretested decision algorithms. RESULTS: One hundred and thirty-one patients received ipratropium (l) and 123 who did not (NI) served as controls. There were no significant pretreatment between group differences in gender, racial composition clinical signs and symptoms, or PEFR. The presence of ipratropium in the regimen did not influence discharge/admission patterns, LOS, the rate of improvement of the patients, or the level of PEFR achieved. CONCLUSION: Anticholinergic agents such as ipratropium are not first-line treatments for acute asthma. They do not add any therapeutic benefit to the effects of albuterol given in divided doses over 1 hour, nor do they facilitate recovery in patients whose immediate response to sympathomimetics is impaired.

Acute Disease↗
PubMed1997

Patterns of health maintenance on Michigan equine operations.

Data from two 12 month prospective monitoring programs that followed management, economics and animal health from randomly-sampled equine operations in Michigan were used to determine patterns of health maintenance. Health maintenance measures were grouped, and average uses per year were computed for the most-common measures reported: respiratory, Potomac Horse Fever, neurological and multiple-system vaccinations, deworming, and general farrier work. Factors examined for potential association with health maintenance measure use were numbers of equids and horse-days on the operation, average age of equids, disease prevention management procedures, and operation and individual equine activities. The most-common vaccinations reported were respiratory vaccines (administered an average of 0.9 times per equid per year, of which 61% were for rhinopneumonitis). Multiple-system, Potomac Horse Fever and neurological vaccines were given on average 0.9, 0.9 and 0.7 times per equid per year, respectively. Deworming treatments were administered approximately 2.7 times per equid per year, of which 64% were ivermectin. Overall farrier work was reported 3.3 times per equid per year, trimming was done 2.9 times and shoeing was done 1.5 times per equid per year. In general, operations with active equids engaged in training, breeding or showing showed increased use of health maintenance measures. Overall use of health maintenance measures in the Michigan equine operations monitored did not appear to reach recommended levels, because many operations reported no use of these measures. However, on operations where health maintenance measures were reported, operators were using these measures at or near recommended levels.

Aging↗
PubMed1997

Protection of chimpanzees from high-dose heterologous HIV-1 challenge by DNA vaccination.

Novel approaches for the generation of more effective vaccines for HIV-1 are of significant importance. In this report we analyze the immunogenicity and efficacy of an HIV-1 DNA vaccine encoding env, rev and gag/pol in a chimpanzee model system. The immunized animals developed specific cellular and humoral immune responses. Animals were challenged with a heterologous chimpanzee titered stock of HIV-1 SF2 virus and followed for 48 weeks after challenge. Polymerase chain reaction coupled with reverse transcription (RT-PCR) results indicated infection in the control animal, whereas those animals vaccinated with the DNA constructs were protected from the establishment of infection. These studies serve as an important benchmark for the use of DNA vaccine technology for the production of protective immune responses.

AIDS Vaccines↗
PubMed1997

Sex trading and psychological distress among women recruited from the streets of Harlem.

OBJECTIVES: This study examines the relationship between sex trading and psychological distress and the implications of that relationship for prevention of human immunodeficiency virus among a sample of young women recruited from the streets of Harlem. METHODS: Interviews were conducted with 346 predominantly drug-using women, aged 18 to 29 years, of whom 176 had exchanged sex for money or drugs in the previous 30 days and were categorized as "sex traders." Psychological distress was measured by using the Brief Symptom Inventory. RESULTS: Sex traders scored significantly higher than non-sex traders on the General Severity Index and on eight of the nine subscales of the Brief Symptom Inventory. Multivariate analysis indicated that after adjustments were made for age; ethnicity; pregnancy; recent rape; perceived risk for acquired immunodeficiency syndrome; current, regular crack use; and current, regular alcohol use, sex traders scored 0.240 units higher on the General Severity Index than non-sex traders. CONCLUSIONS: Poor mental health and drug dependence may under-mine the motivation and ability of these sex traders to adopt safer sex behavior. Therefore, interventions need to be integrated with mental health services and drug treatment to reduce risk behavior in this population.

Adolescent↗
PubMed1997

Childhood abuse as a risk for partner abuse among women in methadone maintenance.

This study examines the relationship between childhood abuse and partner abuse among a sample of predominantly African-American and Hispanic women, who were patients in methadone clinics in Harlem and the South Bronx. A structured questionnaire addressing demographics, psychosocial and physical health characteristics, depression, childhood abuse, and domestic violence was administered to 151 women. Over half of the women (60%, n = 98) reported lifetime physical, life-threatening, or sexual abuse by a spouse or boyfriend. Multiple logistic regression analysis was used to assess the associations between childhood physical abuse and abuse by a spouse or boyfriend and between childhood sexual abuse and abuse by a spouse or boyfriend. After controlling for potential confounders, women who reported childhood physical abuse were almost nine times more likely to report having been abused by a spouse or boyfriend (OR = 8.74, CI, = 3.25 to 23.57). Women who reported childhood sexual abuse were almost four times more likely to report having been abused by a spouse or boyfriend (OR = 3.93, CI = 1.46 to 10.59). Depression and need for social support were significantly associated with partner abuse, while current heroin use was inversely associated with partner abuse. The high rate of domestic violence and the strong association between childhood and partner abuse found in this study suggest areas for intervention in chemical dependency among women.

