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Biomedical subjects

L Gilbert

Publications and source records attributed to L Gilbert.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1995

Private dental practitioners in South Africa--a professional profile.

A questionnaire submitted to dentists in private practice was part of the first National Oral Health Survey 1988/89. The questionnaire investigated demographic and professional characteristics. Completed questionnaires were returned by 2224 dentists (69.5 per cent). Most respondents were located in the 5 main metropolitan areas. There was a paucity of Black and Coloured dentists. Male dentists dominated the profession with almost 74 per cent under 50 years of age. General practitioners made up over 90 per cent of the profession and orthodontists were the largest group of specialists. Conservation was ranked as the most frequently practised service and preventive procedures were ranked low. Medical aid systems were seen to have some disadvantages. Fees and working conditions were felt to be better in private practice than in the public sector.

Adult↗
PubMed1994

Is c-erb B-2 a predictor for recurrent disease in early stage breast cancer?

PURPOSE: To assess the prognostic importance of c-erb B-2 expression in early stage breast cancer. METHODS AND MATERIALS: Immunohistochemical analysis for c-erb B-2 over-expression was retrospectively performed on 107 paraffin-embedded specimens of women with Stage I or II breast cancer entered in a randomized trial. Results were correlated with known prognostic factors such as pathologic axillary involvement, T-size, estrogen and progesterone receptor status, and nuclear grade. Immunohistochemical staining for c-erb B-2 protein expression was also correlated with breast/chest wall failure as well as survival without evidence of disease (NED) and overall survival. RESULTS: C-erb B-2 overexpression was positive in 21% of the biopsy specimens. A significant association was found between c-erb-2 positivity and lesions containing an intraductal component, with 62% of lesions staining positively for c-erb B-2 having an intraductal component compared to only 36% of lesions with an intraductal component staining negatively for the c-erb B-2 protein (p2 = .031). A significant correlation between c-erb B-2 protein over-expression and axillary nodal status, primary tumor size, nuclear grade, and estrogen and progesterone receptor status was not identified. Cox proportional hazards model did not show a significant effect of c-erb B-2 expression for NED or overall survival. CONCLUSION: Our study did not find over-expression of c-erb B-2 to reliably predict for recurrent disease in early stage breast cancer. This data can be added to other series comparing erb B-2 expression and disease outcome among node-positive and node-negative women with carcinoma of the breast.

Adult↗
PubMed1994

Social factors and self-assessed oral health in South Africa.

The question of what determines the dental needs of a population has been widely debated in the dental literature. Although there is no full agreement, the consensus is that substantial consideration should be given to the people's perceptions of what their needs are, based on self-assessment of their oral health and satisfaction with the appearance of their teeth. These perceptions (self-assessments) are likely to be shaped by their previous experiences with the dental service, their understanding of "normally" and knowledge of oral care, which are determined by social factors such as culture, class and race. The purpose of this paper is to examine self-assessed oral health in South Africa according to relevant social factors. In 1988/89 a National Oral Health survey, which included a social survey, was conducted. The data were collected by means of a structured interview, based on a questionnaire, with a sample of 4652 adults aged 20-64 yr. The variables examined in this paper formed part of the items in the questionnaire. There is a higher level of identification that "something is wrong with teeth" in (a) lower educational levels (53%-no formal education; 20%-standard 10+); (b) lower income categories (43%-lowest; 16%-highest); (c) among Xhosa (66%), S. Sotho (58%) and Zulu (53%) speaking groups and (d) among Black people (54%). Similar trends are evident in the degree of satisfaction with the appearance of teeth. The results reveal differences in self-assessed oral health among people with different educational standards, income levels, linguistic/cultural characteristics as well as racial groups as defined by the Population Registration Act of 1950.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Future dental human resource needs--a qualitative approach.

As part of the National Oral Health Survey, dentists in private practice were asked to give their views and opinions on the future planning of human resource needs for South Africa. The data, which were qualitative in nature, yielded 2600 responses. After computing a frequency distribution of these responses it was possible to classify these data into five major categories. These were a) "too many dentists/fewer should be trained" b) "more dentists for developing areas" c) "more auxiliaries in general" d) "greater need for preventive and health education services" and e) "high cost of running and maintaining private dental practices". The predominant view was that fewer dentists and more auxiliaries should be trained, while the need for preventive and health education services received considerably less support.

Black or African American↗