Adult↗
PubMed1996

Urban violence and health--South Africa 1995.

Many cities all over the world are the loci of various forms of violence. Violence is a complex phenomenon, its causes are multidimensional and its consequences have ramifications far beyond the immediate perpetrators and victims. The aim of this paper is to review various forms of urban violence and their health consequences, locating them in the wider South African context. Owing to the lack of centralised data, the information presented in this paper is based on the best available data derived from numerous sources. Using the socio-environmental model of health and disease as a framework, violence and its impact on health is discussed. The brief review of political violence, violent crimes, violence against women and domestic violence in South Africa, highlights the fact that SA is a particularly violent society. The data presented suggest a link between the social context of violence and its health consequences, dealing with the impact of urban violence in the form of physical trauma as well as emotional trauma associated with it. Consequently, adopting a comprehensive approach, that violence needs to be understood in the wider societal context and has to be dealt with in the broadest terms possible, as advocated by the "New Public Health" approach, a way forward to reduce levels of violence and cope with its health consequences is suggested. An emphasis is placed on the three levels of prevention and the vital collaboration between the judicial system, police, the health sector as well as the community.

Adolescent↗
PubMed1996

Correlates of crack abuse among drug-using incarcerated women: psychological trauma, social support, and coping behavior.

This investigation examines the relationship between psychological trauma and crack abuse among 158 women with a recent history of drug use who were incarcerated in a New York City jail facility. Interviewers obtained data on demographics, drug use, psychological trauma history, criminal history, social support, and coping behavior variables. Three-fourths of the total sample had used crack three or more times a week for a month in the past; a quarter had used other drugs, predominantly heroin, three or more times a week for a month in the past. Multiple logistic regression analysis was used to assess the association between adult psychological trauma variables (loss of custody of youngest child and lived in streets prior to arrest) and regular crack use in three sequential models. After adjusting for social support, coping behavior, demographics, and criminal history variables, women who had lost custody of their youngest child were 3.3 times more likely to be regular crack uses. Women who demonstrated more negative coping behavior and perceived themselves as having less emotional support were also more likely to be regular crack users. The association between childhood traumas (i.e., childhood sexual abuse, childhood physical abuse, parental alcohol abuse) and regular crack use was also assessed using multiple logistic regression; however, no significant associations were found between these childhood psychological traumas and regular crack use in both the unadjusted and adjusted models. Study findings underscore the importance of assessing environmental, interpersonal, and intrapersonal factors in tailoring treatment strategies for users of crack and other drugs.

Adaptation, Psychological↗
PubMed1995

DNA inoculation induces cross clade anti-HIV-1 responses.

Nucleic acid or DNA immunization represents a novel approach to vaccine and immune therapeutic development. The direct injection of expression cassettes into a living host results in in vivo gene expression and immune activation. In the case of HIV-1 it has been shown by our laboratory that facilitated injection mimicks aspects of live attenuated vaccines and that both humoral and cellular responses can be induced upon injection of a nucleic acid sequence directly into a host target tissue. Antisera from HIV-1 plasmid expression cassette-immunized animals contain anti-HIV envelope glycoprotein immune responses. The antiserum neutralizes HIV-1 infection and inhibits cell to cell infection in vitro. Cellular immune responses have also been evaluated. We observed both T cell proliferation and isotype switching consistent with the production of relevant T helper immune responses in immunized animals. Furthermore it was demonstrated that CTL lysis of relevant env-expressing targets was similarly induced. These studies further define the importance of evaluating this new technology for vaccine and immune therapeutic development for HIV-1 as well as for other human viral pathogens.

AIDS Vaccines↗
PubMed1995

Induction of humoral and cellular immune responses to the human immunodeficiency type 1 virus in nonhuman primates by in vivo DNA inoculation.

DNA inoculation has the potential to produce antigens in a native as well as a host-"customized" form for presentation to the immune system. As such this technology may have relevance for vaccine/immune therapeutic strategies for a variety of infectious pathogens. In rodents in vivo inoculation of plasmid expression vectors encoding HIV-1 gene products leads to production of HIV-1 antigens in vivo, resulting in the production of both cellular and humoral immune responses. In primates only preliminary studies of serology have been reported. Here we report further evaluation of this new technology as a method to induce humoral and particularly cellular immune responses against a human pathogen, the HIV-1 virus, in nonhuman primates. Following inoculation and boosting of animals with an HIV gp160 plasmid expression vector we observed the induction of neutralizing responses against two diverse HIV-1 isolates in 2 of 3 vaccinated animals. T cell proliferative responses to HIV antigens were also observed in all plasmid-inoculated animals and specific cross-reactive cytotoxic T lymphocyte responses were developed in vaccinated animals. This report establishes the ability of DNA inoculation to induce cellular immune responses in nonhuman primates and suggests that further investigation of this technology with regard to human vaccine or immune therapeutic development is therefore warranted.

AIDS Vaccines↗
PubMed1995

5-Hydroxytryptamine2B receptor mediates contraction in the mesenteric artery of mineralocorticoid hypertensive rats.

Vascular responsiveness to 5-hydroxytryptamine (5-HT) is dramatically increased in hypertension. The hypothesis that augmented vasoconstriction to 5-HT in hypertension is due to a change in receptor subtype on vascular myocytes was tested. Mesenteric arteries from deoxycorticosterone acetate (DOCA)-salt hypertensive (systolic blood pressure > 180 mm Hg) and sham normotensive (systolic blood pressure < 130 mm Hg) rats were mounted in isolated tissue baths for measurement of isometric contractile force. The receptor mediating contraction in isolated mesenteric arteries from sham and DOCA-salt hypertensive rats is a member of the 5-HT2 family based on rank order of agonist potency (5-HT = alpha-methyl-5-HT [5-HT2 receptor agonist]>tryptamine>5-hydroxykynuramine). 5-HT was approximately 10-fold more potent in contracting mesenteric arteries from DOCA-salt hypertensive rats compared with arteries from sham normotensive rats. The tryptophan metabolite kynuramine, which possesses significant contractile activity at the 5-HT2B receptor, contracted hypertensive arteries significantly (50% of 5-HT maximum) but not sham arteries. Ketanserin (5-HT2A antagonist) competitively inhibited contraction to 5-HT in arteries from normotensive rats (-log dissociation constant [mol/L]; pKB = 8.54) but not from hypertensive rats (pKB > 6.5). Moreover, contraction to kynuramine was not blocked by ketanserin. Thus, under normal conditions, 5-HT2A receptors mediate contraction to 5-HT. However, in DOCA-salt hypertension, ketanserin-insensitive 5-HT2 receptors, possibly 5-HT2B receptors, mediate mesenteric arterial contraction to 5-HT.

Algorithms↗
PubMed1995

Tuberculous peritonitis in an adolescent male.

OBJECTIVE: To report the use of a new diagnostic approach in children with tuberculous peritonitis. PATIENT: A 14-year-old boy with tuberculous peritonitis. RESULTS: None of the new diagnostic techniques helped us to make our diagnosis. CONCLUSION: More experience of using the new diagnostic techniques will be necessary before they supersede invasive procedures.

Adolescent↗
PubMed1995

Skills-training groups to reduce HIV transmission and drug use among methadone patients.

Although methadone maintenance may be one of the more effective means of slowing the spread of human immunodeficiency virus among intravenous drug users, methadone patients continue to engage in high-risk behavior. Opiate relapse, alcohol and cocaine use, program attrition, and sexual risk-taking all present serious challenges to methadone maintenance treatment programs. These concerns underscore the need for enhancing the nonpharmacological elements of methadone clinics. This article describes the components and process of a skills-building intervention designed to reduce relapse, program attrition, and high-risk behavior in methadone-maintained populations. The authors offer a research agenda for determining whether the skills-building approach is feasible and efficacious in community- and hospital-based methadone clinics. In learning from social workers and other helping professionals, it is hoped that investigators will be able to recast and retest models that will be useful in freestanding clinical settings.

Adaptation, Psychological↗
PubMed1995

Private dental practitioners--perceptions of needs and barriers to dental care.

The purpose of this paper was to examine needs and barriers to dental care as perceived by private dental practitioners in South Africa. In 1988/89 a National Oral Health survey was conducted. This included a questionnaire sent to 3200 dental practitioners. The items examined in this paper were part of this questionnaire. Fifty six and 29 per cent of practitioners considered that there was a shortage of dentists for black and coloured persons respectively and only 4 per cent perceived a shortage for whites. Twenty two per cent of respondents believed that there was no shortage of dentists for black patients. There was however, a high percentage of "don't know" responses. An analysis of the type of treatment provided indicated that 60 per cent of dentists spend more than 60 per cent of their time on performing extractions for black patients and minimal time on prevention. The main barriers to dental care were seen as attitudinal, structural and dentist-related. Dentist perceptions of these barriers highlight the role non-dental factors play in dentistry and oral health. These factors need to be seriously considered in order to improve the nature and quality of, and accessibility to dental care.

Black or African American↗